标题：早期神经肌电图、震动感觉阈值测定及双下肢血管彩超检查对2型糖尿病周围神经病变的诊断价值

      作者：刘强，梁健，陈燕    珠海市第五人民医院内分泌科，广东 珠海 519000

      卷次： 2021年32卷15期

      【摘要】 目的 探究早期神经肌电图、震动感觉阈值测定及双下肢血管彩超检查对2型糖尿病周围神经病变患者的临床诊断价值。方法 选择2017年1月至2020年10月于珠海市第五人民医院内分泌科就诊的140例2型糖尿病患者作为研究对象(观察组)，根据神经肌电图检测结果将其分为神经病变组44例和非神经病变组96例，同时选取同期于本院进行体检的100例健康志愿者纳入对照组。观察组患者于糖尿病确诊后7 d内行神经肌电图检测、震动感觉阈值测定和双下肢血管彩超检查，对照组志愿者于同意参与研究后7 d内进行上述检查。比较三组受检者的神经肌电图传导速度、下肢震动感觉阈值及血管内中膜厚度。结果 观察组患者经神经肌电图检测、震动感觉阈值检测和双下肢血管彩超检查，结果显示，存在周围神经病变者分别为44例(31.43%)、47例(33.57%)和46例(32.86%)，三种检测方法的检出率比较差异无统计学意义(P>0.05)；神经病变组患者的正中神经运动传导速度为(43.85±2.06) m/s，明显快于非神经病变组的(50.67±2.75) m/s和对照组的(54.36±2.46) m/s，差异均具有统计学意义(P<0.05)；神经病变组患者的正中神经感觉传导速度为(39.64±2.46) m/s，明显快于非神经病变组的(44.81±2.23) m/s和对照组的(56.52±2.47) m/s，差异均具有统计学意义(P<0.05)；神经病变组患者的第一足趾震动感觉阈值为(15.65±1.26) V，明显高于非神经病变组的(10.97±0.83) V和对照组的(6.25±0.34) V，差异均具有统计学意义(P<0.05)；神经病变组患者的内中膜厚度为(1.39±0.15) mm，明显厚于非神经病变组的(1.18±0.16) mm和对照组的(0.92±0.23) mm，差异均具有统计学意义(P<0.05)。结论 2型糖尿病早期周围神经病变患者的周围神经功能已出现一定程度的病理损害，震动感觉阈值测定及双下肢血管彩超检查均具有与神经肌电图相当的诊断价值，综合运用可对患者的神经病变情况作出更加全面的判断。
      【关键词】 2型糖尿病；周围神经病变；神经肌电图；震动感觉阈值；彩超；诊断
      【中图分类号】 R587.1 【文献标识码】 A 【文章编号】 1003—6350（2021）15—1950—05

Diagnostic value of early neuroelectromyography, vibration sensory threshold measurement, and color Dopplerultrasound examination of lower limbs in the diagnosis of type 2 diabetic peripheral neuropathy.
LIU Qiang,LIANG Jian, CHEN Yan. Department of Endocrinology, the Fifth People's Hospital of Zhuhai, Zhuhai 519000, Guangdong,CHINA
【Abstract】 Objective To explore the clinical diagnostic value of early neuroelectromyography, vibration senso-ry threshold measurement, and color Doppler ultrasound examination of lower limbs in patients with type 2 diabetic pe-ripheral neuropathy. Methods A total of 140 patients with type 2 diabetes treated in the Department of Endocrinologyin the Fifth People's Hospital of Zhuhai from January 2017 to October 2020 were selected as the research objects (obser-vation group). According to the results of neuroelectromyography, they were divided into neuropathy sub group (n=44)and non-neuropathy sub group (n=96). At the same time, 100 healthy volunteers who underwent physical examination inour hospital during the same period were selected into the control group. The observation group underwent neuroelectro-myography, vibration sensory threshold measurement, and color Doppler ultrasound examination within 7 days after thediagnosis of diabetes, and volunteers in the control group underwent the above examination within 7 days after agreeingto participate in the study. The neuro-EMG conduction velocity, lower limb vibration sensory threshold, and vascular inti-ma-media thickness of the three groups were compared. Results The observation group were examined by neuroelec-tromyography, vibration sensory threshold, and color Doppler ultrasound examination of blood vessels of lower limbs,and results showed that there were 44 cases (31.43%), 47 cases (33.57%), and 46 cases (32.86%) of peripheral neuropa-thy, with no statistically significant difference among the detection rate of the three detection methods (P>0.05). The me-dian nerve motor conduction velocity in the neuropathy subgroup was (43.85±2.06) m/s, which was significantly fasterthan (50.67±2.75) m/s and (54.36±2.46) m/s of the non-neuropathy subgroup and the control group (P<0.05). The medi-an nerve sensory conduction velocity in the neuropathy subgroup was (39.64±2.46) m/s, which was significantly fasterthan (44.81±2.23) m/s of the non-neuropathy subgroup and (56.52±2.47) m/s of the control group (P<0.05). The first toevibration sensation threshold of the neuropathy subgroup was (15.65 ± 1.26) V, which was significantly higher than(10.97±0.83) V of the non-neuropathy subgroup and (6.25±0.34) V of the control group (P<0.05). The intima-mediathickness of the neuropathy subgroup was (1.39±0.15) mm, which was significantly thicker than (1.18±0.16) mm of the