To explore the role of electromyography in the diagnosis of DPN
2019-06-10
Do you know DPN?
Diabetic Peripheral Neuropathy (DPN) is a complication characterized by sensory impairment of the extremities and pain. Generally, lower extremities are more severe than upper extremities.
It refers to the nervous system damage caused by chronic hyperglycemia and various pathophysiological changes caused by diabetes mellitus, which can involve any part of the peripheral nervous system of the whole body, and can lead to foot ulcers, gangrene and amputation. It is the most common cause of non-traumatic amputation, which has a serious impact on the quality of life of patients; while diabetic autonomic neuropathy can affect all parts of the body. Systematic and serious consequences, especially cardiac autonomic neuropathy (CAN), have a very high rate of disability and mortality.
What are the symptoms of DPN?
Sensory abnormalities include numbness, ant walking, insect crawling, fever and electric shock, often reaching the knee from the distal toe, and patients feel like wearing socks and gloves. Lower extremity arthropathy and ulcer may occur in patients with severe sensory impairment. Pain is tingling, burning, drilling pain, as if deep in the bone marrow pain, sometimes severe pain such as amputation pain is light day and night. Sometimes there is tactile allergy, and even can not bear the pressure of quilts, quilts must be supported. When motor nerve involvement occurs in time, muscle strength often decreases to varying degrees, and malnutritional muscle atrophy occurs in the late stage. Peripheral neuropathy can be bilateral, unilateral, symmetrical or asymmetrical, but bilateral symmetry is more common.
The role of electromyography
Electromyogram (EMG) refers to the electromyogram of muscle recorded by an electromyograph.
To explore the diagnostic value of EMG for DPN, we mainly used to detect the sensation of ulnar nerve, median nerve, tibial nerve and common peroneal nerve, as well as the details of motor conduction velocity, nerve F wave and nerve H wave, and then to judge whether there were pathological changes in peripheral nerve of patients. Among them, the H reflex of the tibial nerve is considered as the longest reflex arc in the human body. If a lesion occurs in a segment of the tibial nerve, it will cause H reflex abnormality.
The Present Situation of DPN
According to the survey and statistics of diabetic patients hospitalized by the Chinese Medical Association in 1990s, the incidence of peripheral neuropathy in diabetic patients was 60.3%, and the most common were distal symmetrical polyneuropathy and DAN.
Today, the incidence of peripheral neuropathy in diabetic patients abroad is 8%-100%, while the incidence of peripheral neuropathy in domestic diabetic patients is 10%-100%, and it is increasing with time.
clinical research
120 patients with diabetes mellitus were selected as the research object. The abnormal characteristics of nerve conduction, F wave, skin sympathetic response (SSR) and their correlation with clinical symptoms were analyzed. The results showed that in DPN patients, the number of abnormal nerve conduction in lower limbs was significantly higher than that in upper limbs, and the highest rate of sensory conduction without waveform was tibial nerve. Peroneal nerve is the highest in motor conduction, and the abnormal amplitude of sensory nerve is more serious than motor nerve. The shortest latency of F wave in tibial nerve and median nerve was higher than that in median and tibial nerve DML. The level of glycosylated hemoglobin was negatively correlated with sensory nerve conduction velocity and wave amplitude, and the occurrence rate of course and F wave was positively correlated with the conduction velocity and wave amplitude of ulnar nerve and tibial nerve. It was negatively correlated with ulnar nerve complex muscle motor potential and sensory nerve conduction velocity.
Come to conclusion
Among 120 patients, 46 patients with peripheral neuropathy had abnormal results after EMG examination. Of the remaining 74 patients, 32 had abnormal EMG. The accuracy of EMG in diagnosing diabetic peripheral neuropathy was 65.0%. The effective rate of clinical diagnosis of diabetes mellitus was 38.3%. Compared with clinical diagnosis, the diagnostic rate of EMG was significantly higher.
So we can conclude that:
The accuracy of EMG in diagnosis of diabetic peripheral neuropathy was 65.0%.
In the past, clinical nervous system examination is commonly used to check whether diabetic patients have peripheral neuropathy. The detection rate of this method is low, which needs to be combined with the clinical manifestations of patients to draw conclusions. Therefore, for early patients, it is more disadvantageous. In recent years, with the wide use of EMG in clinical practice, the detection rate of this disease has increased significantly.
At the same time, I hope you can persist in exercising, cultivate good habits, and have a healthy and strong body.
