神经传导速度和F波对2型糖尿病周围神经病变诊断价值

本文测定了80例T2DM患者感觉和运动神经传导速度以及F波。结果显示：腓肠神经和正中神经感觉传导速度（SCV），正中神经波幅（NAP），胫神经末端运动潜伏期DML和正中神经F波出现率分别为55.63％、65.79％、55.63％、41．88％和41．25％。提示上述指标是诊断DPN最有价值的，其中腓肠神经SCV可用于DPN筛选。     

糖尿病周围神经病变神经传导速度、F波及皮肤交感反应的变化及临床意义

目的 探讨糖尿病周围神经病变（DPN）患者神经传导速度（NCV）、F波及交感神经皮肤反应（SSR）的变化特点及临床应用价值.方法 97例DPN患者进行神经电生理检查,包括运动神经传导速度（MCV）、感觉神经传导速度（SCV）、F波及SSR检测.结果 异常率分别为SSR 75.2％,NCV 48.8％,F波34.5％,下肢神经病变重于上肢（P＜0.05）.结论 NCV、F波及SSR联合应用可全面地评估糖尿病周围神经的损害,三者相辅相成,缺一不可.     

神经传导速度和F波对2型糖尿病周围神经病变诊断价值

本文测定了80例T2DM患者感觉和运动神经传导速度以及F波.结果显示腓肠神经和正中神经感觉传导速度(SCV),正中神经波幅(NAP),胫神经末端运动潜伏期DML和正中神经F波出现率分别为55.63%、65.79%、55.63%、41.88%和41.25%.提示上述指标是诊断DPN最有价值的,其中腓肠神经SCV可用于DPN筛选.     

神经传导速度在糖尿病无症状性周围神经病中的应用价值

目的：探讨神经传导速度（NCV）在糖尿病（DM）无症状性周围神经病变患者中的应用价值。方法：选择DM伴周围神经病变患者（有症状组）25例及无周围神经病变症状患者（无症状组）30例,分别测定双侧正中神经、尺神经、胫神经及腓总神经运动传导速度（MCV）和双侧正中神经、尺神经、胫神经及腓浅神经感觉传导速度（SCV）,并对30例无神经系统症状的患者用空腹血测糖化血红蛋白（HbAlc）,3个月后复查神经传导速度和HbAlc。结果：NCV能及早发现有周围神经损害亚临床糖尿病周围神经病变（DPN）患者,NCV的异常率与血糖升高关系密切,动态观察NCV对了解疾病预后很重要。     

糖尿病患者周围神经病变的H反射和F波探讨

目的：探讨糖尿病近端神经病变的诊断及其发生频度。方法：采用肌电图仪Guo窝肛神经刺激,比目鱼肌记录H反射和F波,检测30例糖尿病组胫神经60条,25例非糖尿病组胫神经50条的远端运动和感觉传导速度度。用多元回归进行对照分析。结果：糖尿病组F波出现率53．33％,F波潜伏期（FL）延长50．8％,往返脊髓传导速度（FCV）减慢50．1％。H反射异常率76％,H反射潜伏期（HL）延长55％,H波幅降低47％,M／H比值异常50．3％,H、M峰间期（HMI）延长53．6％。与正常组95％的正常范围相比,差异有显性意义。结论：糖尿病神经病变为广泛多发性周围神经病变,也可累及中枢神经系统,其近端运动和感觉神经均有相当高的累及频度。     

