Electrophysiological Study Of Peripheral Nerve Function In Patients With Impaired Glucose Regulation

ObjectiveThe application of neurophysiological examination in the evaluation of impaired fasting glucose,impaired glucose tolerance,impaired fasting glucose with impaired glucose tolerance and diabetic peripheral nerve function in patients with abnormal glucose regulation and the analysis of peripheral nerve involvement in patients with abnormal glucose regulation and diabetic patients provide the basis for early diagnosis of peripheral nerve damage in patients with impaired fasting glucose and impaired glucose tolerance.MethodsA total of 131 patients with abnormal glucose regulation(IGR),81 patients with diabetes mellitus and 66 patients with normal person were enrolled in the present study.There were 77 cases of impaired fasting glucose(IFG),31 cases of impaired glucose tolerance(IGT),and 23 cases of mixed state(IFG+IGT).According to the age and gender of each group,diabetes patients and normal glucose tolerance were matched into two groups,which were taken as the control group(DM group and normal group).The numbers of control normal group and DM group in the IFG group were 30 and 40 cases,respectively.The numbers of control normal group in the IGT group were 19 and 23 cases,respectively.The numbers of control normal group and DM group in the IGT+IFG group were 17 and 18 cases,respectively.All subjects were tested for nerve conduction testing(NCS)of one or both median nerves,ulnar nerves,posterior tibial nerves,and common peroneal nerves,and sympathetic response(SSR)of one or both median nerves,posterior tibial nerves F,and the skin of the extremities.The electrophysiological characteristics of peripheral nerves in the subjects were compared.1.Parameters of NCS measurement: amplitude of compound muscle action potential(CMAP)and motor terminal latency(DML)as well as the sensory nerve conduction velocity(SCV)and sensory nerve action potential(SNAP)amplitudes.F wave measurement parameters: FImean and the F wave appearance rate.2.Parameters for F wave measurement: average latency(Flmean).3.Parameters for SSR determination: latency and amplitude of SSR initial wave.Results1.The results of NCS1.1 Compared with the DM group and the normal group,there were overall differences among the three groups in the IFG group(P<0.05),and pairwise comparison was conducted among the groups.Compared with the normal group,the CMAP amplitude of the posterior tibial nerve,the DML of the common peroneal nerve,and the SNAP amplitude of the median,ulnar and common peroneal nerves in the IFG group were decreased,with a statistically significant difference(P < 0.017).Compared with IFG group,the amplitude of SNAP of the ulnar nerve was decreased in DM group,and the SCV of the common peroneal nerve was decreased,with statistical significance(P < 0.017).Compared with the normal group,the DML of the ulnar nerve,the posterior tibial nerve,and the common peroneal nerve was prolonged,the CMAP amplitude of the posterior tibial nerve was decreased,the SCV of the median nerve,the ulnar nerve,and the common peroneal nerve was decreased,and the SNAP amplitude was decreased in the DM group(all P<0.017).1.2 Compared with the DM group and the normal group control group,the IGT group showed overall differences among the three groups,and the pairwise comparison between the groups indicated that there was no significant difference between the IFG group and the normal group(P>0.017).1.3 Compared with the DM group and the normal group,the IFG+IGT group had overall differences among the three groups,and the pairwise comparison was conducted among the groups.Compared with the normal group,the IFG+IGT group had statistically significant differences in median nerve SCV reduction,SNAP amplitude reduction,median nerve DML prolongation,and posterior tibial nerve CMAP amplitude reduction(P<0.017).2.The results of F wave2.1 Compared with the DM group and the normal group,there were overall differences among the three groups in the IFG group(P<0.05).The pairwise comparison was conducted among the groups.Compared with the normal group,the Flmean elongation of the median nerve and posterior tibial nerve in the IFG group was statistically significant(P<0.017).Compared with the IFG group,the Flmean elongation of the median nerve in the DM group was significantly different from that in the IFG group(P < 0.017).Compared with the normal group,the median nerve and posterior tibial nerve Flmean were significantly prolonged in the DM group(P<0.017).2.2 Compared with the DM group and the normal group,the Flmean elongation of the median nerve and the posterior tibial nerve in the IGT group was not statistically significant(P>0.017).2.3 Comparison of IFG+IGT group with DM group and normal group in the control group: There were overall differences among the three groups,and the pairwise comparison was conducted among the groups.There was no significant difference in the Flmean elongation of median nerve between IFG+IGT group and normal group(P>0.017).3.The results of SSR3.1 