Structure-function relationships within peripheral nerves in diabetic neuropathy: The hydration hypothesis
Structure-function relationships within peripheral nerves in diabetic neuropathy: The hydration hypothesis
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DOI：
10.1007/s001250050463
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发表时间：
1996-04-01
期刊：
影响因子：
8.2
通讯作者：
Griffey, RH
中科院分区：
文献类型：
--
作者：
Eaton, RP;Qualls, C;Griffey, RH
为了确定糖尿病状态下神经内膜水肿引起的周围神经结构和功能之间的定量关系，我们通过磁共振波谱测定腓肠神经水合结构的值，并通过神经传导特性（NCV评分）、神经病症状（NS评分）和检查体征（NE评分）评分测定神经功能。在79名平均糖尿病15年的有症状的神经病性糖尿病受试者中，腓肠神经水合系数升高至30 +/-6%（p < 0.05），而在72名非糖尿病对照受试者中，该值为25 +/-3%。相比之下，在75名平均额外6年糖尿病的无症状糖尿病受试者中，平均水合系数仅为28 +/-5%（p < 0.05）。在无症状组中，神经水合过度状态的患病率为25%，其特征是神经水合大于第95百分位数，神经电生理学和神经学检查出现早期变化，但无神经病变。根据神经电生理学恶化对症状性神经病组进行分层，显示神经系统检查（最大NCV评分时RR = 5.39）和神经病变病理学（最大NE评分时RR = 4.80）同时恶化。目前的数据是一致的假设，即神经内膜水肿启动恶化顺序神经电生理，神经系统检查异常的结果，之前的患者的症状性丝袜手套周围糖尿病神经病变的最终看法。
To define the quantitative relationship between peripheral nerve structure and function imposed by endoneurial oedema in the diabetic state, we determined values for sural nerve hydration structure as measured by magnetic resonance spectroscopy, and for neurological function with scores for nerve conduction properties (NCV-score), neuropathic symptoms (NS-score), and examination signs (NE-score). The coefficient of sural nerve hydration was elevated to 30 +/- 6 % (p < 0.05) in 79 symptomatic neuropathic diabetic subjects with an average of 15 years of diabetes mellitus, compared to a value of 25 +/- 3 % in 72 non-diabetic control subjects. In contrast, in 75 asymptomatic diabetic subjects with an average of 6 additional years of diabetes, the mean hydration coefficient was only 28 +/- 5 % (p < 0.05). A nerve hyperhydration state was identified with a prevalence of 25 % within the asymptomatic group characterized by nerve hydration greater than the 95th percentile, early changes in nerve electrophysiology and neurological examination, but with no symptomatology of neuropathy. Stratification of the symptomatic neuropathic group by worsening nerve electrophysiology, demonstrates a coincident deterioration in neurological examination (RR = 5.39 at maximum NCV-score), and neuropathy symptomatology (RR = 4.80 at maximum NE-score). The present data are consistent with the hypothesis that endoneurial oedema initiates deterioration sequentially in nerve electrophysiology, followed by abnormal findings on neurological examination, preceding the patient's final perception of symptomatic stocking-glove peripheral diabetic neuropathy.