中华糖尿病杂志
中華糖尿病雜誌
중화당뇨병잡지
CHINES JOURNAL OF DLABETES MELLITUS
2011年
1期
46-49
,共4页
沈洁%曹瑛%陈志%刘仕群%李际敏%徐玲玲
瀋潔%曹瑛%陳誌%劉仕群%李際敏%徐玲玲
침길%조영%진지%류사군%리제민%서령령
糖尿病,2型%心血管反射试验%排汗
糖尿病,2型%心血管反射試驗%排汗
당뇨병,2형%심혈관반사시험%배한
Diabetes mellitus,type 2%Cardiovascular reflex test%Perspiration
目的 探讨排汗神经功能检测在2型糖尿病患者自主神经病变评估中的作用.方法 纳入2008年8月至2009年12月门诊及入院诊治的2型糖尿病患者164例,男88例,女76例,年龄41～70岁,平均(56±11)岁.另选40名健康成人为对照组.2型糖尿病患者经神经病变症状评价量表评估后分为自主神经病变症状阴性组(n=98)和自主神经病变症状阳性组(n=66),经心血管反射试验评估分为心血管反射试验阴性组(n=92)和心血管反射试验阳性组(n=72),计算2种评估方法的阳性检出率.所有患者和对照者进行排汗神经功能检测,观察欧米诺膏贴变色时间.采用t检验和卡方检验进行数据统计.结果 164例2型糖尿病患者自主神经病变症状阳性检出率为40.2%(66/164),心血管反射试验阳性检出率为43.9%(72/164),排汗神经功能检测阳性检出率为45.1%(74/164);排汗神经功能检测阳性检出率与自主神经病变症状阳性检出率、心血管反射试验阳性检出率的差异无统计学意义(x2值分别为3.12、1.22,均P＞0.05).自主神经病变症状阳性组患者心血管反射试验阳性的发生率为63.6%(42/66),明显高于自主神经病变症状阴性组患者[30.6%(30/98);x2=17.46,P＜0.01].自主神经病变症状阳性组患者排汗神经功能检测阳性检出率为90.9%(60/66),明显高于自主神经病变症状阴性组患者[14.3%(14/98);x2=93.51,P＜0.01].自主神经病变症状阳性组患者左、右足欧米诺膏贴变色时间分别为(18±6)、(18±6)min,明显长于自主神经病变症状阴性组患者(t值分别为22.848、23.694,均P＜0.01).心血管反射试验阳性组患者排汗神经功能检测阳性检测率为94.4%,明显高于心血管反射试验阴性组患者[6.5%(6/92);x2=126.09,P＜0.01].心血管反射试验阳性组患者左、右足欧米诺膏贴变色时间分别为(21±6)、(22±6)min,明显长于心血管反射试验阴性组患者(t值分别为36.841、36.126,均P＜0.01).欧米诺膏贴变色时间与心血管反射试验积分呈正相关(r=0.67,P＜0.01),与深呼吸时每分钟心率差(r=-0.46)、Valsalva指数(r=-0.38)、卧位起立后第30次与第15次R-R间距比值(30/15比值,r=-0.32)呈显著负相关(均P＜0.01).结论 采用欧米诺膏贴进行排汗神经功能检测可早期准确发现2型糖尿病患者自主神经病变.
目的 探討排汗神經功能檢測在2型糖尿病患者自主神經病變評估中的作用.方法 納入2008年8月至2009年12月門診及入院診治的2型糖尿病患者164例,男88例,女76例,年齡41～70歲,平均(56±11)歲.另選40名健康成人為對照組.2型糖尿病患者經神經病變癥狀評價量錶評估後分為自主神經病變癥狀陰性組(n=98)和自主神經病變癥狀暘性組(n=66),經心血管反射試驗評估分為心血管反射試驗陰性組(n=92)和心血管反射試驗暘性組(n=72),計算2種評估方法的暘性檢齣率.所有患者和對照者進行排汗神經功能檢測,觀察歐米諾膏貼變色時間.採用t檢驗和卡方檢驗進行數據統計.結果 164例2型糖尿病患者自主神經病變癥狀暘性檢齣率為40.2%(66/164),心血管反射試驗暘性檢齣率為43.9%(72/164),排汗神經功能檢測暘性檢齣率為45.1%(74/164);排汗神經功能檢測暘性檢齣率與自主神經病變癥狀暘性檢齣率、心血管反射試驗暘性檢齣率的差異無統計學意義(x2值分彆為3.12、1.22,均P＞0.05).自主神經病變癥狀暘性組患者心血管反射試驗暘性的髮生率為63.6%(42/66),明顯高于自主神經病變癥狀陰性組患者[30.6%(30/98);x2=17.46,P＜0.01].自主神經病變癥狀暘性組患者排汗神經功能檢測暘性檢齣率為90.9%(60/66),明顯高于自主神經病變癥狀陰性組患者[14.3%(14/98);x2=93.51,P＜0.01].自主神經病變癥狀暘性組患者左、右足歐米諾膏貼變色時間分彆為(18±6)、(18±6)min,明顯長于自主神經病變癥狀陰性組患者(t值分彆為22.848、23.694,均P＜0.01).心血管反射試驗暘性組患者排汗神經功能檢測暘性檢測率為94.4%,明顯高于心血管反射試驗陰性組患者[6.5%(6/92);x2=126.09,P＜0.01].心血管反射試驗暘性組患者左、右足歐米諾膏貼變色時間分彆為(21±6)、(22±6)min,明顯長于心血管反射試驗陰性組患者(t值分彆為36.841、36.126,均P＜0.01).歐米諾膏貼變色時間與心血管反射試驗積分呈正相關(r=0.67,P＜0.01),與深呼吸時每分鐘心率差(r=-0.46)、Valsalva指數(r=-0.38)、臥位起立後第30次與第15次R-R間距比值(30/15比值,r=-0.32)呈顯著負相關(均P＜0.01).結論 採用歐米諾膏貼進行排汗神經功能檢測可早期準確髮現2型糖尿病患者自主神經病變.
