腓浅神经感觉传导新方法建立及其在糖尿病周围神经病中的应用  

A new method of distal superficial peroneal sensory nerve conduction study and its clinical application in diabetic peripheral neuropathy

作　　者：蔡琼 徐文晓 吴超[1] 梁银杏[1] 廖松洁[1] CAI Qiong;XU Wenxiao;WU Chao;LIANG Yinxing;LIAO Songjie(Department of Neurology,the First Affiliated Hospital,Sun Yat-sen University,Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases,National Key Clinical Department and Key Discipline of Neurology,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院神经科,广东省重大疾病诊治研究重点实验室,国家临床重点专科和国家重点学科,广州510080

出　　处：《中国神经精神疾病杂志》2023年第4期205-210,共6页Chinese Journal of Nervous and Mental Diseases

基　　金：国家自然科学基金面上项目(编号:82071366);广州市临床特色技术项目(编号:2023P-TS21);广东省自然科学基金面上项目(编号:2023A1515010486);广东省重大神经疾病诊治研究重点实验室(编号:2020B1212060017);广东省神经系统疾病临床医学研究中心(编号:2020B1111170002);华南神经疾病早期干预及功能修复研究国际联合研究中心(编号:2015B050501003,2020A050520004);广东省神经系统疾病重大疾病诊治工程技术研究中心;广东省神经系统重大疾病诊治转化医学创新平台;广州市神经系统重大疾病临床医学研究与转化中心(编号:201604020010)

摘　　要：目的建立腓浅神经足背支感觉传导正常参考值范围,为临床评估糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)提供敏感的电生理依据。方法对91例2型糖尿病DPN患者和95名健康对照者进行常规周围神经传导检测和腓浅神经足背支感觉传导检测。该方法以足背趾2~3根部近端刺激,内外踝连线中外1/3处略近端记录,获得感觉神经动作电位(sensory nerve action potential,SNAP)。利用健康对照组数据建立参考值范围,波幅采用各年龄段波幅的最小值,速度下限用x^(-)-2s。比较两组间相关参数的差异,并采用ROC曲线分析腓浅神经足背支传导波幅及速度在DPN中的诊断价值。结果在健康对照组中,各年龄组腓浅神经足背支平均波幅范围为2.77~4.88μV,波幅正常值下限为1.2~3.4μV,腓浅神经足背支传导速度正常值下限为32.29~36.01m/s,未发现其波幅或速度与年龄相关(P>0.05)。DPN组中腓浅神经足背支、足底内侧神经、腓肠神经的波幅及传导速度较健康对照组降低(均P<0.01),并且,腓浅神经足背支感觉传导异常率较足底内侧神经(χ^(2)=7.82,P<0.01)、腓肠神经(χ^(2)=16.10,P<0.01)异常率增高。ROC曲线分析显示,腓浅神经足背支传导速度对DPN诊断价值优于足底内侧神经、腓肠神经,其曲线下面积最大,为0.955(P<0.01)。结论采用足背趾2~3根部近端刺激腓浅神经足背支的方法,可得到清晰稳定的波形,建立了其正常参考值范围。应用于DPN的诊断,具有较高的诊断价值。Objective To establish the reference values of superficial peroneal sensory distal branches,which provides a sensitive electrophysiological basis for evaluation of the diabetic peripheral neuropathy(DPN).Method Ninety-five volunteers and 91 patients with DPN were recruited in the present study.Conventional nerve conduction study(NCS)and sensory nerve study of the distal superficial peroneal nerve were performed.Sensory nerve action potentials(SNAP)of the distal superficial peroneal nerve were elicited by stimulating the proximal dorsum pedis between the second and third toe,and recorded at the lateral 1/3 point of medial and lateral malleoli.The results of reference parameters were described as the lowest normal and x^(-)-2s for amplitude and conductive velocity limits respectively in all ages.The differences of NCS parameters between the two groups were compared,and the diagnostic value of the superficial peroneal sensory distal branch amplitude and conductive velocity in DPN was analyzed by ROC curve.Results In controls,the mean amplitudes of the distal superficial peroneal nerve of all ages ranged from 2.77 to 4.88μV,and the lowest amplitudes limits ranged from 1.2 to 3.4μV.The minimum NCVs limits ranged from 32.29 to 36.01 m/s.The sensory amplitude or velocity had no correlations with age(P>0.05).The amplitudes and velocity of all three nerves in DPN group were lower than those in control group(P<0.01).More importantly,the abnormal rate was significantly higher in the distal superficial peroneal nerve than in either medial plantar nerve(χ^(2)=7.82,P<0.01)or sural nerve(χ^(2)=16.10,P<0.01).ROC curve analysis showed that the diagnostic value of distal superficial peroneal nerve conductive velocity is better than medial plantar nerve and sural nerve for DPN patients.And it had the largest area under the ROC curve was 0.955(P<0.01).Conclusion A clear distal superficial peroneal nerve SNAP can be achieved by stimulating the proximal dorsum pedis between the second and third toe,and normal reference range was e

关 键 词：腓浅神经足背支 感觉神经传导 参考值 ROC曲线 糖尿病周围神经病变 

分 类 号：R741.044[医药卫生—神经病学与精神病学]