| BackgroundDiabetic neuropathy (DN) is the most common complication of diabetes mellitus (DM), which involved in the central nervous system and peripheral nervous system, and the latter one is usually seen in clinical. Researches about diabetic peripheral neuropathy (DPN) are mainly based on nerve conduction velocity (NCV) and various symptom rating scale. However, the region of the current perception threshold (R-CPT) examination rare deals,the diabetic central nervous system disease, especially the abnormality of pyramidal tract, was commonly overlooked. In this study, NCV, SEP, MEP and R-CPT were performed on patients with type 2 diabetes to investigate the practical value of R-CPT and MEP in the diagnosis of DN.Objective1.Using the Neurometer, Region-current perception threshold(R-CPT), to test patients with T2DM on median, ulnar, superficial peroneal and deep peroneal nerves at 2000,250, and 5Hz. The three current frequencies represent Aβ, A8 and C fibers. According to the results, the function of peripheral nervous system, especially the small nerve fiber, can be assessed.2.Motor evoked potentials were performed on patients with T2DM to calculate the central motor conduction time (CMCT) and assess the function of pyramidal tract.3.To investigate the practical value of R-CPT and MEP in the diagnosis of DN for patients with T2DM.Methods1.Subjects:Clinical diagnosis type two diabetes patients 714 cases.2.Groups:714 patients with T2DM were tested by NCV, SEP and R-CPT. The patients were divided into normal and abnormal sensory function groups based on R-CPT testing results,116 patients were selected from the 714 patients mentioned in the previous paragraph. The elected patients must have good blood pressure control, and without infarction, epilepsy and heart disease. Motor evoked potentials were performed on those 166 patients with T2DM to calculate the value of CMCT. According to the CMCT results, patients was divided into normal and abnormal CMCT groups, then compare and analyze with influence factors of diabetic central neuropathy.3.Data collection:collected patients’s Sex, age, course of diabetes, HbAlC, TG, TC, HDL-C, LDL-C,NCV, SEP, R-CPT, MEP test results and neurological symptoms.4.Statistical analysis:The data were processed with SPSS 19.0 statistical software package, and P<0.05 was considered statistically significant.Results1.Taken the NCV as the gold standard, the consistency, sensitivity and specificity of SEP and R-CPT can be calculated. The sensitivity and specificity of SEP and R-CPT were 95.3%,83.4%, and 81.1%,98.9%respectively.2.The abnormal rates of NCV,SEP,2000 Hz,250 Hz,5Hz are 40.3%,25.6%,36.1%,40.8%,and 43.1% respectively. The abnormal rate of NCV is significantly higher than that of SEP,but lower than that of 250 Hz,5Hz.The abnormal rate of SEP was the lowest of all (P<0.05).3.The abnormal rates of NCV,SEP,2000 Hz,250 Hz,5Hz of the patients without DPN symptoms are 23.3%,9.5%,25.3%,27.5% and 30.4% respectively. The abnormal rate of NCV is significantly higher than the rate of SEP, but lower than that of 250,5Hz. The abnormal rate of SEP was the lowest of all(P<0.05)4.The abnormal rates of 2000,250,5Hz in upper and lower limbs in type 2 diabetes are 17.6%,16.2%,24.5%and 28.6%,34.2%,35.9%respectively. The abnormal rate of 250,5Hz were higher than the rate of 2000Hz, and the lower limbs group has higher rate than the upper limbs group (P<0.05).5.Comparing the normal sensory function group with the abnormal group, the abnormal sensory function group has higher rate in the number of male patients, patients’age, course of diabetes, level of HbA1C,TC,HDL-C, and LDL-C. (P<0.05) Logistic regression analysis showed that age, course of diabetes, and HbA1C were the risk factors of DPN in type 2 diabetes.6.The abnormal rates of CMCT,NCV,SEP,R-CPT, and ankle hyperreflexia in the 166 patients are 18.1%(30/166),50%(83/166),41%(68/166),66.9%(111/166), and 3%(5/166) (P<0.05) Among the patients with CMCT abnormalities, abnormal NCV, SEP and R-CPT can be observed.7.The CMCT abnormal rates of four limbs are 76.7%(left upper limb),66.7%(right upper limb),70.7%(left lower limb),and 96.7%(right lower limb). It can be observed that the CMCT abnormal rate of right lower limb is apparently higher than upper limbs and left lower limb (P< 0.05)8.Comparing with the normal CMCT group, it can be observed that the patients’age, course of diabetes, HbAlC,TG,LDL-C in the abnormal CMCT group were higher (P<0.05). Logistic regression analysis showed that course of diabetes was the risk factors of pyramidal tract damage in type 2 diabetes (P<0.05)Conclusion1.R-CPT is a highly sensitive, consistency, objective, quantitative screening method of peripheral nerve sensory dysfunction. The lower extremity nerve fibers, as well as the unmyelinated and small myelinated sensory nerve fibers, are damaged more seriously than the upper of n DPN patients. The risk factors of DPN in T2DM are age, course of diabetes, and HbA1C of the patients.2.MEP can objectively, quantitatively evaluate the function of the central nervous system in T2DM.The pyramidal tract damaged in patients with T2DM was observed, and the lower limbs damaged seriously. The risk factors of Pyramidal tract function in T2DM patients is the course of diabetes... |
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