感觉定量检测在慢性肾脏病患者周围神经病变筛查中的应用

目的通过对80例处于慢性肾脏病（CKD）不同阶段的患者感觉定量检测（QST）及感觉神经传导速度（SCV）的观察分析，探讨QST在慢性肾脏病患者周神经病变诊断方面的应用。方法依据估算肾小球滤过率（eGFR）分别收集了CKD2期，CKD3期，CKD4期，CKD5期各20例CKD的患者和20例正常人，进行QST和SCV测定，然后进行分析。结果1．QST四个温度觉（TT）及振动觉（VT）阈值比较：CKD3期，CKD4期，CKD5期的患者分别较CKD2期患者、正常人闽值显著增大（P〈0．05），且前三组患者各阈值两两比较均有显著差异性（P〈O．05）。2．正中神经、胫神经、腓总神经传导速度比较：CKD4期，CKD5期患者分别较CKD2期，CKD3期，正常人感觉神经传导速度显著减慢（P〈0．05）；前两组患者传导速度比较也有显著差异性（P〈0．05）；3．SCV与QST异常率比较：在CKD4期，CKD5期的患者SCV异常率为55．O％，QST异常率高达80％；在CKD3期SCV异常率为15.0％，而QST异常率为55．0％，两者异常率在这三组患者的比较均有统计学意义（P（0．05）。结论QST在诊断早期慢性肾脏病周围神经病变方面较敏感，CKD患者的周围神经病变最先累及小神经纤维。

Application of quantitative sensory testing in screening peripheral neurophathy of patients with chronic renal failure

Objective To evaluate the application of quantitative sensory testing in chronic kid- ney disease（CKD） patients with peripheral neuropathy. Methods The values of the quantitative senso- ry testing and sensory conduction velocity at different locations of extremities in 80 cases of the chronic kidney disease patients who are different stages and 20 normal persons were recorded. Results 1. Ac- cording to CKD2 stage,CKD3 stage,CKD4 stage and CKD5 stage, the thermal threshold（TT） and vi- bratory threshold （VT） at the four different locations of extremities were increased, the thresholds of the later three groups were significantly higher than those of normal control（P~0. 05）, except that between the CKD2 stage patients and normal control. The differences in TT and VT among CKD3 stage ,CKD4 stage and CKD5 stage patients were statistically significant（P~0. 05）. 2. The SCV val- ues of the median nerve, tibial nerve and lateral popliteal nerve were significantly difference among CKD5 stage and CKD2 stage, CKD3 stage, CKD4 stage patients, normal control and between CKD5 stage and CKD4 stage patients（P~0. 05）, except that among CKD2 stage, CKD3 stage patients and control. 3. SCV and QST were one or more abnormal namely for abnormalities, the total abnormal rate of QST in CKD4 stage and CKD5 stage patients was 80~//00, CKD3 stage patients 55%; Total ab- normal rate of SCV was 55. 0% ~The total abnormal rate of QST were significantly higher than those of SCV among three groups （P〈0. 05）. Conclusions QST is a sensitive method for early diagnosis of chronic renal failure patients with peripheral neuropathy. Chronic renal failure of peripheral neuropa- thy first drag in small nerve fibres.