電流感覺閾值和運動誘發(fā)電位在T2DM患者神經(jīng)病變中的診斷應(yīng)用
發(fā)布時間：2019-05-16 06:49
【摘要】：背景糖尿病神經(jīng)病變(diabetic neuropathy,DN)是糖尿病(diabetic mellitus, DM)常見的慢性并發(fā)癥,可累及中樞及周圍神經(jīng)系統(tǒng),以后者多見。關(guān)于糖尿病周圍神經(jīng)病變(diabetic peripheral neuropathy, DPN)的研究,主要是基于臨床神經(jīng)癥狀、體征和神經(jīng)傳導(dǎo)速度(nerve conductionn velocity, NCV)。然而電流感覺閾值(region-current perception threshold, R-CPT)檢查少見論及,有關(guān)中樞神經(jīng)病變中錐體束損傷則罕有報道。本研究對T2DM患者行R-CPT、運動誘發(fā)電位(motor evoked potentials, MEP)、NCV和體感誘發(fā)電位(somatosensory evoked potential, SEP)檢查,評價R-CPT和MEP在DN的診斷應(yīng)用及其臨床意義。目的1.應(yīng)用感覺神經(jīng)定量檢測儀檢測T2DM患者正中、尺、腓淺、腓深神經(jīng)于2000Hz、 250Hz.5Hz的R-CPT,評估T2DM患者周圍神經(jīng)系統(tǒng)功能,尤其是細小神經(jīng)纖維功能2.應(yīng)用MEP里的中樞運動傳導(dǎo)時間(central motor conduction time,CMCT)評估T2DM患者錐體束功能。3.探討R-CPT和CMCT對T2DM患者DN診斷應(yīng)用及其臨床意義。方法1.研究對象：714例明確診斷的T2DM患者。2.研究分組：對714例T2DM患者聯(lián)合測定R-CPT、NCV和SEP,以R-CPT結(jié)果分為感覺正常組(364例)和異常組(350例),根據(jù)有無癥狀分為有癥狀組(260例)和無癥狀組(454例)；在上述714例T2DM患者中選取166例血壓控制良好無腦血管意外、癲癇和心臟病史患者加測MEP,計算出CMCT值,根據(jù)CMCT值分為正常組(136例)和異常組(30例)。3.資料收集：收集患者的性別、年齡、病程等一般情況,糖化血紅蛋白(HbAlC)、甘油三酯(TG)、總膽固醇(TC)、高密度脂蛋白膽固醇(HDL-C)、低密度脂蛋白膽固醇(LDL-C)等生化結(jié)果,R-CPT、MEP、NCV、SEP等檢測結(jié)果和患者神經(jīng)癥狀。4.統(tǒng)計分析：采用SPSS19.0進行統(tǒng)計分析,P0.05為差異有統(tǒng)計學(xué)意義。結(jié)果1以NCV為金標準,R-CPT的靈敏度為81.1%,特異度為98.9%,一致性(Kappa)為80.3%;SEP的靈敏度為95.3%,特異度為83.4%,一致性(Kappa)為71.8%。2.NCV、SEP、2000Hz、250Hz和5Hz檢出異常率分別為：40.3%、25.6%、36.1%、40.8%、43.1%,NCV異常率明顯高于SEP,低于250Hz和5Hz,2000Hz異常率明顯低于5Hz,SEP異常率最低,且差異有統(tǒng)計學(xué)意義(P0.05),250Hz和5Hz之間無差異性。3.無DPN癥狀患者中NCV、SEP、2000Hz、250Hz和5Hz檢出異常率分別為：23.3%、9.5%、25.3%、27.5%、30.4%,NCV異常率明顯高于SEP,低于250HZ和5HZ,SEP異常率最低,且差異有統(tǒng)計學(xué)意義(P0.05)。4.上肢組2000 Hz、250 Hz和5Hz檢出異常率為：17.6%、16.2%、24.5%,下肢組2000 Hz、250 Hz和5Hz檢出異常率為：28.6%、34.2%、35.9%,2000Hz異常率低于250和5Hz,下肢組2000、250和5Hz異常率明顯高于上肢組,差異有統(tǒng)計學(xué)意義(P0.05)。5.R-CPT正常組和異常組比較發(fā)現(xiàn),年齡越大,病程時間越長,HbA1C越高其周圍神經(jīng)感覺功能異常率越高；異常組男性比例、年齡、病程、HbA1C、TC、HDL-C、 LDI-C均比正常組高,差異有統(tǒng)計學(xué)意義(P0.05)。6.166例患者中CMCT、R-CPT、NCV、SEP異常率分別為：18.1%(30例)、66.9%(111例)、50.0%(83例)、41.0%(68例),踝反射亢進者占3%(5例),經(jīng)統(tǒng)計分析,異常率差異有統(tǒng)計學(xué)意義, (P0.05),且CMCT異常的患者其R-CPT、NCV、SEP均異常。7.左上肢、右上肢、左下肢、右下肢CMCT的異常率為：76.7%、66.7%、70.7%、96.7%,右下肢CMCT異常率明顯高于雙上肢和左下肢CMCT,且差異有統(tǒng)計學(xué)意義(P0.05)。8. CMCT正常組與異常組比較,病程時間越長,CMCT的異常率越高,異常組表現(xiàn)為年齡、病程、HbAlC、TG、LDL-C均高于正常組,差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論1.R-CPT可客觀、定量診斷周圍神經(jīng)深、淺感覺功能異常特異性高,是對NCV檢查的一種補充；DPN主要累及雙下肢,以無髓鞘和細的有髓鞘感覺神經(jīng)纖維為受累為主,患者年齡、病程及HbA1C是其危險因素。2.CMCT可以客觀、定量的評價糖尿病中樞神經(jīng)系統(tǒng)運動神經(jīng)功能,T2DM患者錐體束功能存在異常,以下肢為重,其周圍神經(jīng)功能均出現(xiàn)異常,患者病程是其危險因素。
[Abstract]:Background Diabetic Neuropathy (DN) is a common chronic complication of diabetes (DM), which can involve the central and peripheral nervous system. The study of the diabetic peripheral neuropathy (DPN) is based on the clinical neurological symptoms, signs and nerve conduction velocity (NCV). However, the current perception threshold (R-CPT) is rare, and the damage of the pyramidal tract in the central nervous system is rarely reported. The diagnosis and clinical significance of R-CPT, motor-evoked potential (MEP), NCV and somatosensory evoked potential (SEP) in patients with T2DM were studied in this study. Objective 