刘兴洲 焦劲松 李光伟 孙少杰 毛坤 耿同超 王国相

    100029 北京，中日友好医院神经科(刘兴洲、焦劲松、孙少杰、毛坤、耿同超、王国相)，内分泌科(李光伟) 中华神经科杂志 1998 0 31 3


    关键词：糖尿病；神经病；近段；H-反射；；神经传导 期刊 zhsjkzz 0 *论著* fur -->


    

【摘要】 目的 证实糖尿病近段神经病的存在以及H-反射在糖尿病近段神经病中的诊断作用。方法 通过经典的H-反射和顺向周围神经传导检测方法，对正常组176条胫神经、糖尿病组268条胫神经进行对比研究。正常胫神经H波潜伏期(HL)多元回归方程8.2+0.5×腿长(cm)+0.06×年龄(岁)，再加3.6ms (2s)为建议的正常参考值上限。结果 44.0%(118/268)糖尿病组胫神经HL延长。糖尿病组胫神经中，74.6%(200/268)HL大于95%正常参考值上限，明显高于感觉神经传导速(38.5%)和运动神经传导速(43.3%)检测的阳性率(χ² =115.6,P<0.0001)。结论 H-反射较常规周围神经传导检测具有更高的诊断敏感性，糖尿病近段神经病的发生可能远较临床诊断的频度为高。

    Diagnostic yield of the tibial nerve H-reflex in diabeticproximal neuropathy Liu Xingzhou, Jiao Jinsong, Li Guangwei, et al. China-Japan Friendship Hospital, Beijing 100029

    【Abstract】 Objective To evaluate thefrequency of proximal neuropathy in diabetes mellitus and the clinical application ofH-reflex in the diagnosis of diabetic proximal neuropathy. Methods Soleus H- reflex and orthodromic conduction for sensory and motornerves (SCV, MCV) were performed in 176 tibial nerves of normal controls and 268 tibialnerves of diabetic patients. An analysis of the simultaneous regression of H latency (HL)on the ages and leg lengths in normal subjects, produced the formula as 8.2+0.5×(leglength)+0.06 ×(age). Results The H- reflexes werediagnosed to be delayed in latency in 44.0% (118/268) tibial nerves of the diabeticgroups, if adding 3.6 ms(2s) to the predicted normal value was taken as the upper limit.When 95% normal limit was used for the significance test, 74.6% (200/268) tibial nerves inHL, 53.4% (140/262) in H amplitude, and 49.1% (84/171) in H/M ratio in the diabetic groupwere attributed to be abnormal. In orthodromic nerve conduction, 38.5% (101/262) tibialnerves in SCV, 35.9%(94/262) in sensory action potentials, 43.3% (29/67) in MCV in thediabetic group, were diagnosed as abnormal.The difference of diagnostic sensitivitybetween the H-reflex and the nerve conduction velocity was significant (P<0.0001).Conclusion Among the H-reflex, sensory and motornerve conduction studies, HL was approved to be the most sensitive parameter to diagnosediabetic neuropathy. Compared with distal conduction, a high frequency of H-reflexabnormality suggests that the metabolic and (or) ischemic mechanism may play an importantrole in diabetic neuropathy.

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