本文選題：神經(jīng)傳導(dǎo)速度 + 電流感覺閾值　； 參考：《蘇州大學(xué)》2015年博士論文

【摘要】：第一部分1型糖尿病患者的周圍神經(jīng)病變特點(diǎn)及危險(xiǎn)因素目的糖尿病周圍神經(jīng)病變(DPN)是糖尿病最常見的并發(fā)癥之一,是糖尿病患者致殘、致死的主要原因。DPN可累及不同直徑的感覺運(yùn)動(dòng)神經(jīng)纖維,小神經(jīng)纖維受損比大神經(jīng)纖維更常見。Neurometer CPT/C神經(jīng)定量檢測(cè)儀可反映細(xì)小神經(jīng)纖維的功能。本研究應(yīng)用神經(jīng)傳導(dǎo)速度和Neurometer CPT/C兩種檢測(cè)工具分析1型糖尿病患者的周圍神經(jīng)病變特點(diǎn)及其相關(guān)危險(xiǎn)因素,為1型糖尿病患者DPN的早期診斷治療提供依據(jù)。方法選取我院內(nèi)分泌科確診為1型糖尿病(T1DM)的住院和門診患者70例,我院體檢中心體檢的健康人48例,行四肢神經(jīng)傳導(dǎo)速度和CPT檢查,CPT包括雙側(cè)正中神經(jīng)、腓腸神經(jīng)在2000Hz、250Hz、5Hz電流頻率刺激下的電流感覺閾值。對(duì)1型糖尿病患者進(jìn)行神經(jīng)癥狀及神經(jīng)缺陷評(píng)分,并詳細(xì)記錄糖尿病患者的各項(xiàng)臨床指標(biāo)。比較1型糖尿病組和健康對(duì)照組在三個(gè)電流頻率下的CPT值,并詳細(xì)分析糖尿病患者CPT的變化特點(diǎn)及各頻率各肢體CPT值間的相互關(guān)系,探討影響DPN的相關(guān)危險(xiǎn)因素。結(jié)果和正常對(duì)照組相比,1型糖尿病組在三個(gè)電流頻率刺激下的CPT值均降低。以CPT值為標(biāo)準(zhǔn),67例(95.7%)患者存在周圍神經(jīng)功能異常。同側(cè)下肢腓腸神經(jīng)功能異常率高于上肢正中神經(jīng)(P0.001),除左側(cè)肢體250Hz電流頻率刺激下的CPT值外,其余電流頻率刺激下的CPT值同側(cè)下肢腓腸神經(jīng)低于上肢正中神經(jīng)(P0.05)。上肢正中神經(jīng)在250及5Hz電流頻率刺激下更易出現(xiàn)感覺減退,下肢腓腸神經(jīng)在3個(gè)電流頻率刺激下更易出現(xiàn)感覺過敏。左下肢在5Hz頻率刺激下神經(jīng)功能異常的發(fā)生率更高(P=0.001)。雙側(cè)正中神經(jīng)異常率比較,在2000Hz時(shí)右側(cè)異常率大于左側(cè)(P=0.035),而雙側(cè)腓腸神經(jīng)功能異常率比較發(fā)現(xiàn)在250Hz和5Hz時(shí)左側(cè)神經(jīng)功能異常率大于右側(cè)(P=0.001,0.001),兩組CPT值比較發(fā)現(xiàn)在5Hz時(shí)左側(cè)腓腸神經(jīng)CPT值小于右側(cè)(P=0.040)。提示上肢神經(jīng)中右側(cè)Aβ粗有髓鞘神經(jīng)纖維更易受損,下肢神經(jīng)中左側(cè)Aδ細(xì)有髓鞘和C類無髓鞘神經(jīng)纖維更易受損。以神經(jīng)傳導(dǎo)速度異常與否為因變量進(jìn)行l(wèi)ogistic回歸,結(jié)果發(fā)現(xiàn)病程、NDS評(píng)分和右正中神經(jīng)2000Hz頻率下CPT值是神經(jīng)傳導(dǎo)速度異常的危險(xiǎn)因素。結(jié)論1型糖尿病周圍神經(jīng)損害以雙下肢受累為主,以無髓和有髓小神經(jīng)纖維為主,左右側(cè)上下肢神經(jīng)纖維損傷的特點(diǎn)不同,上肢神經(jīng)更易出現(xiàn)感覺減退,下肢神經(jīng)更易出現(xiàn)感覺過敏。病程、NDS評(píng)分和右正中神經(jīng)2000Hz電流刺激的CPT值是神經(jīng)傳導(dǎo)速度異常的危險(xiǎn)因素。CPT為DPN的小纖維神經(jīng)損傷提供了一種新的客觀定量評(píng)價(jià)手段,可與傳統(tǒng)神經(jīng)傳導(dǎo)速度檢測(cè)聯(lián)合應(yīng)用,能更全面、更早期評(píng)價(jià)1型糖尿病DPN的病變特點(diǎn)。第二部分1型糖尿病患者認(rèn)知功能損害臨床特點(diǎn)及危險(xiǎn)因素目的糖尿病對(duì)認(rèn)知功能的影響越來越引起人們的廣泛重視,已有大量文獻(xiàn)證實(shí)2型糖尿病與認(rèn)知功能損害有關(guān)。而1型糖尿病患者認(rèn)知功能的改變及影響因素的作用目前報(bào)道不一致。本研究應(yīng)用MMSE、Mo CA等量表比較1型糖尿病患者和正常人群認(rèn)知功能的差異,并詳細(xì)分析1型糖尿病患者認(rèn)知功能受損的情況及其相關(guān)危險(xiǎn)因素。方法選取我院內(nèi)分泌科確診為TIDM的住院及門診患者70例,在我院體檢中心體檢的健康人48例,對(duì)所有患者進(jìn)行MMSE和Mo CA量表的評(píng)價(jià),比較兩組認(rèn)知功能的差異,詳細(xì)分析1型糖尿病患者認(rèn)知功能受損的情況。詳細(xì)記錄糖尿病患者的各項(xiàng)臨床指標(biāo),并探討影響1型糖尿病患者認(rèn)知功能的相關(guān)危險(xiǎn)因素。結(jié)果1型糖尿病組Mo CA量表測(cè)試的異常率高于正常對(duì)照組(40.0%vs.11.1%,P=0.001)。MMSE和Mo CA量表的得分,1型糖尿病組均低于正常對(duì)照組(29.1±1.2vs.28.3±1.9,P=0.007;27.1±2.3 vs.25.8±2.9,P=0.006)。進(jìn)一步分析受損認(rèn)知域發(fā)現(xiàn),MMSE量表中定向力和語言能力得分1型糖尿病組小于正常對(duì)照組(9.57±0.84vs.9.87±0.39,P0.001;8.55±0.65 vs.8.81±0.39,P0.001);Mo CA量表中視空間與執(zhí)行功能、記憶力、語言功能、抽象思維和計(jì)算力得分,1型糖尿病組均低于正常對(duì)照組(4.27±0.92 vs.4.56±0.68,P=0.001;2.90±1.51 vs.3.75±1.27,P0.001;4.57±0.93vs.5.31±0.80,P=0.002;1.50±0.71 vs.1.74±0.56,P=0.001;2.81±0.63 vs.2.96±0.20,P=0.002)。以Mo CA得分為標(biāo)準(zhǔn)判斷患者是否存在認(rèn)知功能障礙,logistic回歸顯示患者年齡、C肽、文化程度和神經(jīng)傳導(dǎo)速度異常是患者發(fā)生認(rèn)知障礙的危險(xiǎn)因素(P=0.029,0.017,0.027,0.048)。結(jié)論T1DM成年患者存在認(rèn)知功能減退,主要表現(xiàn)在記憶力、語言能力、抽象思維、計(jì)算力和視空間與執(zhí)行功能方面。Mo CA量表可作為T1DM患者認(rèn)知功能評(píng)價(jià)的主要篩查工具。糖尿病患者的年齡、C肽水平、文化程度和周圍神經(jīng)病變均對(duì)認(rèn)知功能損害有重要影響。
