神经肌电图检测在糖尿病周围神经病变诊断中的应用价值  

Value of neuroelectromyography in the diagnosis of diabetic peripheral neuropathy

作　　者：王淑慧[1] 田瑶 Wang Shuhui;Tian Yao(Department of Neurology,Fenyang Hospital Affiliated to Shanxi Medical University,Fenyang Hospital of Shanxi Province,Fenyang 032200,Shanxi Province,China;Department of Endocrinology,Fenyang Hospital Affiliated to Shanxi Medical University,Fenyang Hospital of Shanxi Province,Fenyang 032200,Shanxi Province,China)

机构地区：[1]山西省汾阳医院山西医科大学附属汾阳医院神经内科,汾阳032200 [2]山西省汾阳医院山西医科大学附属汾阳医院内分泌科,汾阳032200

出　　处：《中国基层医药》2024年第8期1172-1177,共6页Chinese Journal of Primary Medicine and Pharmacy

基　　金：山西省汾阳医院科技攻关项目(202312)。

摘　　要：目的:观察神经肌电图检测中神经传导检测(NCV)联合F波、H反射及皮肤交感反应(SSR)检测对糖尿病周围神经病变(DPN)的诊断价值。方法:选取2022年10月至2023年10月山西省汾阳医院(山西医科大学附属汾阳医院)收治的糖尿病周围神经病患者212例为研究对象,根据有无周围神经病变症状分为无症状组(100例)、有症状组(112例);选择同期在该院体检的健康人100例为对照组,均对正中神经、尺神经、胫神经、腓总神经等行运动神经传导检测(MNCV),对正中神经、尺神经、腓浅神经、腓肠神经等行感觉神经传导检测(SNCV),同时检测正中神经和胫神经行F波,检测胫神经H反射及皮肤交感反应。分析比较不同组间MNCV、SNCV、F波、H反射和SSR等差异。结果:DPN患者无症状组、有症状组与对照组比较[运动传导速度减慢(F=390.32、264.63、228.58、714.30),末端潜伏期延长(F=316.87、106.88、108.58、217.86),CMAP波幅下降(F=113.38、59.58、14.92、10.36),感觉传导速度减慢(F=568.87、532.74、973.75、1181.27),SNAP波幅下降(F=229.53、309.97、251.07、414.82),F波(F=653.96、538.20)、H波潜伏期较正常延长(F=401.54),SSR潜伏期延长(F=147.93、98.85)],差异均有统计学意义(均P<0.05)。同时有症状组与无症状组比较,胫神经、腓总神经的MNCV(t=7.33、13.31)、DML(t=13.56、4.34)、CMAP(t=2.98、2.99)等差异均有统计学意义(均P<0.05);正中神经、尺神经、腓肠神经、腓浅神经的SNCV(t=12.85、13.70、11.08、15.66)、SNAP(t=20.15、20.26、8.96、18.55)差异均有统计学意义(均P<0.05);正中神经、胫神经F波差异均有统计学意义(t=31.96、13.70,均P<0.05)。DPN患者无症状组单纯NCV检测的异常率为86%(86/100),NCV、F波、H反射联合SSR检测异常率为91%(91/100),DPN患者有症状组单纯NCV检测的异常率为90.18%(101/112),NCV、F波、H反射联合SSR检测异常率为98.21%(110/112),联合检测异常率有症状组高于无症状组,�Objective To investigate the value of nerve conduction velocity testing combined with F-waves,H-reflexes,and sympathetic skin responses in electroneuromyography in the diagnosis of diabetic peripheral neuropathy.Methods A total of 212 patients with diabetic peripheral neuropathy who received treatment at Fenyang Hospital of Shanxi Province(Fenyang Hospital Affiliated to Shanxi Medical University)from October 2022 to October 2023 were included in this study.These patients were divided into an asymptomatic group(n=100)and a symptomatic group(n=112)based on the presence or absence of peripheral neuropathy symptoms.Additionally,100 healthy individuals who underwent physical examinations at the same hospital during this period were included in the control group.Motor nerve conduction velocities were measured for the median nerve,ulnar nerve,tibial nerve,and common peroneal nerve,while sensory nerve conduction velocities were assessed for the median nerve,ulnar nerve,superficial peroneal nerve,and gastrocnemius nerve.F-waves were recorded for the median and tibial nerves.The H-reflexes of the tibial nerve and sympathetic skin response were also evaluated.Differences in motor nerve conduction velocity,sensory nerve conduction velocity,F-waves,H-reflexes,and sympathetic skin responses among the different groups were compared.Results In the asymptomatic and symptomatic groups,motor conduction velocities were lower(F=390.32,264.63,228.58,714.30),distal motor latencies were longer(F=316.87,106.88,108.58,217.86),compound muscle action potential amplitudes were lower(F=113.38,59.58,14.92,10.36),sensory conduction velocities were slower(F=568.87,532.74,973.75,1181.27),sensory nerve action potential amplitudes were lower(F=229.53,309.97,251.07,414.82),F-waves were longer(F=653.96,538.20),H-wave latencies were longer(F=401.54),and sympathetic skin response latencies were also longer(F=147.93,98.85)compared with those in the control group(all P<0.05).There were significant differences in motor nerve conduction velocity(t=7.33,13.

关 键 词：糖尿病神经病变 神经传导 正中神经 尺神经 腓肠神经 胫神经 肌电描记术 

分 类 号：R587.2[医药卫生—内分泌]