The Value Of Neuroelectromyography In Diagnosis And Therapeutic Evaluation Of Asymptomatic Diabetic Peripheral Neuropathy

Objective:To explore the value of neuromyography(EMG)in the evaluation of asymptomatic diabetic peripheral neuropathy(ADPN),to analyze the electrophysiological characteristics and the influencing factors and evaluate the therapeutic effect of ADPN,as well as providing clinical references for timely diagnosis,treatment and assessment of therapeutic effect of ADPN.Methods:A total of 79 cases with type 2 diabetic mellitus were selected based on inclusion and exclusion criteria,who were admitted in the department of diabetes of our hospital during November 2016 to January 2018.Another 79 healthy persons taking physical examination during the same period were selected as control group.Nicolet EDX electromyography was used for electrophysiological detection.One nerve was selected from every limb,in which upper limb nerves included median nerve,sensory and motor fibers of ulnar nerve,while lower limb nerves included nervus peroneus communis,motor fiber of tibial nerve and sensory fiber of sural nerve.Distal motor latency(DML),motor nerve conduction velocity(MNCV)and amplitude of compound muscle action potential(CMAP)were recorded.At the same time,F-wave of limbs,H-reflect of lower limb were also detected.The electrophysiological parameters included average latency,frequency and dispersion of F-wave,and shortest latency of H-reflect.The patients with abnormal nerve conduction velocity(NCV)were treated with basic treatment for diabetes and neurotrophic drugs(mecobalamin dispersible tablets,epalrestat tablets)for three months,then electrophysiological parameters were acquired again to evaluate the therapeutic effect and prognosis.Results:1.There were 34 cases with abnormal NCV(43.0%),including 74 abnormal motor nerves and 89 abnormal sensory nerves.The abnormality rate of sensory nerves(37.55%)was significantly higher than motor nerves(25.94%)(X2=13.017,P=0000);while abnormality rate of lower limbs nerves(34.18%)was significantly higher than upper limbs nerves(25.94%)(X2=3.948,P=0.047).Concerning course of disease,abnormality rate was highest in patients with course as 37-60 months(Groups 3)(52.14%),followed by patients with course as 13-36 months(Group 2)(31.42%)and patients with course as 1-12 months(Group 1)(14.70%)(Group 3 vs.Group 2:X2=13.835,P=0.000;Group 2 vs.Group 1:X2=16.547,P=0.000).2.The total abnormality rate of F-wave was 50.63%in patients with abnormal MNCV,and it was 38.09%in patients with normal MNCV of ulnar nerve and posterior tibial nerve.Abnormality rate of F-wave was significantly higher in posterior tibial nerve than ulnar nerve(60.00%vs.18.18%,X2=23.306,P=0.000).For F-wave,abnormality rate of dispersion was significantly higher than average latency(37.30%vs.24.60%,X2=2.475,P=0.029),and also significantly higher than frequency(10.31%)(X2=25.288,P=0.000).3.The abnormality rate of H-reflex was75.94%,significantly higher than F-wave50.63%(X2=13.962,P=0.000).Therefore,H-reflex could be used as an important index in diagnosis of ADPN.4.After CMAP treatment,there were significant improvements in all indexes of other motor nerves and sensory nerves(P<0.05),while there was no significant change in NCV of ulnar nerve(P>0.05)Conclusion:1 NCV combined with F-wave and H-reflex is an important method for early diagnosis of proximal and distal nerve injury in ADPN patients.2、H-reflex is most valuable in the diagnosis of ADPN,indicating that proximal injury appears earlier and more serious than distal injury.3、Nerve conduction measurement is helpful in assessing therapeutic effect in ADPN patients.