【摘要】：目的2型糖尿病周圍神經(jīng)病變可以有小神經(jīng)纖維和（或）大神經(jīng)纖維受累，但Aδ類細(xì)有髓神經(jīng)纖維和C類無(wú)髓鞘神經(jīng)纖維比Aβ類粗有髓神經(jīng)纖維受損更常見,NeurometerCPT/C神經(jīng)測(cè)量檢測(cè)儀可反映細(xì)小神經(jīng)纖維的功能，本研究應(yīng)用該儀器對(duì)早期無(wú)周圍神經(jīng)受損癥狀的糖尿病患者感覺(jué)神經(jīng)進(jìn)行檢測(cè)，在不同參數(shù)的條件下分析神經(jīng)纖維受損的情況。 方法選取我院內(nèi)分泌科確診為2型糖尿�。═2DM）的住院患者共76例，測(cè)定雙側(cè)正中神經(jīng)、腓腸神經(jīng)在2000Hz、250Hz、5Hz電流下的電流感覺(jué)閾值（CPT），分析患者的CPT值屬于感覺(jué)過(guò)敏，感覺(jué)正�；蚋杏X(jué)減退，分析其陽(yáng)性率及各頻率間相互關(guān)系。詳細(xì)記錄糖尿病患者的各項(xiàng)臨床指標(biāo)，，并分析病程及糖化血紅蛋白、空腹血糖值等與CPT值的關(guān)系。 結(jié)果左側(cè)正中神經(jīng)在2000Hz、250Hz和5Hz電流下陽(yáng)性率分別為27.6%、48.7%、34.2%；右側(cè)正中神經(jīng)在2000Hz、250Hz和5Hz電流下陽(yáng)性率分別為32.9%、55.3%、40.8%；左側(cè)腓腸神經(jīng)在2000Hz、250Hz和5Hz電流下陽(yáng)性率分別為36.8%、55.3%、38.2%；右側(cè)腓腸神經(jīng)在2000Hz、250Hz和5Hz電流下陽(yáng)性率分別為46.1%、65.8%、47.4%。同側(cè)正中神經(jīng)和腓腸神經(jīng)同頻率下CPT值相比存在統(tǒng)計(jì)學(xué)意義（P0.01）。同側(cè)正中神經(jīng)及腓腸神經(jīng)同頻率下CPT值與對(duì)側(cè)相比差異無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）。雙側(cè)正中神經(jīng)和腓腸神經(jīng)均以250Hz電流下神經(jīng)敏感性高于5Hz電流下神經(jīng)敏感性，并高于2000Hz電流下神經(jīng)敏感性，差異具有統(tǒng)計(jì)學(xué)意義（P0.05）。病程越長(zhǎng)，CPT值越高，且差異存在統(tǒng)計(jì)學(xué)意義（P0.05）；糖化血紅異常組較正常組CPT值明顯增高，差異存在統(tǒng)計(jì)學(xué)意義（P0.05）；空腹血糖異常組較正常組CPT值增高，差異存在統(tǒng)計(jì)學(xué)意義（P0.05）。 結(jié)論該研究驗(yàn)證得出糖尿病周圍神經(jīng)損害以對(duì)稱性損害為主，雙下肢受累為主，以無(wú)髓和有髓小纖維神經(jīng)為主，病程及高血糖是糖尿病周圍神經(jīng)病神經(jīng)損害的重要危險(xiǎn)因素，該檢測(cè)方法為糖尿病周圍神經(jīng)病變的小纖維神經(jīng)損害提供了一種新的客觀定量評(píng)價(jià)手段，彌補(bǔ)了周圍神經(jīng)傳統(tǒng)檢查技術(shù)的不足，具有潛在的臨床應(yīng)用前景，也可作為治療及預(yù)后觀察的客觀指標(biāo)，使臨床早期診斷糖尿病周圍神經(jīng)病并監(jiān)測(cè)治療結(jié)果和病變演變情況成為可能。
[Abstract]:Objective Type 2 diabetic peripheral neuropathy can have small nerve fibers and / or large nerve fibers involved, but A 未 fine myelinated nerve fibers and C class unmyelinated nerve fibers are more common than A 尾 crude myelinated nerve fibers. NeurometerCPT/C nerve measurement instrument can reflect the function of small nerve fibers. In this study, this instrument was used to detect the sensory nerves of diabetic patients without symptoms of early peripheral nerve injury. The damage of nerve fibers was analyzed under different parameters. Methods 76 inpatients with type 2 diabetes mellitus (T2DM) diagnosed in Endocrinology Department of our hospital were selected to determine the current sensory threshold of sural nerve at 2000Hz, 250Hz and 5Hz current. (CPT), analysis showed that the CPT value of the patients was allergic, normal or hyposensory. The positive rate and the relationship between the positive rate and each frequency were analyzed. The clinical indexes of diabetic patients were recorded in detail, and the relationship between the course of disease, glycosylated hemoglobin, fasting blood glucose and CPT was analyzed. Results the positive rates of left median nerve under 2000Hz, 250Hz and 5Hz current were 27.6%, 48.7%, 34.2%, 32.9%, 55.3% and 40.8%, respectively, and the positive rate of left sural nerve was 36.8%, 55.3% and 38.2% respectively at 2000Hz, 250Hz and 5Hz current, respectively. The positive rates of right sural nerve under 2000Hz, 250Hz and 5Hz currents were 46.1%, 65.8% and 47.4%, respectively. There was significant difference in CPT between ipsilateral median nerve and sural nerve at the same frequency (P 0.01). There was no significant difference in CPT value between ipsilateral median nerve and sural nerve at the same frequency between ipsilateral median nerve and sural nerve (P 0.05). The nerve sensitivity of bilateral median nerve and sural nerve under 250Hz current was higher than that under 5Hz current and higher than that under 2000Hz current, the difference was statistically significant (P 0.05). The longer the course of disease, the higher the CPT value, and the difference was statistically significant (P 0.05). The CPT value in the glycosylated blood red abnormal group was significantly higher than that in the normal group (P 0.05), and the CPT value in the abnormal fasting blood glucose group was significantly higher than that in the normal group (P 0.05). Conclusion the main risk factors of diabetic peripheral nerve damage are symmetrical damage, bilateral lower extremity involvement, unmyelinated and myelinated small fiber nerve. The course of disease and hyperglycemia are the important risk factors of diabetic peripheral neuropathy. This method provides a new objective quantitative evaluation method for diabetic peripheral neuropathy and makes up for the shortcomings of traditional peripheral nerve examination techniques. It has potential clinical application prospect and can also be used as an objective index of treatment and prognosis observation, which makes it possible to diagnose diabetic peripheral neuropathy in the early stage and monitor the treatment results and pathological changes.
【學(xué)位授予單位】：蘇州大學(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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