交感神经皮肤反应与神经传导测定对糖尿病周围神经病变的诊断价值

[摘要]目的 分析比较交感神经皮肤反应与神经传导速度对糖尿病周围神经病变的诊断价值。方法 选取本院2014年1月-2015年12月门诊收治的43例2型糖尿病患者和43例健康体检者,同时行神经电图检测,包括感觉神经传导速度、运动神经传导速度和交感神经皮肤反应,并对结果进行记录和统计学分析。结果 糖尿病组的正中神经、尺神经、腓总神经、胫神经的运动神经传导速度和正中神经、尺神经、腓肠神经、腓浅神经的感觉神经传导速度均明显低于健康组（P＜0.01）;健康组上下肢的起始潜伏期均明显少于糖尿病组（P＜0.01）,但糖尿病组上下肢的波幅与健康组相比较,差异均无统计学意义（P＞0.05）;糖尿病组患者的下肢的神经传导速度的异常率（34.84%）明显高于上肢（18.85%）,两者差异存统计学意义（χ2=16.97,P＜0.01）;上肢的交感神经皮肤反应异常率（35.24%）低于下肢（55.74%）,差异存统计学意义（χ2=10.33,P＜0.01）;神经传导速度和交感神经皮肤反应总异常率分别为25.58%、45.49％,交感神经皮肤反应的总异常率显著高于神经传导速度,差异存统计学意义（χ2=39.96,P＜0.01）。 结论 神经传导速度和交感神经皮肤反应作为糖尿病自主神经及周围神经病变诊断的重要指标,可为糖尿病周围神经病的早期诊断提供重要依据,且交感神经皮肤反应对糖尿病周围神经病早期诊断的敏感性更高。     

血浆同型半胱氨酸和胱抑素C与糖尿病周围神经病变的相关性研究

目的 探讨同型半胱氨酸（Hcy）和胱抑素C（Cys-C）与糖尿病周围神经病变（DPN）的相关性. 方法 选取2009年1月至2013年10月于我院就诊的T2DM患者248例,根据2010年版《中国2型糖尿病防治指南》诊断标准将对象分为亚临床糖尿病神经病变组（SDPN组）80例、糖尿病神经病变组（DPN组）52例和单纯T2DM组（T2DM组）116例.检测各组Hcy、Cys-C、FPG、HbA1 c、TG及TC等水平. 结果 3组年龄、性别比、BMI、FPG、TG、TC、HDL-C和LDL-C、SBP、DBP及血清肌酐（Scr）比较差异无统计学意义（P＞0.05）.与T2DM组比较,SDPN组和DPN组病程、Hcy和Cys-C升高（P＜0.05或P＜0.01）,且DPN组Hcy高于SDPN组（P＜0.05）.SDPN组和DPN组正中神经运动神经传导速度（MCV）和感觉神经传导速度（SCV）、腓总神经MCV和SCV较T2DM组降低（P＜0.05或P＜0.01）;DPN组正中神经MCV和SCV、腓总神经MCV和SCV较SDPN组低（P＜0.05或P＜0.01）.SDPN组和DPN组正中神经F波潜伏期和腓总神经H反射潜伏期较T2DM组升高（P＜0.05或P＜0.01）;DPN组正中神经F波潜伏期,腓总神经H反射潜伏期较SDPN组高（P＜0.05或P＜0.01）.Logistic回归分析显示,Hcy、Cys-C、病程、SBP和HbA1c是DPN的独立影响因素. 结论 SDPN和DPN患者神经反射潜伏期延长,MCV和SCV减慢,且血浆Hcy与肌电图各参数相关,提示血浆Hcy与神经传导异常相关,说明血浆Hey可作为DPN的预测因子与危险因素.这两类患者Cys-C浓度升高,且与Hcy水平相关,提示Cys-C可能与Hcy共同作用,加重DPN.     

120例2型糖尿病患者的周围神经传导速度检测分析

检测并分析2型糖尿病患者（NCV组）与正常对照组的四肢周围神经传导速度（NCV）。结果两组比较，运动神经传导速度（MCV）、感觉神经传导速度（SCV）、复合肌肉动作电位（CAMP）波幅及感觉神经动作电位（SNAP）波幅均有显著统计学差异（P均〈0．05），且SCV异常率高于MCV、下肢NCV异常率高于上肢（P均〈0．01）。糖尿病性周围神经病变（DPN）程度与糖尿病病程有关，与空腹血糖水平元明显相关性。提示NCV检测有助于DPN患者的早期诊断。     

