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目的探讨定量温度阈值检测(QTT)在糖尿病性小纤维神经病变的诊断应用。方法对120例糖尿病患者分别进行QTT,包括冷感觉阈值(CT)、热感觉阈值(TT)、冷痛觉阈值(CPT)、热痛觉阈值(HPT);神经传导研究(NCS)和皮肤交感反应(SSR)检测,并对其结果进行统计学分析。结果①QTT、NCS、SSR异常率分别为90.83%、25.83%和57.50%,3组比较差异均具有统计学意义(P<0.05)。②CT、TT、CPT、HPT异常率分别为39.58%、47.29%、64.58%、71.67%,TT异常率高于CT,HPT异常率高于CPT,差异有统计学意义(P<0.05)。③下肢CT、TT、CPT、HPT异常率分别为51.67%、94.58%、62.08%、85.00%;上肢CT、TT、CPT、HPT异常率分别为22.33%、34.59%、32.5%、58.33%,下肢CT、TT、CPT、HPT异常率均高于上肢,差异有统计学意义(P<0.05)。④糖尿病患者在无、轻、中、重症状4组中CT异常率分别为19.17%、31.25%、43.94%、76.19%;TT异常率分别为41.67%、58.33%、75.76%、90.48%;CT和TT异常率随临床症状递增,组间两两比较,差异具有统计学意义(P<0.05),CPT和HPT则无此现象。结论冷感觉阈值、热感觉阈值是诊断DPN,特别是细小有髓和无髓纤维神经病变的敏感指标。
Objective To investigate the diagnostic value of quantitative temperature threshold (QTT) in the diagnosis of diabetic fibrillary neuropathy. Methods QTT was performed in 120 patients with diabetes mellitus, including cold sensation threshold (CT), thermal sensation threshold (TT), cold pain threshold (CPT), thermal pain threshold (HPT), nerve conduction study (NCS) and skin sympathetic response SSR) test, and the results were statistically analyzed. Results ① The abnormal rates of QTT, NCS and SSR were 90.83%, 25.83% and 57.50%, respectively. The differences among the three groups were statistically significant (P <0.05). The abnormal rates of CT, TT, CPT and HPT were 39.58%, 47.29%, 64.58% and 71.67% respectively. The abnormal rate of TT was higher than that of CT. The abnormal rate of HPT was higher than that of CPT (P <0.05). The abnormal rates of CT, TT, CPT and HPT in lower extremities were 51.67%, 94.58%, 62.08% and 85.00% respectively; the abnormal rates of CT, TT, CPT and HPT in upper limbs were 22.33%, 34.59%, 32.5% and 58.33% The abnormal rates of CT, TT, CPT and HPT were higher than those of the upper limbs, the difference was statistically significant (P <0.05). ④ The abnormal rates of CT in 4 groups of diabetic patients with no, mild, moderate and severe symptoms were 19.17%, 31.25%, 43.94% and 76.19%, respectively. The abnormal rates of TT were 41.67%, 58.33%, 75.76% and 90.48% respectively. CT And TT abnormality rate increased with the clinical symptoms. The differences between the two groups were statistically significant (P <0.05), while CPT and HPT did not. Conclusions Cold sensation threshold and thermal sensation threshold are sensitive indicators for the diagnosis of DPN, especially for small myelinated and unmyelinated fiber neuropathy.