以足底内侧神经检测诊断糖尿病周围神经病变的研究  

Diagnostic value of medial plantar nerve in diabetic peripheral neuropathy

作　　者：岳亚延[1] 于明[1] 陈慧娟[1] YUE Yayan;YU Ming;CHEN Huijuan(Department of Neurology,Affiliated Hospital of Jiangsu University,Zhenjiang 212001,China)

机构地区：[1]江苏大学附属医院神经内科,镇江212001

出　　处：《中国糖尿病杂志》2024年第11期807-812,共6页Chinese Journal of Diabetes

摘　　要：目的探讨足底内侧神经检测对糖尿病周围神经病变(DPN)的诊断价值。方法回顾性分析我院114例T2DM患者的临床资料和电生理结果。根据是否合并DPN分为合并DPN组(DPN,n=73)和单纯T2DM组(n=41),另选取同期体检健康者为正常对照组(NC,n=35)。比较各组一般资料、生化指标及足底内侧神经波幅(AMP)、传导速度(SCV)、异常率。根据有无足底感觉异常症状将DPN组分为有症状亚组(n=52)和无症状亚组(n=21),比较足底内侧神经与同组腓浅神经、腓肠神经异常率的差异。采用受试者工作特征(ROC)曲线分析足底内侧神经对DPN的诊断价值。结果DPN组足底内侧神经AMP较NC、T2DM组降低[(3.00±1.42)vs(6.64±3.76)vs(6.51±3.58)μV,P<0.05],SCV减慢[(46.57±7.42)vs(49.42±6.96)vs(51.22±5.34)m/s,P<0.05],异常率较T2DM组升高[87.67%vs 12.20%,P<0.05]。Spearman相关分析显示,足底内侧神经AMP与Hb A1c呈负相关(r=-0.267,P<0.05),SCV与年龄呈负相关(r=-0.157,P<0.05)。有症状亚组和无症状亚组足底内侧神经异常率均高于同组腓浅神经和腓肠神经(P<0.05)。ROC曲线分析显示,足底内侧神经对DPN诊断的曲线下面积为0.942(P<0.05),有诊断价值。结论足底内侧神经对≤70岁患者具有早期DPN诊断价值,对怀疑有周围神经损伤且常规神经传导正常的DM患者,应进行足底内侧神经的检查,以提高DPN早期诊断率。Objective To investigate the diagnostic value of the medial plantar nerve in diabetic peripheral neuropathy(DPN).Methods A retrospective analysis was conducted in 114 patients with type 2diabetes mellitus in our hospital.All the participants were divided into DPN group(n=73)and type 2 diabetes mellitus(T2DM)group(n=41)based on the presence of peripheral nerve damage.Simultaneously,35healthy volunteers were chosen as the normal control(NC)group.General data,biochemical indexes,medial plantar nerve amplitude,conduction velocity,and abnormal rates were compared among the three groups.DPN patients were further divided into symptomatic and asymptomatic groups based on the presence of plantar paresthesia symptoms.The abnormal rate of the medial plantar nerve was compared with that of the superficial peroneal nerve and sural nerve in each group.Receiver operating characteristic(ROC)curve analysis was employed to assess the diagnostic value of the medial plantar nerve in DPN.Results The amplitude of the medial plantar nerve was significantly lower[(3.00±1.42)vs(6.64±3.76)vs(6.51±3.58)μV],the conduction velocity was markedly reduced[(46.57±7.42)vs(49.42±6.96)vs(51.22±5.34)m/s],and the abnormality rate was elevated(87.67%vs 12.20%)in T2DM group,than in NC groups(P<0.05).Spearman correlation analysis indicated a negative correlation between the medial plantar nerve amplitude and Hb A1c(r=-0.267,P<0.05),while the conduction velocity showed a negative correlation with age(r=-0.157,P<0.05).In both symptomatic and asymptomatic DPN patients,the abnormal rate of the medial plantar nerve was higher than that of the superficial peroneal nerve and sural nerve(P<0.05).The area under the ROC curve was 0.942,signifying a reliable diagnostic value for DPN using the medial plantar nerve(P<0.05).Conclusions The medial plantar nerve proves valuable in the diagnosis of DPN,exhibiting higher sensitivity than the superficial peroneal nerve and sural nerve.

关 键 词：足底内侧神经 糖尿病周围神经病变 神经传导速度 

分 类 号：R587.2[医药卫生—内分泌] R747.9[医药卫生—内科学]