赖明君 潘小平 苏常春

【摘要】 目的：研究糖尿病合并轻度腕管综合征（carpal tunnel syndrome，CTS）的电生理特点和早期诊断方法。方法：收集临床表现符合糖尿病合并轻度CTS的患者，行26只患手的检查。选取性别和年龄相匹配的单纯轻度CTS患者和健康人各26只手作为对照。结果：与健康对照组相比，糖尿病合并轻度CTS组和单纯轻度CTS组均正中神经末端潜伏时延长，指4正中和尺神经感觉传导峰潜伏时差值增大，差异均有统计学意义（P<0.01）。糖尿病合并轻度CTS组正中神经运动传导速度较另外两组减慢，差异均有统计学意义（P<0.05）。在糖尿病合并輕度CTS组与单纯轻度CTS组，正中神经指4的感觉传导速度均明显低于指3的感觉传导速度，差异均有统计学意义（P<0.01）。结论：糖尿病合并轻度CTS与单纯轻度CTS有不同的神经电生理表现，指4正中尺感觉潜伏时对比法有助于轻度CTS（糖尿病与非糖尿病）的早期诊断。

【关键词】 糖尿病; 轻度腕管综合征; 神经电生理; 神经运动传导速度; 指4正中尺感觉潜伏时对比法

【Abstract】 Objective：To study the electrophysiological characteristics and early diagnosis of mild carpal tunnel syndrome（CTS）in diabetic patients.Method：26 cases of diabetic patients with mild CTS were examined.26 patients with idiopathic mild CTS and 26 healthy subjects matched by gender and age were selected as controls.Result：Compared with the healthy control group，both the diabetic mild CTS group and the idiopathic mild CTS group had prolonged terminal latency，lager diffierences between median and ulnar sensory latency peak sensory latencies of digit 4，and the differences were statistically significant（P<0.01）.The median nerve motor conduction velocity in the diabetic mild CTS group was lower than that those in the other two groups，and the differences were statistically significant（P<0.05）.In the diabetic mild CTS group and idiopathic mild CTS group，the sensory conduction velocity of the median nerve in digit 4 were significantly lower than those in digit 3，the differences were statistically significant（P<0.01）.Conclusion：Diabetic patients with mild CTS have different neuroelectrophysiological manifestations than those with idiopathic mild CTS.The digit 4 median ulnar sensory latency contrast test is helpful for early diagnosis of mild CTS（diabetic or non-diabetic）.

【Key words】 Diabetic; Mild carpal tunnel syndrome; Neuroelectrophysiology; Nerve motor conduction velocity; Digit 4 median ulnar sensory latency contrast methodFirst-authors address：Guangzhou First Peoples Hospital，Guangzhou 510180，China

doi：10.3969/j.issn.1674-4985.2019.15.032

腕管综合征（carpal tunnel syndrome，CTS）是一种临床最常见的嵌压性单神经损害[1]。腕管是一个狭窄表浅的U型骨槽，底部和两侧面为腕骨，顶部为腕横韧带包绕，正中神经在腕管处易受到卡压而损害[2]。表现为手麻、灼烧感或疼痛、夜间更重，可放射至整个上肢，后期出现手部无力或大鱼际肌萎缩[3]。腕管综合征多见于手工劳作者，优势手更先受累或更严重，女性及肥胖者多见[4-5]，糖尿病是腕管综合征的危险因素[6-7]。国外报道糖尿病周围神经病患者中合并CTS的发病率为30%，糖尿病合并CTS的患病率为14%[8]，国内报道糖尿病患者合并CTS的患病率为41.9%[9]。……