综合分析法诊断糖尿病周围神经病变对其临床特点和发病危险因素的影响  

Multi,parameter analysis in determing the clinical characteristics and risk factors of diabetic peripheral neuropathy

作　　者：汤正义[1] 侯瑞芳[1] 龚慧[1] 杨洋[1] 张连珍[1] 张炜[1] 王卫庆[1] 李小英[1] 宁光[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院内分泌代谢病科上海市内分泌代谢病临床医学中心,上海200025

出　　处：《内科理论与实践》2007年第3期164-167,共4页Journal of Internal Medicine Concepts & Practice

基　　金：上海市教委重点学科内分泌代谢病专项经费(项目编号:200344)

摘　　要：目的:通过临床和仪器等检查,综合分析诊断糖尿病周围神经病变,探讨其临床特点与发病相关危险因素的变化。方法:筛选434例2型糖尿病患者,收集其一般临床数据,如病史、身高、体重、血压、空腹血糖(FPG)、餐后2h血糖(PPG)、空腹血浆胰岛素(FIns)水平和血脂指标等,结合神经传导速度(NCV)、定量感觉检查(QST)(包括温度觉、振动觉、触觉和痛觉)结果,将其分为有或非糖尿病神经病变组,统计分析神经病变发病情况以及与这些指标的关系。结果:入选糖尿病患者的NCV检查异常率为52.3%,QST异常为62.9%,综合分析结果异常为63.6%,随着年龄和糖尿病病程的增长,神经病变的发生率增加;神经病变组的年龄、糖尿病病程、糖尿病家族史、吸烟史、饮酒史、身高、体重指数、收缩压、PPG、FIns水平、尿微量蛋白、血肌酐(Scr)等数据明显高于非神经病变组,并与神经病变发病相关(P<0.05),这些指标中年龄、身高、糖尿病病程、PPG、FIns水平、Scr是神经病变发病的危险因素(P<0.05)。结论:结合临床和仪器检查综合分析诊断糖尿病神经病变符合疾病的实际特点,最大限度地减少漏诊;分析后的发病相关危险因素与其他诊断方法相似。Objective To evaluate the role of multi-parameter analysis in determing the clinical characteristics and risk factors of diabetic peripheral neuropathy （DPN）. Methods A total 434 cases were enrolled, and the multi-parameter analysis system including medical history, body height, body weight, blood pressure blood sugar level, plasma lipids and insulin level were established. According to the results of nerve conduction velocities （NCV） and quantitative sensory testing （QST）, the patients were divided into DPN group and non-DPN group. Results The abnormal rates of NCV, QST and their combination test were 52.3%, 62.9% and 63.6%, respectively. The DPN was more frequency occurred in patients with senile age and long diabetic history. A significant difference was found between DPN group and non-DNP group, in terms of age, course of diabetes, family history, history of smoking and drinking, body height, body mass index （BMI）, systolic blood pressure, post meal sugar, fast plasma insulin, microalbumin excretion, as well as serum creatinine （P〈0.05）. Furthermore, age, course of diabetes, body height, post meal sugar, fast plasma insulin, and serum creatinine were all risk factors related with DPN （P〈0.05）. Conclusions Diagnosis of DPN should be based on both clinical and lab findings. Risk factors of DPN were similar to those from other diagnosis methods.

关 键 词：糖尿病周围神经病变 诊断方法 神经传导速度 定量感觉检查 

分 类 号：R587.2[医药卫生—内分泌]