Rota Eugenia, Quadri Roberto, Fanti Edoardo, Isoardo Gianluca, Poglio Fabio, Tavella Alessia, Paolasso Ilaria, Ciaramitaro Palma, Bergamasco Bruno, Cocito Dario
UO Neurofisiologia Clinica, Dipartimento di Neuroscienze, Università di Torino, Italy.
J Peripher Nerv Syst. 2005 Dec;10(4):348-53. doi: 10.1111/j.1085-9489.2005.00046.x.
This study was aimed at assessing the electrophysiological signs of peripheral neuropathy in diabetes mellitus (DM) type II patients at diagnosis. Nerve conduction studies (NCS) of median, ulnar, peroneal, tibial and sural nerves were performed in 39 newly diagnosed DM subjects and compared to those of 40 healthy controls. Metabolic indices were also investigated. Electrophysiological alterations were found in 32 (82%) of the DM patients, and more than half of them (62.2%) showed multiple (two to five) abnormal parameters. Because most of the subjects (84.4%) had from two to five nerves involved, these alterations were widespread in the seven nerves evaluated. Forty-two percent of the patients had NCS alterations suggestive of distal median mononeuropathy, implying that metabolic factors in DM make the median nerve more susceptible to focal entrapment. A reduced sensory nerve action potential (SNAP) amplitude was observed in the median nerve in 70% of the patients, in the ulnar in 69% and in the sural nerve only in 22%. In the presence of a decrease in the SNAP amplitude of the ulnar or median nerve, the SNAP amplitude of the sural nerve was normal in 82 or 80% of the subjects, respectively. This finding may be in keeping with a distal involvement of the sensory fibres, as explored by routine median or ulnar NCS. No correlation was found between metabolic indices and NCS parameters. In conclusion, a high percentage of newly diagnosed DM patients show signs of neuropathy, and upper limb nerve sensory NCS seem to be more sensitive in detecting it than lower limb NCS.
本研究旨在评估II型糖尿病（DM）患者确诊时周围神经病变的电生理体征。对39例新诊断的DM患者进行了正中神经、尺神经、腓总神经、胫神经和腓肠神经的神经传导研究（NCS），并与40例健康对照者进行比较。还对代谢指标进行了研究。在32例（82%）DM患者中发现了电生理改变，其中一半以上（62.2%）表现出多个（2至5个）异常参数。由于大多数受试者（84.4%）有2至5条神经受累，这些改变在评估的7条神经中广泛存在。42%的患者NCS改变提示远端正中单神经病，这意味着DM中的代谢因素使正中神经更容易发生局灶性卡压。70%的患者正中神经感觉神经动作电位（SNAP）波幅降低，尺神经为69%，腓肠神经仅为22%。在尺神经或正中神经SNAP波幅降低的情况下，82%或80%的受试者腓肠神经SNAP波幅正常。这一发现可能与常规正中或尺神经NCS所探究的感觉纤维远端受累情况相符。未发现代谢指标与NCS参数之间存在相关性。总之，高比例的新诊断DM患者表现出神经病变体征，上肢神经感觉NCS在检测神经病变方面似乎比下肢NCS更敏感。
