糖尿病病程对糖尿病下肢周围神经病变的影响

摘要

目的 探讨糖尿病(DM)病程对糖尿病周围神经病变(DPN)严重程度及下肢周围神经显微减压术疗效的影响,以及糖尿病周围神经病变早期诊断、早期手术的意义.方法 以5年糖尿病病程作为标准,将我科近年收治的1 526例糖尿病周围神经病患者分为短DM病程组和长DM病程组,按Dellon术式对卡压的神经进行下肢周围神经显微减压术.所有患者术前、术后1.5年进行神经高频超声、定量感觉检查(QST)、神经感觉传导速度(NCV)检测,并选取50例正常人群作为对照组检测相同指标.结果 与对照组相比,DPN患者的NCV、冷感觉阈值较低,热感觉阈值、振动觉阈值及神经横断面积(CSA)较高,差异有统计学意义(P＜0.05).患者术后各项指标明显改善,与术前相比,差异有统计学意义(P＜0.05).短DM病程DPN患者术前和术后备指标均优于长DM病程DPN患者,两组比较差异有统计学意义(P＜0.05).短DM病程DPN患者NCV阳性检测率为71.5％,QST阳性检测率为93.7％；长DM病程DPN患者NCV阳性检测率为90.3％,QST阳性检测率为95.3％.结论 糖尿病病程对DPN患者发病时的严重程度至关重要,同时也对DPN患者的手术疗效和预后产生影响.DPN的早期诊断、早期手术具有重要临床价值.%Objective To investigate the impact of diabetes mellitus (DM) duration on severity and prognosis of diabetic peripheral neuropathy of low extremities.Methods In this study,1526 diabetic peripheral neuropathy (DPN) patients were divided into short DM duration group and long DM duration group using 5 years as a separation point.Patients were treated with Dellon surgical nerve decompression.High-resolution ultrasound,quantitative sensory testing (QST) and nerve conduction velocity (NCV) were performed before and 1.5 years after the surgery in all subjects.These data were compared to that obtained from normal controls.Results Compared to the control group,the DPN patients had lower NCV and cold feeling threshold; higher thermal sensory thresholds,vibration perception threshold and nerve cross-sectional area (CSA).The difference was statistically significant (P ＜ 0.05).These parameters were statistically significantly improved after surgery (P ＜ 0.05).Both preoperative and postoperative indicators in short DM duration DPN patients were better than those in long duration DM patients.The difference was statistically significant (P ＜ 0.05).Short DM duration DPN patients had NCV positive detection rate of 71.5％ and the QST positive detection rate of 93.7％ while long DM duration DPN patients had NCV positive detection rate of 90.3％ and QST positive detection rate of 95.3 ％.Conclusions Duration of diabetes mellitus is a critical factor on severity and prognosis of diabetic peripheral neuropathy of low extremities.Early diagnosis and surgery of DPN have important clinical value.