糖調(diào)節(jié)受損及糖尿病患者周圍神經(jīng)的電生理評(píng)價(jià)
發(fā)布時(shí)間：2019-01-09 10:44
【摘要】：目的:應(yīng)用神經(jīng)電生理方法評(píng)價(jià)糖調(diào)節(jié)受損(Impaired glucose regulation,IGR)及糖尿病(diabetes mellitus,DM)患者的周圍神經(jīng)功能狀態(tài),為IGR患者神經(jīng)損害的早期診斷提供可靠信息,并分析糖尿病及糖調(diào)節(jié)受損患者的神經(jīng)電生理表現(xiàn)及相關(guān)危險(xiǎn)因素。方法:選取2015年3月至2016年3月就診于我院的IGR患者92例,DM患者68例,選擇年齡性別相匹配的來我院進(jìn)行體檢的健康人36名為對(duì)照,對(duì)所有受試者均行密歇根神經(jīng)病變篩查(Michigan Neuropathy Screening Instrument,MNSI)量表評(píng)分及體格檢查并應(yīng)用Keypoint.net肌電圖檢測(cè)儀器進(jìn)行正中神經(jīng)、尺神經(jīng)、脛后神經(jīng)、腓總神經(jīng)常規(guī)神經(jīng)傳導(dǎo)(Nerve conduction studies,NCS),四肢交感皮膚反應(yīng)(Sympathetic skin response,SSR)檢測(cè),應(yīng)用運(yùn)動(dòng)單位數(shù)目估計(jì)(motor unit number estimation,MUNE)檢測(cè)法計(jì)數(shù)小魚際肌及趾短伸肌運(yùn)動(dòng)單位數(shù)目。結(jié)果:1、IGR組與對(duì)照組患者相比,雙下肢SSR波幅減低分別為[0.55±0.54mv與0.75±0.34,p0.05],正中神經(jīng)運(yùn)動(dòng)傳導(dǎo)末端潛伏期延長(zhǎng)[3.33±0.59ms與3.00±0.56ms,p0.05],感覺傳導(dǎo)指1/3 SNAP波幅減低[20.69±8.61uv與25.51±10.48uv/13.46±6.56uv與17.64±7.09uv,p0.05],速度減慢[50.58±8.29m/s與54.41±7.24m/s/54.22±4.63m/s與57.69±7.01m/s],余尺神經(jīng)、脛后神經(jīng)、腓總神經(jīng)感覺運(yùn)動(dòng)傳導(dǎo)差異無統(tǒng)計(jì)學(xué)意義(p0.05)。2、DM組與對(duì)照組患者相比較,四肢SSR波幅減低,雙下肢SSR潛伏期延長(zhǎng),差異有統(tǒng)計(jì)學(xué)意義(p0.05);正中神經(jīng)指1/3、尺神經(jīng)、脛后神經(jīng)、腓總神經(jīng)SNAP波幅減低,CMAP波幅下降(p0.05);并伴有正中神經(jīng)感覺傳導(dǎo),速度指1/3減慢,運(yùn)動(dòng)傳導(dǎo)末端潛伏期延長(zhǎng),均具有統(tǒng)計(jì)學(xué)差異(p0.05);小魚際肌及趾短伸肌運(yùn)動(dòng)單位數(shù)目下降分別為104.98±32.66與152.31±46.33,72.63±24.17與95.43±23.88,差異具有統(tǒng)計(jì)學(xué)意義p0.05。3、DM組與IGR組患者相比,雙下肢SSR潛伏期延長(zhǎng)[1956±321ms與1851±254ms,p0.05],波幅減低[0.36±0.50mv與0.55±0.54mv,p0.05];正中神經(jīng)、尺神經(jīng)、脛后神經(jīng)、腓總神經(jīng)SNAP減低,脛后神經(jīng)及腓總神經(jīng)CMAP波幅下降,小魚際肌與趾短伸肌運(yùn)動(dòng)單位數(shù)目減少,均有統(tǒng)計(jì)學(xué)差異(p0.05)。4、與正常對(duì)照組比較,IGR組患者臨床癥狀(疼痛,麻木,燒灼感),踝反射、大腳趾振動(dòng)覺及單絲壓力覺減弱或缺失的比例較高,差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。與IGR組比較,DM組患者踝反射、大腳趾振動(dòng)覺及單絲壓力覺減弱或缺失的比例更高(p0.05),在其他方面未見統(tǒng)計(jì)學(xué)差異。5、應(yīng)用Logistic回歸對(duì)IGR相關(guān)性神經(jīng)病變的危險(xiǎn)因素進(jìn)行篩查分析,結(jié)果發(fā)現(xiàn)BMI、靜脈血甘油三酯、低密度脂蛋白水平升高是IGR相關(guān)神經(jīng)病變的危險(xiǎn)因素。結(jié)論:IGR患者存在周圍神經(jīng)損害,主要累及下肢小纖維神經(jīng),隨病情進(jìn)展加重為糖尿病,大纖維也可受累,以軸索損害為主,下肢重于上肢。肥胖和血脂異常是IGR性神經(jīng)病變的危險(xiǎn)因素。
[Abstract]:Objective: to evaluate the peripheral nerve function in patients with impaired glucose regulation (Impaired glucose regulation,IGR) and diabetes mellitus (diabetes mellitus,DM) by neuroelectrophysiological method, and to provide reliable information for the early diagnosis of nerve damage in IGR patients. The electrophysiological manifestations and related risk factors of diabetes mellitus and impaired glucose regulation were analyzed. Methods: 92 patients with IGR and 68 patients with DM were selected from March 2015 to March 2016 in our hospital. The median nerve, ulnar nerve, posterior tibial nerve were measured by Keypoint.net electromyography. Common peroneal nerve (Nerve conduction studies,NCS), sympathetic skin reaction (Sympathetic skin response,SSR) of extremities and motor unit number (motor unit number estimation,MUNE) were used to count motor units in hypothenar muscles and extensor digitorum brevis. Results: 1 compared with the control group, the amplitude of SSR in both lower extremities was decreased [0.55 鹵0.54mv vs 0.75 鹵0.34 p0.05], and the latency of motor conduction of median nerve was