2型糖尿病患者痛觉变化与周围神经病变程度相关性研究

NOCICEPTIVE CHANGES AND PERIPHERAL NERVES IN 2 DIABETIC PATIENTS CORRELATION STUDY OF THE GEGREE OF LESIONS

摘要:

目的: 了解2型糖尿病患者周围神经病变对痛觉的影响,分析周围神经损伤程度与痛觉变化的相关性,探索周围神经传导速度改变与痛觉变化的关系。方法: 选取2020年12月到2021年4月就诊于新疆医科大学第一附属医院的106例糖尿病患者,收集患者基本信息、实验室检查指标及肌电图检测四肢周围神经的感觉传导速度,根据病损程度将其分为无损伤、轻度损伤、中度损伤、重度损伤组,再分别给予锐痛刺激、压痛刺激,记录视觉模拟评分及压力痛阈压力值。 结果: DM患者在周围神经轻度损伤时,其痛阈无明显改变；在周围神经中度损伤时四肢压力痛阈升高；双下肢在周围神经重度损伤时压力痛阈下降。无论锐痛刺激疼痛评分还是压力痛阈,在周围神经重度损伤时,痛阈有所下降。结论: 糖尿病周围神经病变患者随着周围神经病变程度的改变,其痛阈也会有规律的改变。下肢压力痛阈的改变与周围神经损伤程度关系最为密切,认为右侧胫神经传导速度对糖尿病周围神经病变患者的压力痛阈影响较大。

Abstract:

Objective: To understand the effect of peripheral neuropathy on nociception in patients with type 2 diabetes mellitus (Diabetes Mellitus , DM), to analyze the correlation between the degree of peripheral nerve damage and changes in nociception in patients, and to explore the relationship between the extent and degree of peripheral nerve involvement and changes in nociception. Methods: 106 diabetic patients attending the First Affiliated Hospital of Xinjiang Medical University from December 2020 to April 2021 were selected, and the basic information, laboratory test indexes and sensory conduction velocities of bilateral ulnar, median, common peroneal and tibial nerves in electromyography were collected, and they were divided into no injury, mild injury, moderate injury and severe injury groups according to the sensory nerve conduction velocity values. The visual analogue scale (VAS) scores and pressure pain threshold pressure values were recorded by giving sharp pain stimulation and pressure pain stimulation, respectively. Results: Patients with DM had no significant change in pain thresholds at mild peripheral nerve injury; pressure pain thresholds in the extremities were elevated at moderate peripheral nerve injury; and pressure pain thresholds in both lower extremities decreased at severe peripheral nerve injury. Regardless of sharp pain stimulus pain scores or pressure pain thresholds, pain thresholds decreased at severe peripheral nerve injury. Conclusion: With the change of the degree of diabetic peripheral neuropathy, the pain threshold will change regularly. The change of lower extremity pressure pain threshold is most closely related to the degree of peripheral nerve injury. It is believed that the conduction velocity of right tibial nerve has a great influence on the pressure pain threshold of diabetic peripheral neuropathy patients.