Comparison Of Diagnostic Value Of Different Electrophysiological Detection Methods For Tibial Nerve Damage In Diabetic Patients

Objective:To explore the same nerve(tibial nerve)in diabetic patients,four different electrophysiological examination methods were used,and the positive rates of tibial nerve injury in four different methods were compared,in order to evaluate the proximal and distal injuries of tibial nerve in diabetes mellitus and compare which method was more sensitive.Methods:1)The motor and sensory nerve conduction velocity,F waves and H-reflex of unilateral tibial nerve was measuerd by electromyography in 63 patients with type 2 diabetas mellitus,and the correlation between them were compared with x2 test.Among them,the nerve conduction velocity examination results were followed li-ying cui diagnostic criteria: in the experimental group of normal range(sd)+ 2,meet the following any one,was judged as abnormal: 1)the nerve conduction velocity was smaller than normal lower limit;2)the distal latency was greater than the normal upper limit;3)the amplitude was below the normal limit.F wave parameters normal value standard were referenced pan hua et al.2007-2011 Beijing tiantan hospital published the normal reference value of F wave in China as a control,its potential period was greater than that of its corresponding height group.The reference value formula of H reflex latency was 2.74+0.05×age(years)+0.14×height(cm)+1.4.As long as the incubation period of H reflection was greater than expected value was abnormal.Results:1)In this group,the abnormal rate of H-reflex?F waves?MCV?SCV was76.19%?53.97%?17.46%?36.51%.The abnormal rate of H-reflex was higher than that of F waves,SCV and MCV respectively,All P values were <0.01,and the differences were statistically significant.The abnormal rate of F waves was compared with theabnormal rate of MCV and SCV,and the positive rate of F waves was the highest,the differences were statistically significant(P<0.05);compared with the abnormal rate of MCV,the positive rate of SCV was higher(x2=5.801,P<0.05.In conclusion,the positive rate of four methods of the tibial nerve in 63 patients with diabetes from high to low was H-reflex,F waves,SCV,MCV,in which the highest positive rate was H-reflex.The positive rate of F wave was second,and the positive rate of MCV was the lowest.2)Form all cases,43 patients of diabetic patients without clinical signs and symptoms of patients with peripheral nerve,the measured tibial nerve SCV and MCV,H reflex,F wave abnormal rate comparison found: H reflex abnormal rate was 76.74%,F wave abnormal rate was 55.81%,the MCV abnormal rate was 13.95%,SCV abnormal rate was 32.56%,The abnormal rate of H-reflex was higher than that of F waves,SCV and MCV respectively,All P values were <0.01,and the differences were statistically significant.The abnormal rate of F waves was higher than that of SCV and MCV respectively(P<0.05);compared with the abnormal rate of MCV,the positive rate of SCV was higher(x2=4.170,P<0.05).In conclusion,the positive rate of four methods of the tibial nerve in 43 patients without clinical symptoms and signs from high to low was H-reflex,F waves,SCV,MCV,in which the highest positive rate is H-reflex.3)In all cases,the total abnormal rate of NCV was 44.44%(28/63),the total abnormal rate of H-reflex and F waves was 80.95%(51/63),the difference between the two rates was statistically significant(x2=17.952,P<0.01),so shows that the proximal nerve was more vulnerable.4)Selected from all cases with no clinical signs and symptoms and NCV normal people with diabetes had 25 people,F wave and H reflex detection of abnormal number was 17 people,detection rate of 68.0%,further illustrate the F wave combined with H reflex test could find more subclinical lesions in diabetes patients.5)Statistical no clinical signs and symptoms and H reflex and F wave normal number of tibial nerve NCV abnormalities in patients with diabetes,selected from all cases with no clinical signs and symptoms and H reflex and F wave of all people with diabetes had 12 people,the number of abnormal tibial nerve NCV was 0.Conclusions:Four different electrophysiological detection methods can comprehensively reflect the proximal and distal injuries of tibial nerve,the tibial nerve damage in diabetics is not limited to the distal end,but is also vulnerable to proximal injuries.The positive rate of H reflex is higher in the four methods,and the subclinical lesions of tibial nerve can be found more.