糖尿病周围神经病变定量感觉检查及神经传导速度检查的相关性和临床选择比较

目的分析定量感觉检查（QST）及神经传导速度（NCV）检查在诊断糖尿病周围神经病变（DPN）中的相关性及差异,探讨临床应用选择。方法根据有或无DPN症状将434名2型糖尿病（T2DM）患者分为有症状组和无症状组,每个患者进行双侧正中、尺、胫神经运动支的NCV及正中、腓肠神经感觉支的NCV和冷感觉、热感觉及振动觉的测定,分析比较QST与NCV检查的相关性及不同情况下两种检查的一致性。结果QST与NCV检查结果有显著相关性（P均〈0.001）;温度觉的异常率均显著大于NCV及振动觉（P均〈0.05）;在NCV检查正常的患者中,冷、热感觉的异常率分别为45.6%和36.8%,在QST正常的患者中,正中、尺、胫神经运动支及正中、腓肠神经感觉支的NCV的异常率分别为21.8%、20.9%、29.1%、24.5%和30.9%。结论在DPN诊断中,QST与NCV检查显著相关,但不能完全相互替代,全面了解DPN病情还需要结合临床。     

糖尿病332例神经传导速度检测分析

对３３２例糖尿病患者肢体神经传导速度（ＮＣＶ）检测结果及临床情况进行回顾性分析。结果显示：Ⅰ型糖尿病４８例中，ＮＣＶ异常率为７７．１％，略高于Ⅱ型糖尿病２８４例中的６６．２％，总异常率为６７．８％。Ⅱ型糖悄病者病程〉５年组的ＮＣＶ阳性率（７４．５％）高于≤５年组。３３２例共检测神经２５４６条，其中运动神经传导速度（ＭＣＶ）检测异常率（３７．０％）和感觉神经传导速度（ＮＣＶ）经（３５．２％）相似。各     

Nerve conduction abnormalities in untreated maturity-onset diabetes: relation to levels of fasting plasma glucose and glycosylated hemoglobin.

The role of metabolic abnormalities in the development of diabetic neuropathy is controversial. To investigate the influence of hyperglycemia on nerve conduction, we studied 20 untreated maturity-onset diabetic patients and 23 normal control subjects of similar age. Nerve conduction velocity of motor (median, peroneal, and tibial) and sensory (median and sural) nerves in diabetic patients was significantly slowed and H-reflex latency time prolonged. Levels of fasting plasma glucose in diabetic subjects were correlated with slowed motor conduction velocity of the median, peroneal, and tibial nerves but not with sensory nerve conduction velocities. Levels of glycosylated hemoglobin, an index of long-term glycemia, were correlated with slowing of peroneal motor conduction velocity in diabetic patients. These associations could not be explained by patient age or duration of diabetes. These findings suggest that the degree of hyperglycemia of untreated maturity-onset diabetes contributes to the motor nerve conduction abnormalities in this disease.     

The electrophysiological findings of subclinical neuropathy in patients with recently diagnosed type 1 diabetes mellitus

To assess the prevalence of subclinical neuropathy within the first year of type 1 diabetes mellitus, 30 patients and 14 healthy subjects have been studied prospectively. The patients whose diabetes duration was longer than 1 year have been excluded from the study. Control group consisted of healthy volunteers. Subjective neuropathy symptoms, neurological examination, and electrophysiological findings were evaluated. All patients were clinically asymptomatic. At least two abnormal independent neurophysiological nerve parameters, which were required as the criterion of the peripheral nervous system subclinical involvement, were found as in 96.6% of diabetic patients in the first years. The percentages of abnormal electrophysiological parameters in different motor and sensory nerves were 86.7% in sural nerve, 83.3% in peroneal motor nerve, 73.3% in posterior tibial motor nerve, 66.7% in median motor nerve, 63.3% in ulnar motor nerve, 60% in median sensory nerve, and 46.7% in ulnar sensory nerve. While distal motor latency, F conduction time, and minimum F latency were the most frequent abnormal parameters in the upper extremity electrophysiological study; conduction velocity, minimum and mean F latencies, F conduction time were the most frequent abnormal parameters in the lower extremity. In all sensory nerve conduction studies, the most frequent abnormal parameter was the onset latency. In the autonomic sympathetic nerve electrophysiological study, plantar SSR latency was found significantly longer than the control group. In the lower extremity generally somatic motor fibres, sensory large fibres and sympathetic autonomic nerve fibres were found to be more affected. There is a correlation between HbA1c levels and nerve conduction velocity in posterior tibial and peroneal nerves. However, upper extremity nerve conduction dysfunction was not correlated with HbA1c value. Neither the duration of disease nor the age of the subject correlated with the nerve dysfunction.     

