Braune H J
Dept. of Neurology, University Hospital, Germany.
Electromyogr Clin Neurophysiol. 1999 Sep;39(6):355-9.
In patients with diabetes mellitus (DM) without any clinical signs of polyneuropathy neurophysiological examinations intend to find early involvement of peripheral nerves. Conventionally, nerve conduction velocity (NCV) measurements of sensory nerves are performed. The purpose of this study is to investigate wether refractory period measurements may be more sensitive.
We compared 30 IDDM/NIDDM diabetics without clinical signs of neuropathy (25 male, 5 female, age 45-73 years, mean 64.3 years) with age-matched controls. Sensible nerve conduction velocity (NCV) of radialis and suralis nerves were performed at 37 degrees C as well as double stimulations. The interstimulus interval were decreased stepwise by 0.2 ms beginning with 4.6 ms to determine the end of the relative refractory period.
Statistically significant differences of NCV and refractory period were found. The most profound differences between diabetics and normals were seen in refractory period of n. suralis. Regarding the 95% percentile as cut-off value of the normal range, pathological NCV of N. suralis were found in 4 patients. Pathological refractory period, however, were found in 9 patients.
Refractory period measurements of N. suralis are more sensitive than conventional NCV assessment in detection of beginning dysfunction in peripheral nerves of patients with diabetes mellitus without clinical signs of polyneuropathy.
在没有任何临床多发性神经病变体征的糖尿病患者中，神经生理学检查旨在发现周围神经的早期受累情况。传统上，会进行感觉神经的神经传导速度（NCV）测量。本研究的目的是调查不应期测量是否可能更敏感。
我们将30名无神经病变临床体征的胰岛素依赖型糖尿病/非胰岛素依赖型糖尿病患者（25名男性，5名女性，年龄45 - 73岁，平均64.3岁）与年龄匹配的对照组进行比较。在37摄氏度下对桡神经和腓肠神经进行感觉神经传导速度（NCV）测量以及双刺激。从4.6毫秒开始，每次刺激间隔以0.2毫秒的步长递减，以确定相对不应期的结束。
发现NCV和不应期存在统计学上的显著差异。糖尿病患者与正常人之间最显著的差异出现在腓肠神经的不应期。将正常范围的第95百分位数作为临界值，4例患者发现腓肠神经的NCV异常。然而，9例患者发现不应期异常。
在检测没有临床多发性神经病变体征的糖尿病患者周围神经早期功能障碍方面，腓肠神经不应期测量比传统的NCV评估更敏感。
