Quantitative Sensory Test And Its Application In The Diabetic Polyneuropahty

Objects:To have a cognition of Quantitative Sensory Test(QST) and its application in the Diabetic Polyneuropathy(DPN).Methods:We recruited 45 non-insulin dependent diabetes mellitus(DM) patients in Hua Shan Hospital and 25 age,sex,height matched healthy people from November, 2008 to February,2009.We conducted clinical evaluation,including:DM duration,the control condition of fasting blood glucose(FBG),Neuropathy Symptom Score(NSS),Physical Examination:Neuropathy Disability Socre(NDS) of Low limbs and Nerve Conduction Velocity(NCV) test;Cold sensation and heat pain threshold tested by limit method and quantitative vibration threshold tested by level method using Neuro Sensory Analyzer Model TSA-Ⅱmachine in thenar eminence,proximal anterior thigh and dorsum of foot to evaluate the DM patients' nerve function.Results:1.All the 45 DM patients' cold sensation threshold in proximal anterior thigh and dorsum of foot were lower than control group,heat pain threshold in these two places were higher than control group and quantitative vibration threshold in index finger and first toe were higher than control group.All of the above had the statistically significance.Furthermore,the difference of both cold sensation and heat pain threshold in the distal limbs were most obvious.But there were no difference in the ability of detecting small fiber nerve lesion themselves between cold sensation and heat pain threshold.2.According to the result of NCV and socres of NSS and NDS,there were 42 out of 45 DM patients had diagnosed as length-dependent diabetic polyneuropathy(LDDP), the incidence was up to 93%,but the abnormality rate of NCV was only 27%;Pain was the first of these 42 LDDP patients'chief complaints(69%) and the most kind of pain was twinge(45%).The next chief complaint was numbness(62%);Of all the body parts,incidence of distal lower limbs sensation lesion was the high,incidence of ankle reflex disappearance was highest.Besides,the incidence of foot swelling and cutaneous change were also not low.3.In 42 LDDP patients,the quantitative vibration threshold in dorsum foot correlated with DM duration,the heat pain and quantitative vibration threshold in dorsum foot both correlated with NDS socre.There was no correlation between all the parameters of QST and NSS score.4.In 42 LDDP patients,the thermal threshold(including cold sensation and heat pain) and quantitative vibration threshold of Index finger correlated with the amplitude of both peroneal and sural nerve.The quantitative vibration threshold of first toe correlated with the amplitude of sural nerve.There was no correlation between all the parameters of QST and distal latency of peroneal nerve。5.Thirty out of 42 LDDP patients had normal NCV results.Compared these 30 patients with age,sex and height matched health people,their cold sensation thresholds in proximal anterior thigh and dorsum of foot were lower than control group,the heat pain threshold in these two places were higher than control group, both had statistically significance.Furthermore,the difference in dorsum of foot was the most obvious.The quantitative vibration threshold in index finger and first toe were higher than control group statistically.6.According to the results of NCV,we divided 42 LDDP patients into normal NCV and abnormal NCV groups.Compared these two groups,we found the scores of NSS and NDS,heat pain threshold in dorsum of foot and quantitative vibration threshold in index finger and fist toe in abnormal NCV group were higher than normal NCV group, all had statistically significance.7.According to the condition of fast blood glucose(FBG),we divided 42 LDDP patients into good FBG control and bad FBG control groups.There was no statistically difference in all the parameters between these two groups.8.In the 42 LDDP patients,compared the patients with metabolic syndrome (MS)with the others without metabolic syndrome,the age was older in metabolic syndrome group.This result was also found in the groups of with and without hypertension group or with and without high body mass index(BMI) group.But there was no statistically difference in thermal and quantitative vibration threshold of all the three places between with and without MS groups,with and without hypertension groups,with and without higer body mass index groups and with and without hyperlipema groups.Conclusion:1.QST was a steady instrument to apply in the examination of peripheral neuropathy including DPN.It can predict the possible incidence of DPN,detect early phase DPN and reflect the severity of DPN.Its abnormality detection rate was high and its evaluation of DPN was thorough.It can serve as the supplementary of NCV,because it detected small fiber and large fiber lesion simultaneously.Cold sensation and heat pain threshold had the same detection ability of small fiber lesion. The changes of threshold in dorsum of foot were the highest in three places,this indicating the length dependent characteristic of LDDP honestly.The methods in this study was good enough to apply in the diagnosis of DPN.2.DPN featured small fiber and large fiber lesion simultaneously and length dependent.There was no obvious difference between the lesion of Aδfiber and C fiber.Small fiber lesion existed before the abnormality detected by NCV.The factors including control condition of FBG and metabolic factors didn't influence the degree of DPN nerve lesion.