天津医药

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接触性热痛诱发电位对糖尿病患者三叉神经功能的评价作用

李倩1,张哲成2,刘娜3,朱炬4,5,张静5   

  1. 1. 天津医科大学三中心临床学院
    2. 天津市第三中心医院
    3. 第三中心医院神经内科
    4.
    5. 天津市第三中心医院神经内科
  • 收稿日期:2010-11-29 修回日期:2011-01-22 出版日期:2011-06-15 发布日期:2011-06-15
  • 通讯作者: 李倩

Trigeminal small-fiber dysfunction assessed with contact heat evoked potential in patients with diabetes mellitus

  • Received:2010-11-29 Revised:2011-01-22 Published:2011-06-15 Online:2011-06-15

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摘要： 【摘要】 目的 探讨接触性热痛诱发电位(CHEP)在评价糖尿病(DM)患者三叉神经功能状态中的应用价值。方法 应用CHEP刺激器对46例DM患者一侧眉弓进行刺激，CZ点记录CHEP N波潜伏期及N-P波波幅，以20例健康志愿者作为对照，同时行同侧的瞬目反射(BR)及面神经直接反应检测。DM患者根据正中神经、尺神经、胫后神经、腓总神经传导结果分为异常组(DMA) 33例与正常组(DMN) 13例。结果 DM组与对照组CHEP N波潜伏期分别为(382.7±36.8)、(342.2±20.8)ms (t=5.465，P=0.000)，N-P波波幅对数值分别为(1.66±0.21)、(1.84±0.24) (t=2.922，P =0.005)；BR R1、R2、R2′潜伏期、R/D值(R1的潜伏期/直接刺激面神经的潜伏期)差异均无统计学意义；DMN组与对照组比较CHEP潜伏期延长；DMA组与DMN组比较波幅对数值减低。结论 糖尿病神经病变不仅累及四肢，三叉神经损伤可与之并存。在BR及大的有髓纤维神经传导正常阶段，三叉神经小纤维即可受损，且在前者异常时更明显。CHEP对评价DM患者颅神经小纤维功能状态具有潜在的临床应用价值。

关键词: 糖尿病, 三叉神经, 诱发电位, 瞬目反射

Abstract: 【Abstract】 Objective To investigate the application value of the contact heat evoked potential (CHEP) for the trigeminal small-fiber dysfunction in patients with diabetes mellitus. Methods Heat stimuli was delivered to the skin above the eyebrow with a contact heat stimulator in 46 diabetic patients and 20 normal subjects. The peak latency of the negative component and the peak-to-peak amplitude of CHEP was recorded at the vertex (Cz). Blink reflex (BR) and direct electrical stimulation of the facial nerve were performed in the same side. The patients with diabetes mellitus were divided into the group with normal conduction (DMN group) and the group with abnormal conduction (DMA group) according to the results of the nerve conduction of the limbs. Results In DM group and the control group, the peak latency of the negative component of CHEP was (382.7±36.8) ms vs (342.2±20.8)ms (t=5.465, P=0.000), the common logarithm of the peak-to-peak amplitude of CHEP was (1.66±0.21) vs (1.84±0.24) (t=2.922, P=0.005). There were no statistical differences between two groups in the latencies of R1、R2、R2′ in BR and R/D ratio(the latency of R1/ the latency of direct electrical stimulation of the facial nerve); The peak latency of the negative component of CHEP in DMN group was longer than that of the control group. The common logarithm of the peak-to-peak amplitude of CHEP was lower in DMA group than that of DMN group. Conclusion Limb nerves may be involved in patients with diabetic neuropathy, the trigeminal nerve can also be involved coexistence of limb nerve injuries; The trigeminal small-fiber dysfunction may occur when BR or nerve conduction of the large myelinated nerve was normal, and becomes obvious when the former was abnormal. CHEP has potential clinical application value in the evaluation of the cranial nerve small-fiber function in patients with diabetes mellitus .

Key words: Diabetes mellitus, Trigeminal nerve, Evoked potentials, Blink reflex