Uccioli L, Giacomini P G, Pasqualetti P, Di Girolamo S, Ferrigno P, Monticone G, Bruno E, Boccasena P, Magrini A, Parisi L, Menzinger G, Rossini P M
Department of Endocrinology, University of Rome Tor Vergata, Italy.
Diabetes Care. 1997 Jun;20(6):929-34. doi: 10.2337/diacare.20.6.929.
To evaluate the contribution of central neuropathy on postural impairment observed in diabetic patients with peripheral neuropathy.
Central sensory and motor nervous propagation, nerve conduction velocity, and static posturography were assessed in the following age-matched subjects: 7 IDDM patients with peripheral neuropathy (group DN), 18 IDDM patients without peripheral neuropathy (group D), and 31 control subjects (group C). Somatosensory-evoked potentials (SEPs) during tibial nerve stimulation were recorded, and the spine-to-scalp sensory central conduction time (SCCT) was evaluated. Motor-evoked potentials (MEPs) were recorded from leg muscles during magnetic transcranial brain stimulation, and the scalp-to-spine motor central conduction time (MCCT) was evaluated. The following posturographic parameters were calculated from the statokinesigram: trace length, trace surface, velocity of body sway with its standard deviation, and VFY (a parameter derived from the velocity variance and the anteroposterior mean position of the body).
SCCT was significantly higher in the DN group than in the C and D groups (P < 0.001). MCCT was similar in all groups. Posturographic parameters were all significantly impaired in the DN group (P < 0.01). While posturographic parameters showed a direct relationship with some parameters of peripheral nerve conduction, no correlations were observed with SEP and MEP central conduction time. These results were also confirmed by logistic regression, which indicates peripheral neuropathy as the only implicating factor in postural instability (odds ratio 0.22, 95% CI 0.07-0.75) after data reduction by means of factor analysis.
Although diabetic patients with peripheral neuropathy show a delay in central sensory conduction, postural instability may be fully explained by the presence of peripheral neuropathy.
评估中枢神经病变对糖尿病周围神经病变患者姿势障碍的影响。
对以下年龄匹配的受试者进行中枢感觉和运动神经传导、神经传导速度及静态姿势描记法评估：7例患有周围神经病变的1型糖尿病患者（DN组）、18例无周围神经病变的1型糖尿病患者（D组）和31例对照受试者（C组）。记录胫神经刺激时的体感诱发电位（SEP），并评估脊柱至头皮的感觉中枢传导时间（SCCT）。在磁刺激经颅脑刺激期间记录腿部肌肉的运动诱发电位（MEP），并评估头皮至脊柱的运动中枢传导时间（MCCT）。根据姿势图计算以下姿势描记参数：轨迹长度、轨迹面积、身体摆动速度及其标准差，以及VFY（一个由速度方差和身体前后平均位置得出的参数）。
DN组的SCCT显著高于C组和D组（P < 0.001）。所有组的MCCT相似。DN组的姿势描记参数均显著受损（P < 0.01）。虽然姿势描记参数与周围神经传导的某些参数呈直接关系，但未观察到与SEP和MEP中枢传导时间的相关性。通过因子分析进行数据简化后，逻辑回归也证实了这些结果，表明周围神经病变是姿势不稳定的唯一相关因素（优势比0.22，95%可信区间0.07 - 0.75）。
虽然患有周围神经病变的糖尿病患者显示中枢感觉传导延迟，但姿势不稳定可能完全由周围神经病变的存在来解释。
