CAJ | 학술논문

目的：探讨糖尿病周围神经病变（DPN）中医证型与神经电生理的相关性，为 DPN 的中医辨证提供基本参考证型与客观参考指标。方法：200例确诊为 DPN 的患者根据中医辨证分为气虚血瘀、阴虚血瘀、痰瘀阻络、肝肾亏虚四组；应用Toronto 临床评分体系对入选对象进行病情评分与分级；按常规方法进行神经电生理检测：正中神经、尺神经、腓总神经，计算运动神经传导速度，感觉神经检查正中神经、尺神经、腓肠神经，计算感觉神经传导速度；按照统计学方法，探讨该病的证型与神经电生理的相关性。对照组选择健康志愿者20例，均排除糖尿病史及各种神经肌肉病变。结果：①肝肾亏虚型在神经功能评分、年龄、病程、神经传导速度上与其他组相比差异显著，表现为病程较长，年龄偏大，神经传导速度减慢、神经功能受累较重；②肝肾亏虚证在上肢和下肢神经中与其他证型比较受累均较重；③气虚血瘀证无论在上肢还是下肢，是感觉神经还是运动神经受累均较轻；④在感觉神经中以腓肠神经所体现的各证型之间的差异较明显；在运动神经中以腓总神经较明显；⑤在中医证型与正中神经、胫神经运动体感诱发电位的关系中，阴虚血瘀型、痰瘀阻络型、肝肾亏虚型均较气虚血瘀型潜伏期延长。结论：中医辨证所得出的 DPN 的中医证型的变化趋势与通过神经查体、神经电生理评定所得出的 DPN 病情分级的判断都同样反映了病情的严重程度。两者可互相参考。
목적：탐토당뇨병주위신경병변（DPN）중의증형여신경전생리적상관성，위 DPN 적중의변증제공기본삼고증형여객관삼고지표。방법：200례학진위 DPN 적환자근거중의변증분위기허혈어、음허혈어、담어조락、간신우허사조；응용Toronto 림상평분체계대입선대상진행병정평분여분급；안상규방법진행신경전생리검측：정중신경、척신경、비총신경，계산운동신경전도속도，감각신경검사정중신경、척신경、비장신경，계산감각신경전도속도；안조통계학방법，탐토해병적증형여신경전생리적상관성。대조조선택건강지원자20례，균배제당뇨병사급각충신경기육병변。결과：①간신우허형재신경공능평분、년령、병정、신경전도속도상여기타조상비차이현저，표현위병정교장，년령편대，신경전도속도감만、신경공능수루교중；②간신우허증재상지화하지신경중여기타증형비교수루균교중；③기허혈어증무론재상지환시하지，시감각신경환시운동신경수루균교경；④재감각신경중이비장신경소체현적각증형지간적차이교명현；재운동신경중이비총신경교명현；⑤재중의증형여정중신경、경신경운동체감유발전위적관계중，음허혈어형、담어조락형、간신우허형균교기허혈어형잠복기연장。결론：중의변증소득출적 DPN 적중의증형적변화추세여통과신경사체、신경전생리평정소득출적 DPN 병정분급적판단도동양반영료병정적엄중정도。량자가호상삼고。
Objective: To explore the correlation between diabetic peripheral neuropathy (DPN) with neuroelectrophysiology so to provide basic reference syndrome and objective reference indicator for DPN TCM syndrome differentiation. Methods: 200 cases diagnosed as DPN were divided into groups of Qixuxueyu, Yinxuxueyu, Tanyuzuluo and Ganshenkuixu according to TCM syndrome differentiation. Toronto Clinical Scoring System was applied to assess and classify the conditions of the patients. Neuroelectrophysiological test was carried out in normal ways for the median nerve, ulnar nerve and peroneal nerve and motor nerve conduction velocity (MNCV) was calculated. For sensory nerve, the median nerve, ulnar nerve and Sural nerve was tested and sensory nerve conduction velocity (SNCV) was calculated. And then the correlation between TCM syndromes and neuroelectrophysiology was explored. 20 healthy volunteers were selected for the control group with no diabetes history or any neuromuscular disorder. Results: ①Compared to other groups, Ganshenkuixu group shows significant difference in neural function scores, ages, course and nerve conduction velocity, manifesting as longer course, older ages, slower nerve conduction velocity and more severe neurological involvement. Compared to other groups② ,Ganshenkuixu group had more severe neurological involvement of both upper and lower limb nerves. Qixuxueyu group had more mild neurological involvement of both upper and lower limb nerves③ , sensory and motor nerves.④In sensory nerves, the Sural nerve showed more significant difference of different syndromes while in motor nerves, the peroneal nerve showed the most significant difference. In the relationship of TCM syndromes and aomatosensory evoked potentials of the median nerve⑤and tibial nerve, Yinxuxueyu, Tanyuzuluo, Ganshenkuixu type had longer incubation period than Qixuxueyu type. Conclusions: Both DPN syndromes by TCM syndrome differentiation and DPN medical grading by nervous examination and neuroelectrophysiological assessment can reflect the illness conditions which they can be reference for each other.