糖耐量受损患者周围神经功能的电生理评价  

Electrophysiological evaluation of peripheral nerve in patients with impaired glucose tolerance

作　　者：刘杰[1] 张哲成[2] 刘娜[2] 朱炬[2] 张静[2] 李霞[2] 

机构地区：[1]天津医科大学三中心临床学院,300170 [2]天津市第三中心医院神经内科

出　　处：《中华内分泌代谢杂志》2017年第7期574-577,共4页Chinese Journal of Endocrinology and Metabolism

基　　金：天津市卫生行业重点攻关项目（14KG110）

摘　　要：选取2015年3月至2015年10月就诊于本院的糖耐量受损（IGT）患者75例,对所有患者行多伦多临床评分系统（TCSS）量表评分,按评分结果有无异常分为评分正常组（TCSS-N）50例和评分异常组（TCSS-A）25例,选择年龄性别相匹配的健康志愿者30名作为对照,应用Keypoint.net（Medoc Ltd）肌电图仪对所有受试者进行常规神经传导及四肢交感皮肤反应（Sympathetic skin response,SSR）检测.结果显示,与对照组相比,IGT组双下肢SSR波幅减低[（0.61±0.44对1.00±0.33）mv,P〈0.05],潜伏期延长[（1 880±282对1 642±256）ms,P〈0.05],正中神经、尺神经、胫后神经、腓总神经感觉运动传导差异无统计学意义;与对照组相比较,TCSS-A组双下肢SSR波幅减低[（0.47±0.39）mv,P〈0.05],潜伏期延长[（2 062±291）ms,P〈0.05],胫后神经SNAP波幅减低[（1.83±0.37对2.07±0.30）μv,P〈0.05].与TCSS-N组相比,TCSS-A组双下肢SSR潜伏期延长[（2 062±291对1 808±246）ms,P〈0.05];与对照组相比,TCSS-N组双下肢SSR波幅减低[（0.66±0.44）mv,P〈0.05],潜伏期延长（P〈0.05）.Pearson相关分析提示双下肢SSR波幅及潜伏期与餐后2 h血糖、血糖波动、体重、体重指数相关.本研究结果提示IGT患者存在周围神经损害,主要累及下肢小纤维神经,随病情进展加重,大纤维也可轻度受累.This study retrospectively reviewed 75 patients with impaired glucose tolerance（IGT）admitted in our hospital from March 2015 to October 2015.All patients underwent Toronto clinical scoring system（TCSS） evaluation.Patients with IGT were further divided into normal score group（TCSS-N, n=50）and abnormal score group（TCSS-A, n=25）according to their scoring results, and 30 healthy volunteers were served as control group.All patients and controls underwent motor and sensory nerve conduction studies, as well as sympathetic skin response（SSR）test using the Keypoint.Net（Medoc Ltd）electromyogram device.The results showed that the SSR amplitude of lower limbs was reduced [（0.61±0.44 vs 1.00±0.33）mv, P〈0.05]andlatencyoflowerlimbswas extended [（1 880±282 vs 1 642±256）ms, P〈0.05]in IGT group compared with control group.But median, ulnar, tibial, and peroneal nerve sensory and motor conduction revealed no difference between two groups.In TCSS-A group, the SSR amplitude of lower limbs was reduced [（0.47±0.39）mv, P〈0.05], latency of lower limbs was extended [（2 062±291）ms,P〈0.05]and the sensory nerve action potential（SNAP）amplitude of the tibial nerve was significantly lower compared with control group [（1.83±0.37 vs 2.07±0.30）μv, P〈0.05].Compared to TCSS-N group, latency of lower limbs was extended [（2 062±291 vs 1 808±246）ms, P〈0.05]in TCSS-A group.The SSR amplitude of lower limbs were reduced[（0.66±0.44）mv,P〈0.05]and latency were prolonged（P〈0.05）in TCSS-N group compared with control group.Pearson correlation analysis showed that the SSR amplitude and latency of the lower limbs were correlated with the postprandial blood glucose, blood glucose fluctuation, body weight, as well as body mass index.These results suggest that there exists peripheral nerve damage in the patients with IGT, mainly involving the small fiber nerve of the lower limbs.Large fibers may also be mildly affected as the disease progresses.

关 键 词：周围神经 糖耐量受损 神经传导 交感皮肤反应 

分 类 号：R587.2[医药卫生—内分泌]