週邊血管及電生理檢查在糖尿病週邊神經病變患者上的關係

Relationship Between Peripheral Vessels and Electrophysiological Examination in Patients with Diabetic Peripheral Neuropathy

目的：糖尿病週邊神經病變是糖尿病微小血管病變的結果。這篇文章目的在於探討糖尿病患者的血管狀態及其神經功能的關係。方法：我們回溯性收集自2012 年1 月至2012 年12 月160 名病患。所有病患進行踝臂指數（ABI），再以ABI<0.9 分成兩組有或無週邊血管疾病（PAD）。我們使用脈搏波傳導速度（baPWV）來測量病患血管硬度。電生理檢查在測量正中神經，脛神經的運動及感覺神經纖維，腓腸神經的感覺纖維，再依測量數據將糖尿病週邊神經病變（DPN）嚴重程度分為不同等級。結果：160位病患（77位男性，83位女性）平均年齡為67.45±11.35 歲。病患 DPN 分級程度越嚴重，與PAD的發生有意義的相關（p<0.01）。在電生理測量中脛神經及腓腸神經的動作電位及傳導速度的下降，還有脛神經及正中神經的晚期反應的延長（F波及H反射）也和PAD的發生有意義的相關（p<0.05）。但是，baPWV數值的增加和 DPN的嚴重程度沒有顯著的關係。baPWV與脛神經和腓腸神經動作電位的減少（p<0.01），還有脛神經的晚期反應的延長具有意義的相關（p<0.05）。結論：DPN 的嚴重程度與PAD 的發生具有意義的相關性。脛神經及腓腸神經動作電位的減少，或是脛神經晚期反應的延長，或許可以預測糖尿病患者血管硬化的風險及PAD的發生。

Purposes: Diabetic peripheral neuropathy (DPN) is a result of diabetic microangiopathy. This study aimed to investigate the relationship between the vascular status of patients with diabetes and their nerve function. Methods: We conducted a retrospective cross-sectional study involving 160 patients from January 2012 to December 2012. We measured the ankle brachial index (ABI) of all patients and divided the patients into two groups, a group with and a group without peripheral arterial disease (PAD), defined as an ABI of <0.9 We assessed arterial stiffness by using brachial-ankle pulse wave velocity (baPWV). Sensorimotor fibers of the median and tibial nerves, and sensory fibers of the sural nerve were measured through electrophysiological examination. DPN severity was divided into different grades in accordance with the measurement data. Results: The mean age of the 160 patients (77 men and 83 women) was 67.45±11.3 years. More severe DPN grades significantly correlated with the occurrence of PAD (p<0.01). Among the electrophysiological measures, a decrease in the action potential and conduction velocity of the tibial and sural nerves, and the prolonged late response of the tibial and median nerves (F-waves and H-reflex) significantly correlated with the occurrence of PAD (p<0.05). However, an increase in baPWV did not significantly correlate with DPN severity. BaPWV significantly correlated with the decrease in the action potential of the tibial and sural nerves (p<0.01), and the prolonged late response of the tibial nerves (p<0.05). Conclusions DPN severity significantly correlated with the occurrence of PAD. The decrease in the action potential of the tibial and sural nerves or the prolonged late response of the tibial nerve may predict the risk of arterial stiffness and the occurrence of PAD in patients with diabetes.