糖尿病周围神经病700例临床与神经电生理分析

目的探讨糖尿病周围神经病的临床和电生理特点,明确电生理检查的诊断价值。方法对700患者进行感觉和运动神经传导测定,240例患者进行针极肌电图测定。结果507例(724%)患者电生理检查异常,其中307例(606%)为多发性周围神经病,74例(146%)为腕管综合征;感觉神经传导异常程度重于运动神经,波幅的下降程度较传导速度减慢明显,下肢重于上肢(P<005)。仅有46%的患者针极肌电图异常而神经传导正常。结论糖尿病周围神经病的临床和电生理表现均以感觉神经受损为主;电生理检查有助于发现临床病变,但并非所有患者均能发现电生理异常;建议不将针极肌电图进行糖尿病周围神经病的筛查作为常规使用。     

肌电电生理诊断糖尿病早期周围神经病变的敏感指标探讨

本文报道了１７１例糖尿病患者通过肌电图电生理检查，测定运动和感觉传导速度及胫神经Ｈ反射的结果，并分析了临床症状，发现糖尿病周围神经病１１６例（６７．８％），其中单纯Ｈ反射异常２７例，神经传导异常兼有或无Ｈ反射异常８９例，提出了诊断糖尿病性周围神经病电生理检查最敏感的指标，并探讨了神经传导与年龄、病程、空腹血糖、果糖胺及ＨｂＡｌｃ之间的相互关系。     

Cross sectional study to evaluate the effect of duration of type 2 diabetes mellitus on the nerve conduction velocity in diabetic peripheral neuropathy

ObjectiveTo study the nerve conduction velocity in clinically undetectable and detectable peripheral neuropathy in type 2 diabetes mellitus with variable duration.Material and methodsThis cross sectional study was conducted in diagnosed type 2 diabetes mellitus patients. They were divided in groups: Group I (n = 37) with clinically detectable diabetic peripheral neuropathy of shorter duration and Group II (n = 27) with clinically detectable diabetic peripheral neuropathy of longer duration. They were compared with T2DM patients (n = 22) without clinical neuropathy. Clinical diagnosis was based on neuropathy symptom score (NSS) and neuropathy disability score (NDS) for signs. Nerve conduction velocity was measured in both upper and lower limbs. Median, ulnar, common peroneal and posterior tibial nerves were selected for motor nerve conduction study and median and sural nerves were selected for sensory nerve conduction study.ResultsThe comparisons were done between nerve conduction velocities of motor and sensory nerves in patients of clinically detectable neuropathy and patients without neuropathy in type 2 diabetes mellitus population. This study showed significant electrophysiological changes with duration of disease. Nerve conduction velocities in lower limbs were significantly reduced even in patients of shorter duration with normal upper limb nerve conduction velocities.ConclusionDiabetic neuropathy symptom score (NSS) and neuropathy disability score (NDS) can help in evaluation of diabetic sensorimotor polyneuropathy though nerve conduction study is more powerful test and can help in diagnosing cases of neuropathy.     

Influence of glucoregulation with continuous subcutaneous insulin infusion on nerve conduction velocity and beat to beat variation in diabetics

Limited and contrasting data are available on the relationship between metabolic control and diabetic neuropathy. In eight type I diabetics peripheral and autonomic neuropathy were studied, first in conditions of poor metabolic control and then after one and three months during which an improved control of glycemic levels had been obtained by continuous subcutaneous insulin infusion. Autonomic neuropathy was investigated by evaluating beat to beat variation during deep breathing; peripheral neuropathy by measuring maximum motor conduction velocity of peroneal and median nerves and sensory conduction velocity of median nerve. Our data showed significant improvement of motor conduction velocity in both nerves studied, whilst sensory conduction velocity did not show any significant variation. The changes observed in beat to beat variation in five subjects with initially abnormal scores might reflect an improvement in autonomic nervous function, even if long-term studies are needed.     

