【摘要】：背景：皮膚內(nèi)感覺(jué)神經(jīng)纖維根據(jù)其粗細(xì)程度常被分為三類：粗有髓(Aβ)纖維(直徑5-15gm)、細(xì)有髓(Aδ)纖維(直徑1-41μm)、無(wú)髓(C)纖維(直徑0.5-1.5μm)。隨著多種檢查方法和檢測(cè)儀器的出現(xiàn),可以實(shí)現(xiàn)對(duì)不同感覺(jué)神經(jīng)纖維的定量檢測(cè),電流感覺(jué)閾值(current perception threshold, CPT)測(cè)試便是其中的一種檢測(cè)手段。CPT檢測(cè)儀通過(guò)皮膚表面電極向人體發(fā)出電刺激,可以測(cè)定身體一個(gè)或多個(gè)部位的感覺(jué)神經(jīng)興奮閾值,這一閾值我們用CPT來(lái)表示,它的定義為持續(xù)引起感覺(jué)的最小電刺激強(qiáng)度。檢測(cè)儀可以發(fā)放三種不同頻率的電流刺激,選擇性刺激不同的感覺(jué)神經(jīng)纖維亞群：5Hz測(cè)試無(wú)髓纖維,250Hz測(cè)試細(xì)有髓纖維,2000Hz測(cè)試粗有髓纖維。目前,基于中國(guó)人群大樣本研究建立的CPT臨床正常值較為少見(jiàn),且性別、年齡等因素對(duì)檢測(cè)結(jié)果的影響尚未形成統(tǒng)一結(jié)論。目的：對(duì)健康受試者的CPT數(shù)據(jù)進(jìn)行分析,明確其影響因素,依據(jù)影響因素的不同建立適合于不同特征受試者的臨床實(shí)用的CPT參考值范圍。方法：本研究為前瞻性研究,作為2013-2015年期間“十二五”國(guó)家支撐計(jì)劃課題“農(nóng)村心腦血管病防治關(guān)鍵技術(shù)集成與應(yīng)用示范研究”中的一部分,共收集CPT數(shù)據(jù)146例,另外以公開(kāi)招募的形式招募健康志愿者20例。入組正常值研究的受試者要求無(wú)任何感覺(jué)障礙主訴及既往史,神經(jīng)系統(tǒng)查體正常。采集的臨床資料包括性別、年齡、職業(yè)、既往病史等。CPT數(shù)據(jù)采集部位為左手食指／手背和右足第一足趾,采用自動(dòng)雙盲CPT測(cè)試模式,分別記錄每位受試者在兩個(gè)部位2000Hz、250Hz、5Hz CPT值,最后進(jìn)行統(tǒng)計(jì)分析。結(jié)果：全部受試者在2000Hz、250Hz、5Hz的CPT值(X±S),食指部位為226.8-4±63.7、100.0+34.8、57.2±21.8；手背部位為136.8±37.8、39.8±11.7、19.9±8.0；足趾部位為287.7±72.1、124.0±47.0、71.4±34.9。三種頻率刺激下所得CPT值手背部位比足趾部位顯著更低(p0.001),食指和足趾部位僅在2000Hz CPT值體現(xiàn)出顯著性差異(p0.01)。影響因素分析：不同性別在2000Hz頻率電流刺激下手背和足趾部位獲得的CPT值表現(xiàn)出顯著差異p0.01),男性比女性CPT值更高。年齡與250Hz頻率電流刺激下食指部位p0.05)以及2000Hz頻率電流刺激下手背(P0.001)和食指p0.05)部位所得CPT值呈正相關(guān)。體力勞動(dòng)者相較于腦力勞動(dòng)者在足趾部位250Hz頻率電流刺激下所得CPT值更高(p0.01)。結(jié)論：年齡、性別及職業(yè)因素對(duì)CPT測(cè)定值有不同程度的影響,依據(jù)受試者特征建立了適用于不同情況的CPT正常值范圍。
[Abstract]:Background: Intradermal sensory nerve fibers are often classified into three categories according to their thickness: coarse myelinated (A 尾) fibers (diameter 5-15gm) and fine myelinated (A 未) fibers (diameter 1-41 渭 m), unmyelinated (C) fibers (diameter 0.5-1.5 渭 m). With the emergence of various inspection methods and testing instruments, quantitative detection of different sensory nerve fibers can be realized. The current sense threshold (current perception threshold, CPT) test is one of the detection methods. CPT detector sends electrical stimulation to the human body through the skin surface electrode, which can measure the sensory nerve excitatory threshold of one or more parts of the body. This threshold is expressed in terms of CPT, which is defined as the minimum intensity of electrical stimulation that continues to cause sensation. The instrument can release three kinds of electric current stimuli with different frequencies, and selectively stimulate different sensory nerve fiber subsets: 5Hz to test unmyelinated fibers, 250Hz to fine myelinated fibers and 2000Hz to test coarse myelinated fibers. At present, the clinical normal value of CPT based on large sample study in Chinese population is relatively rare, and the influence of sex, age and other factors on the test results has not yet reached a unified conclusion. Objective: to analyze the CPT data of healthy subjects and determine the influencing factors, and establish the range of clinical CPT reference values suitable for different characteristic subjects according to the different influencing factors. Methods: this study is a prospective study. As a part of the "demonstration study on the Integration and Application of key Technologies for the Prevention and treatment of Cardiovascular and Cerebrovascular Diseases in Rural areas", a total of 146 cases of CPT data were collected. In addition, 20 healthy volunteers were recruited in the form of open recruitment. Subjects in the normal value study were asked to have no major complaints and previous history of sensory disorders and normal neurological examination. The clinical data collected included sex, age, occupation, medical history and so on. The first toe of left index finger / back of hand and right foot were collected. The data were recorded by automatic double-blind CPT test mode. Finally, statistical analysis is carried out. Results: the CPT values of all the subjects were 226.8-4 鹵63.7100.0 34.8c57.2 鹵21.8in the 2 000 Hz (X 鹵S),) 250 Hz, 136.8 鹵37.8 鹵11.791 鹵19.9 鹵8.0 in the dorsal part of the hand, 287.7 鹵72.1124.0 鹵47.0 鹵71.4 鹵34.9in the toe. The CPT value of the dorsal part of the hand was significantly lower than that of the toe part (p0. 001), while the 2000Hz CPT value of the index finger and the toe was only significantly different (p0. 01). Analysis of influencing factors: the CPT values obtained from the dorsal and toe of the hand under 2000Hz frequency current stimulation showed significant difference (p0.01). The CPT value of male was higher than that of female. Age was positively correlated with the CPT values of the forefinger under the stimulation of 250Hz frequency current (p0.05) and that of the dorsal hand (P0.001) and the forefinger (p0.05) stimulated by the 2000Hz frequency current. The CPT value of manual workers was higher than that of mental workers stimulated by 250Hz frequency current (p0.01). Conclusion: age, sex and occupation factors have different influence on CPT. According to the characteristics of subjects, the normal range of CPT is established.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R33

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