糖尿病周邊神經病變患者的運動能力及平衡表現

Exercise Capability and Balance Performance in Patients with Diabetic Neuropathy

由於糖尿病合併周邊神經病變患者之感覺神經或感覺動作神經之缺損，可能影響其運動及平衡能力，本研究主要目的在比較不同症候程度周邊神經病變之第2型糖尿病患者的運動及平衡能力，並探討可能造成這類廳患能力下降之主要機制。本研究包含22位合併有周邊神經病變的第2型糖尿病患，11名（4男7女）神經病變症狀分數 2分者為第一組， 3分為第二組（明顯神經症狀組）。所有受試者除接受休息之血糖和心博量等量測外，另接受平衡能力（感覺整合測試、單腳站立時間、計時起走測試）、最大運動測試以及下肢肌、耐力的測試。本研究以Mann-Whitney U Test比較兩組各測量值之差異，以Spearman’s rank correlation coefficient來探討運動與平衡表現各測量值間的相關性，p<0.05表示有統計上之顯著差異。兩組之基本資料及休息時測量參數均無明顯差異，然而第二組病患單位體重之最大攝氧量（13.7±2.9 ml/min/kg vs. 17.8 ±3.2 ml/min/kg）、肌力（1.3±0.3N-m/kg vs.1.8±0.5 N-m/kg）、單腳站立時間（17.1±15.5sec vs.。37.1±12.8 sec）及第六種感覺整合測試（36.6±25.2% vs. 61.9±8.4%）明顯低於第一組（p<0.05）。單位體重之最大肌力與最大攝氧量、單腳站立時間和總平衡分數明顯相關（r 分別為0.74、0.55和0.47，p<0.05）。症狀明顯之周邊神經糖尿病患之單位體重的股四頭肌力與最大攝氧量、第六種感覺整合測試分數、單腳站立時間明顯較差。肌力是影響運動和平衡能力的重要因素，建議相關的肌力和平衡訓練宜包含在這類病人的整體照護計畫內。

Peripheral neuropathy is a major complication of diabetic mellitus resulting in significant impairments. The purpose of this study was to compare exercise capability and balance performance in patients with different diabetic neuropathy severity measured by Modified Neuropathy Symptom Scores (NSS). Twenty-two patients were studied and were grouped into 1 (NSS≦2) or 2 (NSS≧3). All subjects then underwent a maximal exercise test and maximal oxygen consumption (VO2max) was obtained. Stroke volume at rest and during exercise as well as muscle strength and endurance of the left quadriceps were measured. Balance performance was evaluated with sensory organization test (SOT), unipedal stance time, and timed up and go test. Nonparametric Mann-Whitney U test was used to compare variables between groups. Correlations between different variables were analyzed by Spearman’s rank correlation coefficients. Group 1 had significantly lower values in VO2max (13.7±2.9 ml/min/kg versus 17.8 ±3.2 ml/min/kg), muscle strength (1.3±0.3N-m/kg versus 1.8±0.5 N-m/kg), unipedal stance time (17.1±15.5sec versus 37.1±12.8 sec), and SOT condition 6 (36.6±25.2% versus 61.9±8.4%) than that of group 2. Muscle strength significantly correlated with VO2max (r=0.74), unipedal stance time (r=0.55), and average balance score (r=0.47). the average balance score significantly correlated with all the variables, except for SOT condition 2, unipedal stance time, timed up ad go test, and muscle endurance. Our results showed that the severity of peripheral neuropathy symptoms did affect the exercise capacity and balance performance in patients with diabetic mellitus and the potential mechanism might due to different muscle strength among them. We suggest that muscle strengthening should be an integrated part of interventions for patients with diabetic neuropathy.