Diabetic neuropathy and plasma glucose control

Diabetic neuropathy is defined, and theories of its pathogenesis are reviewed. Recent studies designed to investigate the influence of plasma glucose on nerve function in noninsulin-dependent diabetic patients are summarized. Motor nerve conduction velocities in the median and peroneal nerves were measured using a double-stimulus technique, and sensory conduction velocity was measured by conventional methods before and after therapy with oral agents or insulin. The degree of hyperglycemia was assessed by measurement of fasting plasma glucose and glycosylated hemoglobin concentrations. The degree of slowing in motor nerve conduction velocity in untreated patients was found to correlate with the fasting plasma glucose and glycosylated hemoglobin concentrations, but sensory nerve function, although abnormal, did not show such correlation. Reduction of hyperglycemia was associated with improvement in motor nerve conduction velocity in the peroneal and median motor nerves of these patients, but sensory nerve conduction velocity showed no such improvement. Improvement in median motor nerve conduction velocity was directly related to the degree of reduction in fasting plasma glucose concentration. These findings suggest that metabolic factors related to hyperglycemia are important in the impaired motor nerve function seen in noninsulin-dependent patients with maturity-onset diabetes.     

Ulnar entrapment neuropathy in patients with type 2 diabetes mellitus: An electrodiagnostic study

Aims

This study aimed to assess the prevalence and electrophysiological features of ulnar entrapment neuropathy in patients with type 2 diabetes mellitus (DM).

Methods

Nerve conduction studies (NCS) were performed in a sample of consecutive diabetic patients aged 25–75 years, referred by the Diabetology Unit. NCS of the median, ulnar, radial, peroneal and sural nerves were performed on the non-dominant side. Median entrapment neuropathy at the wrist (MNW) and ulnar neuropathy at the elbow (UNE) and wrist (UNW) were diagnosed according to standard electrodiagnostic criteria.

Results

Sixty-four patients were enrolled, 28 male (44%), average age 61, average DM duration 14.5 years. Polyneuropathy was diagnosed in 45 subjects (70%). UNE was detected in 22 patients (34%) (4 did not have polyneuropathy), in the abductor digiti minimi in 16, the first interosseus in 14 and in both in 8. UNW was detected in 7 (11%) subjects and MNW in 40 (63%). NCS alterations consistent with ulnar neuropathy were detected in a high proportion of patients (45%), suggesting that the ulnar nerve is very susceptible to focal entrapment in DM.

Conclusions

Upper limb sensory and motor NCS, including motor conduction velocity across the elbow, should be considered in the staging of DM patients.     

单唾液酸四己糖神经节苷脂钠联合α-硫辛酸治疗糖尿病周围神经病变的疗效观察

目的 探讨单唾液酸四己糖神经节苷脂钠（GM1）联合α-硫辛酸治疗糖尿病周围神经病变（DPN）的疗效及安全性. 方法 将DPN患者80例分为治疗组40例和对照组40例.在控制血糖的基础上,治疗组予静脉滴注GM1 40 mg和α-硫辛酸600 mg,对照组予静脉滴注α-硫辛酸600 mg,均1次/d,疗程2周.观察治疗后症状改善情况,测定治疗前后正中、腓总神经的运动神经传导速度（MCV）和感觉神经传导速度（SCV）. 结果 2周后,治疗、对照组总有效率分别为92.5％（37/40）、72.5％ （29/40）,治疗组疗效较对照组显著（P＜0.05）.两组MCV、SCV均较治疗前提高,治疗组提高更显著（P＜0.05）. 结论 GM1联合α-硫辛酸治疗DPN疗效显著.