1. The sensory nerve quantitative detector was used to detect the R-CPT of median, ulnar, sural and sural nerve at 2000 Hz,250 Hz and 5 Hz in patients with T2DM, and to evaluate the function of peripheral nervous system in patients with T2DM, especially the function of fine nerve fiber 2. In the application of MEP, central motor-conduction time (CMCT) was used to evaluate the function of pyramidal tract in patients with T2DM. To investigate the clinical significance of R-CPT and CMCT in the diagnosis of DN in patients with T2DM. Method 1. Study object:714 patients with T2DM clearly diagnosed.2. Study group: The results of R-CPT, NCV and SEP in 714 patients with T2DM were divided into normal group (364 cases) and abnormal group (350 cases) according to the results of R-CPT, and the symptoms were divided into symptomatic group (260 cases) and asymptomatic group (454 cases) according to the presence or absence of symptoms. In the above 714 patients with T2DM,166 patients with T2DM had good blood pressure control, and MEP was added to the patients with history of epilepsy and heart disease. The CMCT value was calculated and divided into the normal group (136 cases) and the abnormal group (30 cases) according to the CMCT value. Data collection: collect the biochemical results such as sex, age and course of the patient, such as glycosylated hemoglobin (HbAlC), triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), R-CPT, MEP, NCV, SEP and other test results and patient neurological symptoms. Statistical analysis: The statistical analysis was performed using SPSS19.0, and the difference was significant between P0.05. Results 1 With the NCV as the gold standard, the sensitivity of R-CPT was 81.1%, the specificity was 98.9%, the consistency (Kappa) was 80.3%, the sensitivity of SEP was 95.3%, the specificity was 83.4%, the consistency (Kappa) was 71.8%. 43.1%, the abnormal rate of NCV was significantly higher than that of SEP, less than 250 Hz and 5 Hz, the abnormal rate of 2000 Hz was lower than 5 Hz, the abnormal rate of SEP was the lowest, and there was no difference between 250 Hz and 5 Hz. The abnormal rates of NCV, SEP, 2000Hz, 250Hz and 5Hz in patients without DPN were 23.3%, 9.5%, 25.3%, 27.5%, 30.4%, and the abnormal rate of NCV was higher than that of SEP, lower than 250HZ and 5HZ, and the abnormal rate of SEP was the lowest. The abnormal rate was 28.6%, 34.2%, 35.9%, the abnormal rate of 2000Hz was lower than 250 and 5Hz, and the abnormal rate of 2000,250 and 5Hz in lower limb group was significantly higher than that of upper limb group. The higher the age, the longer the course of the disease, the higher the abnormal rate of the peripheral nerve sensory function, the higher the proportion of the male, the age, the course of the disease, the HbA1C, the TC, the HDL-C and the LDI-C than the normal group. The abnormal rates of CMCT, R-CPT, NCV and SEP in 6.166 patients were 18.1% (30 cases), 66.9% (111 cases), 50.0% (83 cases), 41.0% (68 cases) and 3% (5 cases) of the hyperreflexia group. SEP was abnormal.7. The abnormal rate of the left upper limb, the right upper limb, the left lower limb and the right lower limb CMCT was 76.7%, 