Compared with the DM group and the normal group,there were differences among the three groups in the IFG group(P<0.05),and pairwise comparison was conducted among the groups.Compared with the normal group,the SSR latencies of upper limbs in the IFG group were longer,and the differences were statistically significant(P < 0.017).Compared with the normal group,the SSR latencies and amplitudes of upper and lower limbs in the DM group were significantly prolonged(P<0.017).3.2 Compared with the DM group and the normal group control group,the IGT group showed overall differences among the three groups,and the pairwise comparison was conducted among the groups.Compared with the normal group,the lower SSR amplitude of the upper limb in the IGT group had statistical significance(P<0.017).3.3 Compared with the DM group and the normal group,the IFG+IGT group had overall differences among the three groups,and the pairwise comparison was conducted among the groups.Compared with the normal group,the SSR latencies of upper limbs in the IFG+IGT group were longer,and the difference was not statistically significant(P>0.017).4.After the detection parameters of the IFG group,the IGT group,the IFG+IGT group and the control DM group were compared with the normal reference values,the abnormal rate was compared4.1 NCS abnormal rate comparison4.1.1 As for the SCV and SNAP of the ulnar nerve DML,the CMAP of the common peroneal nerve,the median nerve,the ulnar nerve,the posterior tibial nerve,and the common peroneal nerve,there were significant differences in the abnormal rate between the IFG group and the DM group(P<0.05),which was higher in the DM group than in the IFG group.4.1.2 There were significant differences in the abnormal SNAP rates of the median and ulnar nerves between the IGT group and the DM group(P < 0.05),and the abnormal SNAP rate of the DM group was higher than that of the IGT group.4.1.3 Compared with the DM group,the abnormality rates of DML of the common peroneal nerve,the SNAP of the median nerve,the ulnar nerve,and the posterior tibial nerve,and the SCV of the posterior tibial nerve in the IFG+IGT group were statistically significant(P<0.05),and the abnormality rate in the DM group was higher than that in the IFG+IGT group.4.2 F wave anomaly rate comparison4.2.1 Comparison between IFG group and DM group: There was a significant difference in the abnormal rate of median F-wave Flmean(P<0.05),and the abnormality rate in DM group was higher than that in IFG group.4.2.2 Comparison between the IGT group and the DM group: There was no significant difference in the abnormal rate of F wave FLmean in the median nerve and posterior tibial nerve(P>0.05).4.2.3 Comparison between IFG+IGT group and DM group: There was no significant difference in the abnormal rate of F wave FLmean in the median nerve and posterior tibial nerve(P>0.05).4.3 SSR abnormal rate comparison4.3.1 4.3.1 Comparison between IFG group and DM group: The abnormal rate of SSR amplitude in lower limbs was statistically significant(P<0.05),and the abnormal rate in DM group was higher than that in IFG group.4.3.2 There was no significant difference in SSR latency or abnormal amplitude between IGT and DM groups(P>0.05).4.3.3 Comparison between IFG+IGT group and DM group: There were significant differences in the latency of the lower limbs and the abnormal rate of amplitude of the upper limbs(P<0.05).conclusion1.Patients with impaired fasting glucose and patients with diabetes both have large and small fiber nerve damage,and the damage of sensory nerve is more serious than that of motor nerve.Their peripheral nerve damage includes both demyelination and axonal degeneration,with axonal damage as the main lesion,and is characterized by involvement of both distal and proximal peripheral nerves.2.The patients with impaired glucose tolerance mainly suffer from small fiber nerve damage,while the large fiber nerve damage is not significant.3.Patients with impaired fasting glucose with impaired glucose tolerance mainly suffer from large fiber nerve damage,and both upper and lower limbs can be involved.No significant impairment of unmyelinated C-type small fibers after sympathetic ganglia in patients with impaired fasting glucose with impaired glucose tolerance.4.Patients with impaired fasting glucose have proximal peripheral nerve damage,while patients with impaired glucose tolerance and impaired fasting glucose with impaired glucose tolerance have no significant proximal peripheral nerve damage.5.Patients with abnormal glucose regulation have different abnormal blood glucose levels and different characteristics of peripheral nerve damage.With the increase in blood glucose and gradual aggravation of peripheral nerve damage,the peripheral nerve involvement in patients with diabetes mellitus is significantly heavier than that in patients with abnormal glucose regulation.Therefore,early intervention for patients with abnormal glucose regulation can significantly reduce the incidence of diabetes and its diabetic peripheral neuropathy,DM group was higher than IFG+IGT group.