CAJ | 학술논문

目的：探讨皮肤交感反应（SSR）对糖尿病周围神经病（DPN）的早期诊断价值。方法2型糖尿病患者200例，其中有周围神经损害症状组（有症状组）100例、无周围神经损害症状组（无症状组）100例，正常对照组60例，均进行四肢感觉、运动神经传导检测（NCS）和 SSR检测。结果糖尿病患者感觉神经异常比例高于运动神经，下肢神经损害的程度重于上肢（均P＜0．05）；四肢NCS正常的52例糖尿病患者中SSR异常率达67．3％（35/52）。无症状组与有症状组SSR异常率比较，差异有统计学意义（P＜0．01）；糖尿病患者单独应用SSR检测的总异常率为81．5％，应用 NCS检测的总异常率为74．0％，两种检测技术异常率比较差异无统计学意义（P＞0．05）；糖尿病患者 SSR联合NCS检测的总异常率高达90．0％，有症状组、无症状组联合检测的异常率均明显高于单独使用NCS检测的异常率（均P＜0．05）。结论糖尿病患者在无症状早期即存在不同程度的周围神经病变，感觉神经、运动神经、自主神经均可受累，且以小纤维神经受累为主，随症状出现周围神经损害进一步加重。NCS是诊断 DPN的基本检查，将其与 SSR联合进行检测，能明显提高亚临床型DPN的早期检出率。
목적：탐토피부교감반응（SSR）대당뇨병주위신경병（DPN）적조기진단개치。방법2형당뇨병환자200례，기중유주위신경손해증상조（유증상조）100례、무주위신경손해증상조（무증상조）100례，정상대조조60례，균진행사지감각、운동신경전도검측（NCS）화 SSR검측。결과당뇨병환자감각신경이상비례고우운동신경，하지신경손해적정도중우상지（균P＜0．05）；사지NCS정상적52례당뇨병환자중SSR이상솔체67．3％（35/52）。무증상조여유증상조SSR이상솔비교，차이유통계학의의（P＜0．01）；당뇨병환자단독응용SSR검측적총이상솔위81．5％，응용 NCS검측적총이상솔위74．0％，량충검측기술이상솔비교차이무통계학의의（P＞0．05）；당뇨병환자 SSR연합NCS검측적총이상솔고체90．0％，유증상조、무증상조연합검측적이상솔균명현고우단독사용NCS검측적이상솔（균P＜0．05）。결론당뇨병환자재무증상조기즉존재불동정도적주위신경병변，감각신경、운동신경、자주신경균가수루，차이소섬유신경수루위주，수증상출현주위신경손해진일보가중。NCS시진단 DPN적기본검사，장기여 SSR연합진행검측，능명현제고아림상형DPN적조기검출솔。
Objective To investigate the value of skin sympathetic response(SSR)in the early diagnosis of diabetic peripheral neuropathy(DPN).Methods Sensory and motor nerve conduction studies(NCS),SSR in both upper and lower limbs were measured in 200 patients with type 2 diabetes mellitus,in which 100 cases had the symptom of peripheral neuropathy (symptomatic group),100 cases did not have the symptom of peripheral neuropathy (non-symptomatic group),and 60 normal subjects were set up as controls.Results In the diabetic group,the ratio of sensory nerve conduction abnormality was higher than that of motor nerve,and the severe extent of neuropathy in lower extremity was more serious than that of upper extremity (all P<0.05).The abnormal rate of SSR was 67.3%(35/52)in the 52 patients with normal neural conduction in their extremities.The abnormal rate of SSR in symptomatic group was significantly higher than that of non-symptomatic group (P<0.01).The total abnormal rate of SSR was 81.5% and that of NCS was 74.0% in the diabetic group,there was no statistical difference in the abnormality rate between SSR and NCS used alone (P>0.05).The whole abnormal rate diagnozed by combining the SSR and NCS test together was 90.0% in the diabetic group,which was much higher than with the NCS test used alone,and symptomatic group and non-symptomatic group also got the same detection rate (all P<0.05).Conclusion Diabetic patients hold peripheral neuropathy to different extent in the early non-symptomatic stage.At this time,sensory,motor and automatic nerves may be suffered from.Moreover,the small fiber is affected earlier than other nerve fibers.Along with the emerge of symptoms,peripheral neuropathy aggravated over time.NCS is a necessary test for diagnosing DPN.Early diagnosis rate of subclinical neuropathy will be obviously elevated owing to combination of the NCS and SSR tests.