[Abstract]:Partial diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes mellitus (diabetic peripheral neuropathy). It is the main cause of diabetes in patients with diabetes. The main cause of death is that.DPN can involve the sensory motor nerve fibers of different diameters, and the damage of small nerve fibers is more common than that of the large nerve fibers. The Neurometer CPT/C nerve quantitative detector can reflect the function of the fine nerve fibers. In this study, the characteristics of peripheral neuropathy and related risk factors of type 1 diabetic patients were analyzed by two kinds of detection tools of nerve conduction velocity and Neurometer CPT/C, which provided the basis for the early diagnosis and treatment of DPN in type 1 diabetic patients. The Department of endocrinology was diagnosed as type 1 diabetes mellitus (T1DM) in 70 cases of hospitalization and outpatients. 48 healthy people were examined in the physical examination center of our hospital. The nerve conduction velocity and CPT examination were performed. CPT included bilateral median nerve and gastrocnemius nerve under 2000Hz, 250Hz, 5Hz current frequency stimulation. The neurological deficit score and the detailed records of the clinical indexes of diabetic patients were recorded. The CPT values of type 1 diabetes and healthy controls at three current frequencies were compared, and the changes of CPT in diabetic patients and the relationship between the frequencies of each limb CPT were analyzed in detail, and the related risk factors of DPN were discussed. Results and normal controls were also discussed. In the group of type 1 diabetes, the CPT value decreased with three current frequency stimuli. In the CPT value, 67 cases (95.7%) had abnormal peripheral nerve function. The rate of abnormal sural nerve function of the lower extremities was higher than that of the upper middle median nerve (P0.001), except the CPT value of the left limb 250Hz current frequency stimulation, and the other current frequency stimulated by the frequency stimulation. The CPT value of the lower extremity was lower than the median nerve of the upper limb (P0.05). The median nerve of the upper limb was more susceptible to hyposensory stimulation under the 250 and 5Hz current frequency stimulation, and the lower extremity gastrocnemius was more susceptible to hypersensitivity under the 3 current frequency stimuli. The incidence of abnormal nerve function under the 5Hz frequency stimulation of the left lower extremities was higher (P=0.001). Bilateral median The abnormal rate of nerve abnormality was greater than that on the left side (P=0.035) at 2000Hz, while the abnormal rate of bilateral sural nerve function was higher than that on the right (P=0.001,0.001) at 250Hz and 5Hz. The two group CPT value found that the CPT value of the left gastrocnemius was less than the right (P=0.040) at 5Hz, suggesting the right side A of the upper limb nerve. The myelin nerve fibers were more vulnerable to beta myelin fibers. The left A delta of the lower extremity was more vulnerable to myelin myelin and C non myelinated nerve fibers. Logistic regression was used as a dependent variable for abnormal nerve conduction velocity. The outcome was found in the course of the disease, and the CPT value of the right median nerve 2000Hz was a risk factor for the abnormal conduction velocity of nerve conduction. Conclusion 1 The peripheral nerve damage of type 2 diabetes is mainly affected by double lower limbs, mainly with unmyelinated and myelinated small nerve fibers, and the characteristics of nerve fiber damage in the left and right lower limbs are different. The upper limb nerve is more susceptible to sensory degeneration, and the