神经传导、F波及皮肤交感反应联合检测对糖尿病周围神经病变早期诊断的价值  

Application of NCS,F and SSR Wave Electrophysiology Combined Examination for Early Diagnosis of Diabetic Neuropathy

作　　者：魏易琼[1] 苏常春[1] 周倩[2] 卢祖能[3] Wei Yiqiong;Su Changchun;Zhou Qian(Department of Neurology,Guangzhou First People’s Hospital,Guangzhou 510180;Department of Endocrinology,Guangzhou First People’s Hospital,Guangzhou 510180)

机构地区：[1]广州市第一人民医院神经内科,广州510180 [2]广州市第一人民医院内分泌科,广州510180 [3]武汉大学人民医院神经内科,武汉430060

出　　处：《华中科技大学学报（医学版）》2020年第4期477-480,共4页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：广州市卫生健康科技项目(No.20202A022002)。

摘　　要：目的采用受试者工作特征曲线(ROC)探讨神经传导检测(NCS)、F波及皮肤交感反应(SSR)联合检测对早期糖尿病周围神经病变的诊断价值。方法对78例糖尿病周围神经病(diabetic peripheral neuropathy,DPN)患者(观察组)和81例单纯糖尿病患者(对照组)进行常规神经传导检测及正中神经和胫后神经F波检测和SSR检测,对单独检测和联合检测的异常率进行比较,并采用ROC曲线分析NCS、F波及SSR联合检测的诊断效能。结果观察组NCS检查总异常率为91.36%。观察组F波总异常率为80.25%。NCS、F波及SSR的联合检验灵敏度与特异度分别为89.41%、86.33%。观察组与对照组相比,患者双侧胫后神经、腓总神经远端动作潜伏期(DML)明显延长,复合肌肉动作电位(CMAP)波幅显著降低(均P<0.05)。观察组与对照组F波检测相比,正中神经、胫后神经Fimin及Fimean延长,F波出现率降低,Fchd增加(均P<0.05)。观察组,上、下肢皮肤交感反应(SSR)起始潜伏期较对照组明显延长(均P<0.05),SSR波幅较对照组明显下降(P<0.05)。结论NCS检测是诊断DPN患者的基本手段,将其与F波及SSR联用,是早期诊断糖尿病自主神经病变的敏感手段,能明显提高亚临床型DPN患者的早期检出率。Objective To explore the value of NCS,F and SSR wave electrophysiology combined with receiver operating characteristic curve(ROC)in the diagnosis of early diabetic peripheral neuropathy.Methods Totally,78 patients with diabetic peripheral neuropathy(DPN)and 81 patients with simple diabetes were examined by routine nerve conduction test,median nerve and posttibial F wave test and SSR test.The abnormal rates of single and combined detection were compared,and the diagnostic efficacy of NCS,F wave and SSR was analyzed by ROC curve.Results The total abnormal rate of NCS in the observation group was 91.36%.The total abnormal rate of F wave in DPN group was 80.25%.The sensitivity and specificity of NCS,F and SSR were 89.41%and 86.33%,respectively.DML of bilateral posterior tibial nerve and common peroneal nerve was significantly longer and CMAP amplitude was significantly lower in the observation group than in the control group(all P<0.05).Compared with the control group,Fimin and Fimean of median nerve and posterior tibial nerve were prolonged,the frequency of F wave was decreased,and Fchd was increased in the observation group(all P<0.05).In the observation group,the initial latency of SSR in the upper and lower extremities was significantly longer than that in the control group(both P<0.05),and the amplitude of SSR was significantly lower than that in the control group(P<0.05).Conclusion NCS is the basic method for the diagnosis of DPN patients,and it is sensitive for the early diagnosis of diabetic autonomic neuropathy,which can significantly improve the early detection rate of subclinical DPN patients.

关 键 词：神经传导检测 F波 皮肤交感反应 糖尿病周围神经病变 诊断价值 

分 类 号：R587.25[医药卫生—内分泌]