prolonged [3.33 鹵0.59ms and 3.00 鹵0.56ms, respectively]. The amplitude of 1 / 3 SNAP of sensory conduction finger decreased [20.69 鹵8.61uv vs 25.51 鹵10.48uv/13.46 鹵6.56uv vs 17.64 鹵7.09uvanp0.05]. The velocities slowed down [50.58 鹵8.29m/s vs 54.41 鹵7.24m/s/54.22 鹵4.63m/s vs 57.69 鹵7.01m/s]. There was no significant difference in sensory motor conduction between the ulnar nerve, the posterior tibial nerve and the common peroneal nerve (p0.05). Compared with the control group, the amplitude of SSR was decreased and the latency of lower extremity SSR was prolonged in DM group (p0.05). The median nerve finger 1 / 3, ulnar nerve, posterior tibial nerve, common peroneal nerve SNAP amplitude decreased, CMAP wave amplitude decreased (p0.05); The sensory conduction of the median nerve was accompanied by a decrease of 1 / 3 of the velocity index and the prolongation of the terminal latency of motor conduction (p0.05). The number of motor units in the hypothenar muscles and extensor digitorum brevis decreased by 104.98 鹵32.66 and 152.31 鹵46.33, 72.63 鹵24.17 and 95.43 鹵23.88, respectively. The difference was statistically significant between the DM group and the IGR group. The latency of SSR in both lower limbs was prolonged [1956 鹵321ms vs 1851 鹵254 Ms p0.05], and the amplitude decreased [0.36 鹵0.50mv vs 0.55 鹵0.54 mvp0.05]. The SNAP of median nerve, ulnar nerve, posterior tibial nerve, common peroneal nerve decreased, the amplitude of CMAP of posterior tibial nerve and common peroneal nerve decreased, and the number of motor units of hypothenar muscle and extensor digitorum brevis decreased (p0.05). Compared with the normal control group, the clinical symptoms (pain, numbness, burning sensation), ankle reflex, big toe vibration and monofilament pressure in IGR group were significantly decreased or absent (p0.05). Compared with IGR group, the proportion of malleolus reflex, big toe vibration sensation and monofilament pressure perception in DM group was decreased or missing (p0.05), but there was no statistical difference in other aspects. 5. Logistic regression was used to screen and analyze the risk factors of IGR related neuropathy. The results showed that the elevated level of triglyceride and low density lipoprotein (LDL) in venous blood of BMI, was the risk factor of IGR related neuropathy. Conclusion: there is peripheral nerve damage in patients with IGR, mainly involving the small fibrous nerve of lower extremity. With the progression of the disease, it is diabetes mellitus, and the large fiber can also be involved. The axonal injury is the main lesion, and the lower extremity is more serious than the upper limb. Obesity and dyslipidemia are risk factors for IGR neuropathy.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R587.2
本文編號(hào)：2405518
[Abstract]:Objective: to evaluate the peripheral nerve function in patients with impaired glucose regulation (Impaired glucose regulation,IGR) and diabetes mellitus (diabetes mellitus,DM) by neuroelectrophysiological method, and to provide reliable information for the early diagnosis of nerve damage in IGR patients. The electrophysiological manifestations and related risk factors of diabetes mellitus and impaired glucose regulation were analyzed. Methods: 92 patients with IGR and 68 patients with DM were selected from March 2015 to March 2016 in our hospital. The median nerve, ulnar