66.7%, 70.7%, 96.7%, and the abnormal rate of the right lower limb CMCT was significantly higher than that of the two upper and left lower limbs (P0.05). Compared with the abnormal group, the longer the course of the disease, the higher the abnormal rate of the CMCT, the higher the age, the course of the disease, the HbAlC, the TG and the LDL-C in the normal group, and the difference was statistically significant (P0.05). Conclusion 1.R-CPT can objectively and quantitatively diagnose the peripheral nerve deep and the abnormal specificity of the superficial sensory function is high, it is a supplement to the NCV examination; the DPN mainly involves the double lower limbs, and is mainly affected by the non-medullary and fine pulpious sensory nerve fibers, and the patient's age, The course of the disease and HbA1C are the risk factors.2. The CMCT can objectively and quantitatively evaluate the motor nerve function of the central nervous system of the diabetes mellitus. The function of the cone-body beam in the patients with T2DM is abnormal, and the function of the peripheral nerves of the patients with T2DM is abnormal, and the course of the patient is the risk factor.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R587.2
本文編號：2478096
[Abstract]:Background Diabetic Neuropathy (DN) is a common chronic complication of diabetes (DM), which can involve the central and peripheral nervous system. The study of the diabetic peripheral neuropathy (DPN) is based on the clinical neurological symptoms, signs and nerve conduction velocity (NCV). However, the current perception threshold (R-CPT) is rare, and the damage of the pyramidal tract in the central nervous system is rarely reported. The diagnosis and clinical significance of R-CPT, motor-evoked potential (MEP), NCV and somatosensory evoked potential (SEP) in patients with T2DM were studied in this study. Objective 1. The sensory nerve quantitative detector was used to detect the R-CPT of median, ulnar, sural and sural nerve at 2000 Hz,250 Hz and 5 Hz in patients with T2DM, and to evaluate the function of peripheral nervous system in patients with T2DM, especially the function of fine nerve fiber 2. In the application of MEP, central motor-conduction time (CMCT) was used to evaluate the function of pyramidal tract in patients with T2DM. To investigate the clinical significance of R-CPT and CMCT in the diagnosis of DN in patients with T2DM. Method 1. Study object:714 patients with T2DM clearly diagnosed.2. Study group: The results of R-CPT, NCV and SEP in 714 patients with T2DM were divided into normal group (364 cases) and abnormal group (350 cases) according to the results of R-CPT, and the symptoms were divided into symptomatic group (260 cases) and asymptomatic group (454 cases) according to the presence or absence of symptoms. In the above 714 patients with T2DM,166 patients with T2DM had good blood pressure control, and MEP was added to the patients with history of epilepsy and heart disease. The CMCT value was calculated and divided into the normal group (136 cases) and the abnormal group (30 cases) according to the CMCT value. Data collection: collect the biochemical results such