Wysocka-Mincewicz Marta, Trippenbach-Dulska Hanna, Emeryk-Szajewska Barbara, Zakrzewska-Pniewska Beata, Kochanek Krzysztof, Pańkowska Ewa
Klinika Pediatrii Centrum Zdrowia Dziecka w Warszawie.
Pediatr Endocrinol Diabetes Metab. 2007;13(1):17-22.
Hypoglycemia is an acute disturbance of energy, especially impacting the central nervous system, but direct influence on peripheral nervous function is not detected. The aim of the study was to establish the influence of hypoglycemic moderate and severe episodes on the function of peripheral nerves, hearing and visual pathway.
97 children with type 1 diabetes (mean age 15.4+/-2.16 years, mean duration of diabetes 8.11+/-2.9 years, mean HbA1c 8,58+/-1.06%), at least 10 years old and with at least 3 years duration of diabetes, were included to study. Nerve conduction studies, visual (VEP) and auditory (ABR) evoked potentials were performed with standard surface stimulating and recording techniques. Moderate hypoglycemic episodes were defined as events of low glycemia requiring help of another person but without loss of consciousness and/or convulsions but recurrent frequently in at least one year. Severe hypoglycemia was defined as events with loss of consciousness and/or convulsions. Univariate ANOVA tests of significance or H Kruskal-Wallis test were used, depending on normality of distribution.
The subgroups with a history of hypoglycemic episodes had significant delay in all conduction parameters in the sural nerve (amplitude p<0.05, sensory latency p<0.05, and velocity p<0.005) and in motor potential amplitude of tibial nerve (p<0.005). In ABR wave III latency and interval I-III in subgroups with episodes of hypoglycemia (p<0,05) were significantly prolonged. In analyses of VEP parameters no differences were detected.
The study showed influence of hypoglycemic episodes on function of all sural nerve parameters and tibial motor amplitude, and in ABR on wave III and interval I-III. Frequent moderate hypoglycemic episodes were strong risk factors for damage of the peripheral and central nervous systems, comparable with impact of several severe hypoglycemias.
低血糖是一种急性能量紊乱，尤其会影响中枢神经系统，但尚未发现其对周围神经功能有直接影响。本研究的目的是确定中度和重度低血糖发作对周围神经、听觉和视觉通路功能的影响。
纳入97例1型糖尿病儿童（平均年龄15.4±2.16岁，平均糖尿病病程8.11±2.9年，平均糖化血红蛋白8.58±1.06%），年龄至少10岁，糖尿病病程至少3年。采用标准的表面刺激和记录技术进行神经传导研究、视觉诱发电位（VEP）和听觉诱发电位（ABR）检查。中度低血糖发作定义为血糖过低事件，需要他人帮助但未失去意识和/或抽搐，且在至少一年内频繁复发。严重低血糖定义为伴有意识丧失和/或抽搐的事件。根据分布的正态性，使用单因素方差分析或H检验（Kruskal-Wallis检验）。
有低血糖发作史的亚组在腓肠神经的所有传导参数（波幅p<0.05，感觉潜伏期p<0.05，速度p<0.005）以及胫神经运动电位波幅（p<0.005）方面均有显著延迟。在有低血糖发作的亚组中，ABR波III潜伏期和I-III间期（p<0.05）显著延长。在VEP参数分析中未发现差异。
该研究表明低血糖发作对腓肠神经所有参数和胫神经运动波幅功能有影响，对ABR的波III和I-III间期也有影响。频繁的中度低血糖发作是周围神经系统和中枢神经系统损伤的强危险因素，与多次严重低血糖发作的影响相当。
