目的 比较不同的神经电生理检测方法对糖尿病患者胫神经损害的诊断价值.方法 应用EMG仪对63例确诊2型糖尿病患者进行单侧胫神经运动传导速度(MCV)及感觉传导速度(SCV)、F波及H反射检测,比较四者的诊断阳性率.结果 本组63例糖尿病患者胫神经四种检查方法阳性率从高到低依次为H反射(76.19%)、F波(53.97%)、SCV(36.51%)、MCV(17.46%)(均P<0.05).本组中43例无周围神经临床症状和体征的糖尿病患者胫神经四种检查方法阳性率从高到低依次为H反射(76.74%)、F波(55. 81%)、SCV(32.56%)、MCV(13.95%)(均P<0.05).本组63例糖尿病患者中反映神经远端传导功能的神经传导速度总异常率为44.44%(28/63),而反映神经近端传导功能的H反射与 F波总异常率为80.95%(51/63),二者比较差异有统计学意义(χ2=17.952,P<0.01).结论 四种不同的电生理检测方法可以较全面反映胫神经远近端的损害,糖尿病患者胫神经损害不仅仅限于远端,其近端亦容易受损.四种检测方法中H反射阳性率更高,可以更早发现胫神经的亚临床病变.%Objective To compare the diagnostic value of different electrophysiological examination methods for tibial nerve damage in diabetic patients.Methods The motor nerve conduction velocity(MCV)and sensory nerve conduction velocity(SCV),F waves and H-reflex of unilateral tibial nerve was measuerd by electromyography in 63 patients with type 2 diabetas mellitus, and the diagnostic positive rate of which were compared.Results In this group,the positive rate of the tibial nerve in 63 patients with diabetes from high to low was H-reflex(76.19%), F waves(53.97%),SCV(36.51%)and MCV(17.46%)(all P<0.05).Form all cases,the positive rate of the tibial nerve in 43 patients without clinical symptoms and signs from high to low was H-reflex(76.74%), F waves (55.81%),SCV(32.56%)and MCV(13.95%)(all P<0.05).In all cases,the total abnormal rate of nerve conduction velocity was 44.44%(28/63),the total abnormal rate of H-reflex and F waves was 80.95%(51/63),the difference between the two rates was statistically significant(χ2=17.952,P<0.01).Conclusions Four different electrophysiological detection methods can comprehensively reflect the proximal and distal injuries of tibial nerve,the tibial nerve damage in diabetics is not limited to the distal end, but is also vulnerable to proximal injuries.The positive rate of H reflex is higher in the four methods,and the subclinical lesions of tibial nerve can be found more.
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