as sex, age and course of the patient, such as glycosylated hemoglobin (HbAlC), triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), R-CPT, MEP, NCV, SEP and other test results and patient neurological symptoms. Statistical analysis: The statistical analysis was performed using SPSS19.0, and the difference was significant between P0.05. Results 1 With the NCV as the gold standard, the sensitivity of R-CPT was 81.1%, the specificity was 98.9%, the consistency (Kappa) was 80.3%, the sensitivity of SEP was 95.3%, the specificity was 83.4%, the consistency (Kappa) was 71.8%. 43.1%, the abnormal rate of NCV was significantly higher than that of SEP, less than 250 Hz and 5 Hz, the abnormal rate of 2000 Hz was lower than 5 Hz, the abnormal rate of SEP was the lowest, and there was no difference between 250 Hz and 5 Hz. The abnormal rates of NCV, SEP, 2000Hz, 250Hz and 5Hz in patients without DPN were 23.3%, 9.5%, 25.3%, 27.5%, 30.4%, and the abnormal rate of NCV was higher than that of SEP, lower than 250HZ and 5HZ, and the abnormal rate of SEP was the lowest. The abnormal rate was 28.6%, 34.2%, 35.9%, the abnormal rate of 2000Hz was lower than 250 and 5Hz, and the abnormal rate of 2000,250 and 5Hz in lower limb group was significantly higher than that of upper limb group. The higher the age, the longer the course of the disease, the higher the abnormal rate of the peripheral nerve sensory function, the higher the proportion of the male, the age, the course of the disease, the HbA1C, the TC, the HDL-C and the LDI-C than the normal group. The abnormal rates of CMCT, R-CPT, NCV and SEP in 6.166 patients were 18.1% (30 cases), 66.9% (111 cases), 50.0% (83 cases), 41.0% (68 cases) and 3% (5 cases) of the hyperreflexia group. SEP was abnormal.7. The abnormal rate of the left upper limb, the right upper limb, the left lower limb and the right lower limb CMCT was 76.7%, 66.7%, 70.7%, 96.7%, and the abnormal rate of the right lower limb CMCT was significantly higher than that of the two upper and left lower limbs (P0.05). Compared with the abnormal group, the longer the course of the disease, the higher the abnormal rate of the CMCT, the higher the age, the course of the disease, the HbAlC, the TG and the LDL-C in the normal group, and the difference was statistically significant (P0.05). Conclusion 1.R-CPT can objectively and quantitatively diagnose the peripheral nerve deep and the abnormal specificity of the superficial sensory function is high, it is a supplement to the NCV examination; the DPN mainly involves the double lower limbs, and is mainly affected by the non-medullary and fine pulpious sensory nerve fibers, and the patient's age, The course of the disease and HbA1C are the risk factors.2. The CMCT can objectively and quantitatively evaluate the motor nerve function of the central nervous system of the diabetes mellitus. The function of the cone-body beam in the patients with T2DM is abnormal, and the function of the peripheral nerves of the patients with T2DM is abnormal, and the course of the patient is the risk factor.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R587.2
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