CAJ | 학술논문

目的探讨神经传导检测(NCS)、F波、体感诱发电位(SEP)及皮肤交感反应(SSR)对糖尿病周围神经病变(DPN)的早期诊断价值.方法共选取110例糖尿病患者纳入糖尿病组,同时选取健康志愿者50例纳入正常对照组.分别对上述对象进行正中神经、尺神经、胫后神经、腓总神经感觉及运动NCS检查、正中神经和胫后神经F波检查、上下肢SEP、SSR检查.结果糖尿病组NCS检查总异常率为74.5％,感觉神经异常比例高于运动神经(均P＜0.01).糖尿病组F波总异常率为57.3％,远端运动神经传导正常者的F波异常率为50.7％.糖尿病组SEP近端周围神经电位总异常率为70.0％,上肢正中神经感觉传导正常者锁骨上电位无明显异常,下肢胫后神经感觉传导正常者臀点电位异常率为62.5％.糖尿病组SSR总异常率为80.0％,四肢NCS正常者中SSR异常率达72％.糖尿病组联合应用NCS、F波、SEP及SSR检查的总异常率高达90.9％,高于单独使用其中任何一项检查时的异常率(均P＜0.05).结论 NCS检查是诊断DPN患者的基本手段,将其与SSR、SEP及F波联用,能明显提高亚临床型DPN患者的早期检出率.
목적 탐토신경전도검측(NCS)、F파、체감유발전위(SEP)급피부교감반응(SSR)대당뇨병주위신경병변(DPN)적조기진단개치.방법 공선취110례당뇨병환자납입당뇨병조,동시선취건강지원자50례납입정상대조조.분별대상술대상진행정중신경、척신경、경후신경、비총신경감각급운동NCS검사、정중신경화경후신경F파검사、상하지SEP、SSR검사.결과 당뇨병조NCS검사총이상솔위74.5％,감각신경이상비례고우운동신경(균P＜0.01).당뇨병조F파총이상솔위57.3％,원단운동신경전도정상자적F파이상솔위50.7％.당뇨병조SEP근단주위신경전위총이상솔위70.0％,상지정중신경감각전도정상자쇄골상전위무명현이상,하지경후신경감각전도정상자둔점전위이상솔위62.5％.당뇨병조SSR총이상솔위80.0％,사지NCS정상자중SSR이상솔체72％.당뇨병조연합응용NCS、F파、SEP급SSR검사적총이상솔고체90.9％,고우단독사용기중임하일항검사시적이상솔(균P＜0.05).결론 NCS검사시진단DPN환자적기본수단,장기여SSR、SEP급F파련용,능명현제고아림상형DPN환자적조기검출솔.
Objective To investigate the value of nerve conduction studies (NCSs),F wave analysis,somatosensory evoked potential (SEP) and skin sympathetic response (SSR) in the early diagnosis of diabetic peripheral neuropathy (DPN).Methods A total of 110 patients with diabetes mellitus were recruited as the diabetic group and another 50 well-matched healthy volunteers as the normal controls.Sensory and motor NCSs of the median,ulnar,posterior tibial and common peroneal nerves were performed.F waves were recorded from the median and posterior tibial nerves.SEPs elicited by stimulation to nerves of both the upper and lower limbs as well as SSRs were measured,all in both the diabetic group and the normal controls.Results The total rate of nerve conduction abnormality was 74.5％ in the diabetic group,with sensory nerve conduction abnormalities more frequent and more severe among motor nerves in the extremities.The total rate of F wave abnormalities was 57.3％ in the diabetic group.The rate in patients with normal distal motor conduction in their median and posterior tibial nerves was 50.7％.The total SEP abnormality rate was 70.0％ with regard to the proximal peripheral nerve potentials in the diabetic group,but there was no obvious abnormality of the supraclavicular electrical potential in the upper limbs for those with normal sensory nerve conduction in the median nerve.The rate of occurrence of abnormality in the gluteus point potential in the lower limbs of those with normal posterior tibial sensory conduction was 62.5％.The total rate of SSR abnormalities was 80.0％ in the diabetic group but 72％ among those with normal nerve conduction in their extremities.Combining the NCS,SSR,SEP and F wave results,the total abnormality rate was 90.9％ in the diabetic group,which was much higher than with any single test used alone.Conclusion NCS is essential for diagnosing DPN.Early diagnosis of subclinical diabetic neuropathy will be significantly enhanced when nerve conduction,SSRs,SEPs and F waves are tested together.