本文選題：葡糖耐受不良 + 神經(jīng)纖維��； 參考：《天津醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的： 通過神經(jīng)傳導(dǎo)(NCS)、皮膚交感反應(yīng)(SSR)和接觸性熱痛誘發(fā)電位(CHEP)三種電生理方法評(píng)價(jià)糖耐量異常(IGT)和早期糖尿病(eDM)患者周圍神經(jīng)大小纖維的功能狀態(tài),以期探討IGT者周圍神經(jīng)功能損害特點(diǎn)。 方法： 選取eDM患者100例,IGT者50例,健康對(duì)照者50例,應(yīng)用Keypoint. net(Medoc Ltd)肌電圖儀對(duì)受試者行右側(cè)正中神經(jīng)、尺神經(jīng)、脛后神經(jīng)、腓總神經(jīng)NCS檢測(cè)及四肢SSR檢測(cè),測(cè)定電生理參數(shù)包括運(yùn)動(dòng)末端潛伏期(DML)、復(fù)合肌肉動(dòng)作電位波幅(CMAP)、感覺神經(jīng)傳導(dǎo)速度(SCV)、感覺神經(jīng)動(dòng)作電位的波幅(SNAP)、SSR波幅、SSR起始潛伏期等；應(yīng)用CHEP刺激器,刺激受試者右側(cè)前臂、小腿皮膚,于Cz點(diǎn)記錄N波潛伏期及N-P波波幅。 結(jié)果： 1.IGT組和對(duì)照組NCS結(jié)果比較：IGT組和對(duì)照組正中神經(jīng)、尺神經(jīng)、脛后神經(jīng)、腓總神經(jīng)的DML、CMAP、SCV、SNAP差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。 2.eDM組中經(jīng)NCS檢測(cè)有32例異常,將NCS正常的68例納入DM-NCN組。IGT組、DM-NCN組和對(duì)照組SSR結(jié)果比較：IGT組和對(duì)照組比較,IGT組下肢SSR波幅減低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；上肢SSR波幅及上、下肢SSR潛伏期差異均無統(tǒng)計(jì)學(xué)意義(P0.05)；DM-NCN組和對(duì)照組比較,DM-NCN組上、下肢SSR波幅減低,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)；下肢SSR潛伏期延長(zhǎng),差異有統(tǒng)計(jì)學(xué)意義(P0.05)；上肢SSR潛伏期差異無統(tǒng)計(jì)學(xué)意義(P0.05)。IGT組和DM-NCN組上、下肢SSR潛伏期、波幅差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。 3.IGT組、DM-NCN組和對(duì)照組CHEP結(jié)果比較：IGT組和對(duì)照組比較,IGT組CHEP前臂和小腿刺激點(diǎn)N-P波波幅減低,差異均有統(tǒng)計(jì)學(xué)意義(均P0.05)；兩組前臂刺激點(diǎn)、小腿刺激點(diǎn)N波潛伏期差異無統(tǒng)計(jì)學(xué)意義(P0.05)；DM-NCN組和對(duì)照組比較,DM-NCN組CHEP前臂和小腿刺激點(diǎn)N-P波波幅減低,差異均有統(tǒng)計(jì)學(xué)意義(均P0.05)；前臂刺激點(diǎn)、小腿刺激點(diǎn)N波潛伏期延長(zhǎng),差異均有統(tǒng)計(jì)學(xué)意義(均P0.05)；IGT組和DM-NCN組CHEP前臂刺激點(diǎn)、小腿刺激點(diǎn)N-P波波幅以及N波潛伏期差異均未見統(tǒng)計(jì)學(xué)意義(均P0.05)。 結(jié)論： 1、IGT者存在周圍神經(jīng)損害,小神經(jīng)纖維受累為著,下肢較上肢易受累,尚不提示周圍神經(jīng)大神經(jīng)纖維受累證據(jù)。 2、早期糖尿病患者周圍神經(jīng)大、小神經(jīng)纖維均可受累,下肢較上肢易受累,在周圍神經(jīng)大神經(jīng)纖維尚未損害前可存在周圍神經(jīng)小神經(jīng)纖維受累,提示損害首先累及小神經(jīng)纖維,損害特點(diǎn)與IGT者相似,重于IGT者。 3、神經(jīng)電生理診斷方法對(duì)于發(fā)現(xiàn)IGT及糖尿病階段周圍神經(jīng)大小神經(jīng)纖維損害具有重要價(jià)值,SSR和CHEP是對(duì)周圍神經(jīng)小纖維損害的重要檢測(cè)方法,CHEP是比SSR更敏感的電生理方法。
[Abstract]:Objective:
The functional state of the peripheral nerve fiber in patients with impaired glucose tolerance (IGT) and early diabetes (eDM) was evaluated by three electrophysiological methods, nerve conduction (NCS), skin sympathetic response (SSR) and contact heat pain evoked potential (CHEP), in order to explore the characteristics of peripheral nerve function damage in IGT patients.
