Objective To investigate the significance of quantitative thermal testing (QTT) in the diagnosis of diabetic peripheral neuropathy. Methods One hundred and sixty-nine diabetic patients with neurological deficit (DM group) and 53 age-matched healthy controls underwent the determination of cold threshold (CT), warm threshold (WT), clod pain threshold (CPT), warm pain threshold (WPT) in both dorsum of hand and dorsum of foot. DM group were divided into subgroups with a course of disease > 5 years or with a course of disease ≤ 5 years, or divided into subgroups with normal or abnormal nerve conduction study (NCS). Results CT and WT of DM group with a course of disease ≤ 5 years ((29.6 ± 1.4), (26. 5±4. 3) ℃ ; (35.9±3.0), (41.3±4. 0) ℃) were higher than the health controls' ((30. 2±1.2), (29.1±1.5) ℃; (35.0±1.9), (36.5±1.5) ℃, respectively; t=3.27, 6.63, 2.80, 8.61, all P< 0. 05). The CT and WT of DM group with a course of disease > 5 years' ((28. 2±4. 0), (23. 1 ±7.9) ℃ ; (37.0±4. 7), (42. 6±4. 2) ℃, respectively) were higher than the DM group with course of disease≤ 5 years(t =4. 09, 4.63, 2.55, 2. 68 ,all P <0. 05). CT and WT of the normal NCS group((29. 5 ± 1.8), (27.0±4. 6) ℃ ; (35.0±1.9), (40. 9±3. 8)℃, respectively) were higher than the healthy controls' , and the difference was significant(t =3.22, 4. 17, 3.51,9. 95,all P<0.01). The frequency of abnormal QTT in DM group was higher than that of NCS in DM group. The QTT and NCS of DM group with a course of disease >5 years were higher than these in DM group with a course of disease ≤5 years; the frequency of abnormal WT in DM group(86. 4% ,146/169)was higher than that of CT in DM group(68. 1% ,115/169,x2=15.49, P<0.01), the frequency of abnormal QTT in the dorsum of foot in DM group was higher than that in the dorsum of hand in the DM group. PT of diabetic patients were higher than that in the healthy controls. Condusions QTT is more sensitive than NCS in the diagnosis diabetic peripheral neuropathy, which is neeossary to assist NCS when diabetic peripheral neuropathy is suspected, WT in dorsum of foot is a sensitive parameter in the diagnosis of diabetic peripheral neuropathy.%目的 探讨定量温度觉阈值检查(QTT)在糖尿病周围神经病诊断中的应用价值.方法 选取有神经系统症状的169例糖尿病患者[根据病程分为≤5年(69例)和>5年(100例)2个亚组;根据神经传导检测(NCS)是否存在异常分为正常组(45例)和异常组(124例)],并选取年龄匹配的53名健康对照,进行手及足背的冷感觉阈值(CT)、热感觉阈值(WT)、冷痛觉阈值(CPT)、热痛觉阈值(WPT)测定.结果 病程≤5年糖尿病组的手及足背CT[分别为(29.6±1.4)、(26.5±4.3)℃]、WT[(35.9±3.0)、(41.3±4.0)℃]高于健康对照组[手背CT(30.2±1.2)℃,足背CT(29.1±1.5)℃;手背WT(35.0±1.9)℃,足背WT(36.5±1.5)℃;t=3.27、6.63、2.80、8.61,均P<0.05],病程>5年糖尿病组[手背CT(28.2±4.0)℃,足背CT(23.1±7.9)℃;手背WT(37.0±4.7)℃,足背WT(42.6±4.2)℃]高于病程≤5年糖尿病组(t=4.09、4.63、2.55、2.68,均P<0.05),NCS正常的糖尿病组[手背CT(29.5±1.8)℃,足背CT(27.0±4.6)℃;手背WT(35.0±1/9)℃,足背WT(40.9±3.8)℃]高于健康对照组(t=3.22、4.17、3.51、9.95,均P<0.01),差异具有统计学意义.糖尿病组QTT的异常率比NCS的异常率更高,病程>5年糖尿病组NCS、QTr的异常率较病程≤5年糖尿病组高;糖尿病组WT异常率(86.4%,146/169)高于CT异常率(68.1%,115/169,x2=15.49,P<0.01),足背刺激QTT的异常率高于手背刺激QTT的异常率.与健康对照组相比,糖尿病患者的痛觉阈值较高.结论 QTT较常规NCS在糖尿病周围神经病诊断中具有更高的灵敏度,可作为常规NCS的必要补充.下肢热感觉阈值检查是诊断糖尿病周围神经病的敏感指标.
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