nerve, posterior tibial nerve were measured by Keypoint.net electromyography. Common peroneal nerve (Nerve conduction studies,NCS), sympathetic skin reaction (Sympathetic skin response,SSR) of extremities and motor unit number (motor unit number estimation,MUNE) were used to count motor units in hypothenar muscles and extensor digitorum brevis. Results: 1 compared with the control group, the amplitude of SSR in both lower extremities was decreased [0.55 鹵0.54mv vs 0.75 鹵0.34 p0.05], and the latency of motor conduction of median nerve was prolonged [3.33 鹵0.59ms and 3.00 鹵0.56ms, respectively]. The amplitude of 1 / 3 SNAP of sensory conduction finger decreased [20.69 鹵8.61uv vs 25.51 鹵10.48uv/13.46 鹵6.56uv vs 17.64 鹵7.09uvanp0.05]. The velocities slowed down [50.58 鹵8.29m/s vs 54.41 鹵7.24m/s/54.22 鹵4.63m/s vs 57.69 鹵7.01m/s]. There was no significant difference in sensory motor conduction between the ulnar nerve, the posterior tibial nerve and the common peroneal nerve (p0.05). Compared with the control group, the amplitude of SSR was decreased and the latency of lower extremity SSR was prolonged in DM group (p0.05). The median nerve finger 1 / 3, ulnar nerve, posterior tibial nerve, common peroneal nerve SNAP amplitude decreased, CMAP wave amplitude decreased (p0.05); The sensory conduction of the median nerve was accompanied by a decrease of 1 / 3 of the velocity index and the prolongation of the terminal latency of motor conduction (p0.05). The number of motor units in the hypothenar muscles and extensor digitorum brevis decreased by 104.98 鹵32.66 and 152.31 鹵46.33, 72.63 鹵24.17 and 95.43 鹵23.88, respectively. The difference was statistically significant between the DM group and the IGR group. The latency of SSR in both lower limbs was prolonged [1956 鹵321ms vs 1851 鹵254 Ms p0.05], and the amplitude decreased [0.36 鹵0.50mv vs 0.55 鹵0.54 mvp0.05]. The SNAP of median nerve, ulnar nerve, posterior tibial nerve, common peroneal nerve decreased, the amplitude of CMAP of posterior tibial nerve and common peroneal nerve decreased, and the number of motor units of hypothenar muscle and extensor digitorum brevis decreased (p0.05). Compared with the normal control group, the clinical symptoms (pain, numbness, burning sensation), ankle reflex, big toe vibration and monofilament pressure in IGR group were significantly decreased or absent (p0.05). Compared with IGR group, the proportion of malleolus reflex, big toe vibration sensation and monofilament pressure perception in DM group was decreased or missing (p0.05), but there was no statistical difference in other aspects. 5. Logistic regression was used to screen and analyze the risk factors of IGR related neuropathy. The results showed that the elevated level of triglyceride and low density lipoprotein (LDL) in venous blood of BMI, was the risk factor of IGR related neuropathy. Conclusion: there is peripheral nerve damage in patients with IGR, mainly involving the small fibrous nerve of lower extremity. With the progression of the disease, it is diabetes mellitus, and the large fiber can also be involved. The axonal injury is the main lesion, and the lower extremity is more serious than the upper limb. Obesity and dyslipidemia are risk factors for IGR neuropathy.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R587.2
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