Method:
100 patients with eDM, 50 cases of IGT and 50 healthy controls were used to test the right median nerve, ulnar nerve, posterior tibial nerve, the posterior tibial nerve, the common peroneal nerve NCS detection and the extremities SSR detection by Keypoint. net (Medoc Ltd) electromyography. The electrophysiological parameters including the terminal latent period (DML), the complex muscle action potential amplitude (CMAP), and the sensory nerve were measured. The conduction velocity (SCV), the amplitude (SNAP) of the sensorineural action potential (SNAP), the amplitude of SSR, the initial incubation period of the SSR, and so on; the CHEP stimulator was used to stimulate the right forearm, the calf skin, and the N wave latency and N-P wave amplitude at Cz point.
Result:
The results of NCS in group 1.IGT and control group were compared: there was no significant difference between group IGT and control group with median nerve, ulnar nerve, posterior tibial nerve, DML of peroneal nerve, CMAP, SCV, and SNAP (P0.05).
In group 2.eDM, 32 cases were detected by NCS, and 68 cases of normal NCS were included in group.IGT of group DM-NCN. The results of SSR in group DM-NCN and control group were compared. Compared with the control group, the amplitude of SSR wave in the lower extremities decreased in the group IGT and the difference was statistically significant (P0.05). Compared with group DM-NCN, the SSR amplitude of lower extremities decreased, the difference was statistically significant (P0.05), and the latency of lower extremity SSR prolonged, the difference was statistically significant (P0.05); there was no statistical significance (P0.05).IGT group and DM-NCN group in the upper limb SSR latency (P0.05), and there was no statistical significance (P0.05) in the latency period of lower extremity SSR.
3.IGT group, DM-NCN group and control group CHEP results: IGT group and control group, IGT group CHEP forearm and leg stimulation point N-P wave amplitude decreased, the difference was statistically significant (all P0.05); two groups of forearm stimulation point, the leg stimulation point N wave latency difference was not statistically significant (P0.05); DM-NCN group and control group, DM-NCN group forearm The amplitude of N-P wave in the stimulating point of the calf decreased, the difference was statistically significant (P0.05), and the latency of the forearm stimulation point and the N wave of the leg stimulation was prolonged, the difference was statistically significant (P0.05), and there was no significant difference between the CHEP forearm stimulation points, the N-P wave amplitude of the calf stimulation point and the N wave latency (all P0.05) in the IGT and DM-NCN groups.
Conclusion:
1, there were peripheral nerve damage in IGT patients. Small nerve fibers were involved. The lower extremities were more easily affected than the upper limbs.
2, the peripheral nerve of the early diabetic patients is large, the small nerve fiber can be involved, the lower limb is more susceptible to the upper limb, and the peripheral nerve fibers may be involved before the nerve fibers of the peripheral nerve are not damaged. It is suggested that the damage first involve the small nerve fibers. The damage characteristics are similar to those of the IGT, which is heavier than the IGT.
3, the method of electrophysiological diagnosis is of great value for the detection of nerve fiber damage around IGT and diabetic peripheral nerve. SSR and CHEP are important detection methods for the damage of small peripheral nerve fibers. CHEP is a more sensitive electrophysiological method than SSR.
【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】：2014
【分類號(hào)】：R587.2;R745

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