Fierro B, Brighina F, Cardella F, Oliveri M, La Bua V, Caravaglios G, Buffa D, Aloisio A, Daniele O
Istituto di Neuropsichiatria, Università di Palermo, Italy.
Electromyogr Clin Neurophysiol. 1999 Sep;39(6):337-44.
A neurophysiological (SEP, VEP) follow-up study was carried out in 30 diabetic patients with type I diabetes mellitus of ten or more years duration. This in order to investigate whether one year of improved glucoregulation may influence the progression of central damage. In our series, patients showed a significant decrement of HbA1C levels (p < 0.05) in the one-year follow-up. In the same period the frequency of SEP and VEP abnormalities varied from 10/30 (33%) to 16/30 (53%) and from 8/30 (26%) to 5/30 (16%) respectively. This finding would suggest that prevailing glycaemic control would be a major determinant for the outcome of VEP measurements. SEP alterations, in contrast, tend to progress in a 12 months period despite a considerable improvement in glycaemic control. However, by dividing patients in two groups according mean one year HbA1C less than 8% and more than 8%, the latter group only showed a significant increasing of absolute latencies of each median and tibial SEP components. Our results suggest that VEP abnormalities are still reversible in diabetic patients with improved metabolic control. The acquired abnormalities of somatosensory pathways persist longer, but a strict glycaemic control may influence and retard the progression of central conduction involvement.
对30例病程达10年及以上的I型糖尿病患者进行了神经生理学(体感诱发电位、视觉诱发电位)随访研究。目的是调查一年的血糖调节改善是否会影响中枢神经损伤的进展。在我们的研究系列中,患者在一年的随访中糖化血红蛋白水平显著下降(p<0.05)。同期,体感诱发电位和视觉诱发电位异常的发生率分别从10/30(33%)变化到16/30(53%)以及从8/30(26%)变化到5/30(16%)。这一发现表明,血糖的有效控制将是视觉诱发电位测量结果的主要决定因素。相比之下,尽管血糖控制有显著改善,但体感诱发电位改变在12个月期间仍有进展。然而,根据平均一年糖化血红蛋白低于8%和高于8%将患者分为两组,后一组仅显示每个正中神经和胫神经体感诱发电位成分的绝对潜伏期显著增加。我们的结果表明,在代谢控制改善的糖尿病患者中,视觉诱发电位异常仍然是可逆的。躯体感觉通路获得性异常持续时间更长,但严格的血糖控制可能会影响并延缓中枢传导受累的进展。