探讨糖尿病周围神经病变患者神经损伤特点及电流感觉阈值联合神经传导检测的预测价值  

To explore the characteristics of nerve injury in patients with diabetic peripheral neuropathy and the predictive value of current perception threshold combined with nerve conduction velocity

作　　者：郑薇[1] 焦宁宁[1] 马亚红[1] Zheng Wei;Jiao Ningning;Ma Yahong(Department of Endocrinology,Beijing Puren Hospital,Beijing100062,China)

机构地区：[1]北京市普仁医院内分泌科,北京100062

出　　处：《中国医师进修杂志》2022年第10期898-902,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的分析糖尿病周围神经病变(DPN)患者神经损伤的特点,探讨电流感觉阈值(CPT)和神经传导检测(NCV)对DPN的诊断价值。方法选取北京市普仁医院2017年6月至2019年12月收治的136例DPN患者,另取同期收治的130例糖尿病非DPN患者作为对照。受检者均行CPT和NCV检测,其中NCV检测包括感觉神经传导速度(SCV)和运动神经传导速度(MCV)检测,对两组受检者相关指标进行统计分析。结果DPN患者上肢正中神经和尺神经在2000、250、5 Hz时的CPT值、腓浅神经在250、5 Hz时的CPT值、腓肠神经在2000、250 Hz时的CPT值均高于非DPN患者,DPN损伤主要发生于下肢细有髓鞘神经纤维[60.29%(82/136)],差异均有统计学意义(P<0.05)。DPN组正中神经、尺神经、腓总神经的SCV和MCV均低于非DPN组,SCV异常率均高于MCV[55.88%(76/136)比37.50%(51/136)、80/136(58.82%)比41.18%(56/136)、67.65%(92/136)比50.00%(68/136)],差异均有统计学意义(P<0.05)。CPT对DPN的预测价值曲线下面积(AUC)为0.815(95%CI 0.735~0.895);NCV对DPN的AUC为0.875(95%CI 0.813~0.944);CPT联合NCV对DPN的AUC为0.923(95%CI 0.876~0.970)。结论DPN患者存在CPT和NCV异常,神经损害多发于下肢细有髓鞘神经纤维和SCV。将CPT和NCV联合对DPN进行诊断,有利于提高DPN检出率。Objective To analyze the characteristics of nerve injury in patients with diabetic peripheral neuropathy(DPN)and explore the diagnostic value of current perception threshold(CPT)and nerve conduction velocity(NCV)for DPN.Methods One hundred and thirty-six DPN patients admitted to Beijing Puren Hospital from June 2017 to December 2019 were selected,and 130 diabetic non-DPN patients admitted during the same period were used as controls.All the subjects were tested by CPT and NCV.Among them,the detection of NCV included sensory nerve conduction velocity(SCV)and motor nerve conduction velocity(MCV).Statistical analysis was performed on the relevant indicators of the two groups of subjects.Results The CPT values of the upper limb median nerve and ulnar nerve at 2000 Hz,250 Hz,and 5 Hz,the superficial peroneal nerves at 250 Hz,and 5 Hz,and the CPT values of the sural nerve at 2000 Hz and 250 Hz were higher than those of non-DPN patients,DPN injury mainly occurred in myelinated nerve fibers in the lower extremities[60.29%(82/136)],and the difference were statistically significant(P<0.05).The SCV and MCV of the median nerve,ulnar nerve,and common peroneal nerve in the DPN group were lower than those in the non-DPN group,the SCV abnormal rate was higher than the MCV:55.88%(76/136)vs.37.50%(51/136);58.82%(80/136)vs.41.18%(56/136);67.65%(92/136)vs.50.00%(68/136),and the differences were statistically significant(P<0.05).The area under the predictive value curve(AUC)of CPT for DPN was 0.815(95%CI 0.735~0.895).The AUC of NCV for DPN was 0.875(95%CI 0.813~0.944).The AUC of CPT and NCV for DPN was 0.923(95%CI 0.876~0.970).Conclusions DPT patients have abnormal CPT and NCV,and nerve damage occurs mostly in myelinated nerve fibers and SCV.Diagnosing DPN by combining CPT and NCV is helpful to improve the detection rate of DPN.

关 键 词：糖尿病神经病变 电流感觉阈值 神经传导检测 诊断价值 

分 类 号：R587.2[医药卫生—内分泌]