lower extremity nerve is more susceptible to hypersensitivity. The course of disease, the NDS score and the CPT value of the right median nerve 2000Hz current stimulation are nerve conduction. .CPT, a risk factor for velocity abnormalities, provides a new objective quantitative evaluation method for the small fiber nerve injury of DPN. It can be combined with traditional nerve conduction velocity detection. It can be more comprehensive and more early evaluation of the pathological features of type 1 diabetes DPN. The clinical characteristics and risk factors of cognitive impairment in type 1 diabetes patients are in the second part. The effect of diabetes on cognitive function has attracted more and more attention. A large number of literatures have proved that type 2 diabetes is related to cognitive impairment. The changes of cognitive function and influence factors in type 1 diabetic patients are not consistent. This study compared type 1 diabetes and normal people with MMSE, Mo CA isometric scale. The cognitive function difference and the related risk factors of cognitive function in type 1 diabetes patients were analyzed in detail. Methods 70 cases of hospitalized and outpatient patients with TIDM in Department of endocrinology in our hospital were selected and 48 healthy people were examined in the physical examination center of our hospital. All patients were evaluated by MMSE and Mo CA scale, and the cognitive function was compared. A detailed analysis of the impairment of cognitive function in type 1 diabetic patients. A detailed record of various clinical indicators of diabetic patients and related risk factors affecting cognitive function of type 1 diabetic patients were discussed. Results the abnormal rate of the Mo CA scale test in type 1 diabetes was higher than that of the normal control group (40.0%vs.11.1%, P=0.001).MMSE and Mo CA The score of the type 1 diabetes group was lower than that of the normal control group (29.1 + 1.2vs.28.3 + 1.9, P=0.007; 27.1 + 2.3 vs.25.8 + 2.9, P=0.006). Further analysis of the impaired cognitive domain was found that the orientation and language ability score of type 1 diabetes group in the MMSE scale was less than that of the normal control group (9.57 + 0.84vs.9.87 + 0.39, P0.001; 8.55 + 0.65 vs.8.81 + 0.39, P0.001); M. The visual space and executive function, memory, language function, abstract thinking and computing power score in the o CA scale were lower than that of the normal control group (4.27 + 0.92 vs.4.56 + 0.68, P=0.001; 2.90 + 1.51 vs.3.75 + 1.27, P0.001; 4.57 + 0.93vs.5.31 + 0.80, P=0.002; 1.50 + 0.71 vs.1.74 + 0.56, P=0.001; 2.81 + vs.2.96 + P=0.002). Mo CA scores were used to determine whether patients had cognitive impairment. Logistic regression showed that patients' age, C peptide, educational level, and abnormal nerve conduction velocity were risk factors for cognitive impairment (P=0.029,0.017,0.027,0.048). Conclusion T1DM adult patients were characterized by cognitive impairment, mainly in memory and language ability. The.Mo CA scale of abstract thinking, computational power, visual space and executive function can be used as the main screening tool for the evaluation of cognitive function in T1DM patients. The age, C peptide level, educational level, and peripheral neuropathy of diabetic patients have important effects on cognitive impairment.

【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R587.2

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