糖尿病周围神经病700例临床与神经电生理分析

目的探讨糖尿病周围神经病的临床和电生理特点,明确电生理检查的诊断价值。方法对700患者进行感觉和运动神经传导测定,240例患者进行针极肌电图测定。结果507例(724%)患者电生理检查异常,其中307例(606%)为多发性周围神经病,74例(146%)为腕管综合征;感觉神经传导异常程度重于运动神经,波幅的下降程度较传导速度减慢明显,下肢重于上肢(P<005)。仅有46%的患者针极肌电图异常而神经传导正常。结论糖尿病周围神经病的临床和电生理表现均以感觉神经受损为主;电生理检查有助于发现临床病变,但并非所有患者均能发现电生理异常;建议不将针极肌电图进行糖尿病周围神经病的筛查作为常规使用。

Clinical and neurophysiological features of 700 patients with diabetic peripheral neuropathy

Objective To study the clinical and electrophysiological features of diabetic peripheral neuropathy in 700 patients to elucidate the relationships between them and evaluate the value of electromyography in the diagnosis of diabetic peripheral neuropathy. Methods Standard sensory and motor nerve conduction studies were performed in the 700 patients, sensory nerve conduction velocity(SCV), amplitude of sensory nerve action potential (SNAP), distal motor latency(DML) and amplitude of compound muscle action potential (CMAP) of median nerve, ulnar nerve, posterior tibial nerve and common peroneal nerve were studied simultaneously. Needle electromyogram (EMG) test was performed in 239 patients. Results (1) The most common symptoms of peripheral neuropathy were numbness and pain in limbs, while impaired or lost tendon reflexes were the most common abnormal signs in lower limbs. (2) The abnormal rate of nerve conduction studies was 72.4% in the 700 patients. Slow SCV, prolonged DML and decreased amplitude of SNAP and CMAP were detected. (3) More severe abnormal nerve conduction was found in lower limbs than in upper limbs. The abnormal degree was more severe in sensory nerve than in motor nerve and severity was more in amplitude than in conduction velocity (P<0.05). (4) Abnormal motor and/or sensory nerve conduction was detected in 67.3% of the patients with clinical manifestations of neuropathy and 5.1% patients without signs or symptoms of neuropathy, while motor or sensory nerve conduction was normal in 27.6% patients with manifestations of neuropathy. Needle EMG showed neurogenic lesion in 4.6% of the patients with normal motor and sensory nerve conduction. (5) polyneuropathy is the most common type of diabetic neuropathy and carpal tunnel syndrome the next. Conclusions The most common clinical and electrophysiological manifestation of diabetic neuropathy is sensory disturbance, which is more severe in lower limbs. The electrophysiological changes are not always accordant with clinical manifestations. Subclinical diabetic peripheral neuropathy can be detected by electrophysiological tests, which are useful to verify the range and extent of the nerve lesion involved in the early stage of diabetic peripheral neuropathy. Needle EMG is not recommended for screening diabetic neuropathy.