목적 탐토배한신경공능검측재2형당뇨병환자자주신경병변평고중적작용.방법 납입2008년8월지2009년12월문진급입원진치적2형당뇨병환자164례,남88례,녀76례,년령41～70세,평균(56±11)세.령선40명건강성인위대조조.2형당뇨병환자경신경병변증상평개량표평고후분위자주신경병변증상음성조(n=98)화자주신경병변증상양성조(n=66),경심혈관반사시험평고분위심혈관반사시험음성조(n=92)화심혈관반사시험양성조(n=72),계산2충평고방법적양성검출솔.소유환자화대조자진행배한신경공능검측,관찰구미낙고첩변색시간.채용t검험화잡방검험진행수거통계.결과 164례2형당뇨병환자자주신경병변증상양성검출솔위40.2%(66/164),심혈관반사시험양성검출솔위43.9%(72/164),배한신경공능검측양성검출솔위45.1%(74/164);배한신경공능검측양성검출솔여자주신경병변증상양성검출솔、심혈관반사시험양성검출솔적차이무통계학의의(x2치분별위3.12、1.22,균P＞0.05).자주신경병변증상양성조환자심혈관반사시험양성적발생솔위63.6%(42/66),명현고우자주신경병변증상음성조환자[30.6%(30/98);x2=17.46,P＜0.01].자주신경병변증상양성조환자배한신경공능검측양성검출솔위90.9%(60/66),명현고우자주신경병변증상음성조환자[14.3%(14/98);x2=93.51,P＜0.01].자주신경병변증상양성조환자좌、우족구미낙고첩변색시간분별위(18±6)、(18±6)min,명현장우자주신경병변증상음성조환자(t치분별위22.848、23.694,균P＜0.01).심혈관반사시험양성조환자배한신경공능검측양성검측솔위94.4%,명현고우심혈관반사시험음성조환자[6.5%(6/92);x2=126.09,P＜0.01].심혈관반사시험양성조환자좌、우족구미낙고첩변색시간분별위(21±6)、(22±6)min,명현장우심혈관반사시험음성조환자(t치분별위36.841、36.126,균P＜0.01).구미낙고첩변색시간여심혈관반사시험적분정정상관(r=0.67,P＜0.01),여심호흡시매분종심솔차(r=-0.46)、Valsalva지수(r=-0.38)、와위기립후제30차여제15차R-R간거비치(30/15비치,r=-0.32)정현저부상관(균P＜0.01).결론 채용구미낙고첩진행배한신경공능검측가조기준학발현2형당뇨병환자자주신경병변.
Objective To investigate the predictive effects of perspiration-nerve examination on diabetic automomic neuropathy (DAN) in patients with type 2 diabetes mellitus (T2DM).Methods A total of 164 T2DM outpatients and inpatients were recruited from August 2008 to December 2009 ( male 88,female 76,aged 41 to 70 years,mean (56 ± 11 ) years).They were divided into non-DAN symptom group ( n = 98 ) and DAN symptom positive group ( n = 66 ) according to neuropathy symptoms evaluation form,and also divided into cardiovascular reflex test (CRT) positive group (n = 92) and CRT negative group ( n = 72).Another 40 healthy individuals were served as controls.The positive rate of these two assessment methods was calculatod.All patients and healthy adult volunteers underwent perspiration-nerve test and Ou Minuo plaster color changing time test.Student' s t test and Chi-square test were used for statistic analysis.Results DAN symptom positive rate in 164 T2DM patients was 40.2% (66/164),the positive rate of cardiovascular reflex test was 43.9% ( 72/164 ),and the perspiration-nerve test had the positive rate of 45.1% (74/164).There was no significant difference between positive rate in perspiration-nerve test,DAN symptom test and cardiovascular reflex test ( x2 values were 3.12 and 1.22,both P ＞ 0.05 ).The positive rate of cardiovascular reflex test in patients with positive DAN symptoms was 63.6% (42/66),significantly higher than in patients with negative DAN symptoms ( 30.6% ( 30/98 ); x2 = 17.46,P ＜ 0.01 ).And the positive rate of perspiration-nerve test in patients with positive DAN symptoms was 90.9% (60/66),significantly higher than in patients with negative DAN symptoms ( 14.3% (14/98) ;x2 =93.51,P ＜0.01 ).In DAN symptom positive group,Ou Minuo plaster color changing time of the left and right foot was ( 18 ±6) and ( 18 ±6) min,significantly longer than that in the non-DAN symptom group (t values were 22.848and 23.694,both P ＜0.01 ).In cardiovascular reflex test positive group,the positive rate of perspirationnerve test was 94.4% ( 68/72 ),significantly higher than that in the cardiovascular reflex test negative group (6.5% (6/92); x2 = 126.09,P ＜ 0.01 ).In the cardiovascular reflex test positive group,Ou Minuo plaster color changing time of the left and right foot was (21 ± 6) and (22 ± 6) min,significantly longer than that in the cardiovascular reflex test negative group (t values were 36.841 and 36.126,both P ＜0.01 ).Ou Minuo plaster color changing time was positively related to cardiovascular reflex test ( r = 0.67,P ＜0.01 ),and was negatively related with heart rate difference per minute with deep breathing (r = - 0.46),Valsalva index (r= -0.38) and 30/15 ratio (r= -0.32) (all P＜0.01).Conclusion DAN in patients with T2DM could be detected early by using perspiration-nerve function evaluation.
