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دور تخطيط العضلات احادي الليف على مرضى اعتلال الاعصاب المحيطية السكري وعلاقته بمؤشرات الاكسدة == The Role of Single Fiber Electromyography In Patients With Diabetic Neuropathy And Its Relation To Oxidative Stress Parameters
Author name:
زاهد محمد علي كاظم
Supervisor name:
احسان محمد عبود عجينة
General topic:
Medicine
Specific topic:
Physiology
Degree:
Doctorate
University:
University of Kufa - Faculty Of Medicine - Department Of Physiology And Medical Physics
Language:
English
University location:
Najaf
First pages:
19T1118 - p.pdf
Abstract:
الخلفية : يعتبر اعتلال الاعصاب المحيطية السكري من اكثر مضاعفات داء السكري شيوعا التي تؤثر على الاوعية الدموية الدقيقة. سريريا يؤثر المرض اولا على الاطراف القصيه مؤديا الى فقدان الاحساس في تلك الاطراف على نمط الجورب والقفاز. يؤثر المرض على كل من الالياف ال | Background : diabetic peripheral neuropathy (DPN) is the most common microvascular complication of diabetes mellitus (DM). Clinically, it affects the most distal extremities first resulting in a stock and glove pattern of sensory loss. It affects both small fibers (myelinated and un - myelinated) as well as the large myelinated nerve fibers. However, the earliest manifestations might be due to small fiber dysfunction. Hyperglycaemia and subsequent metabolic derangement is the main pathogenitic factor of DPN. However, oxidative stress, deficiency of neuroprotective factors and neurovascular insufficiency might play a role.AIMS : This study aims to : 1. Test the value of applying SFEMG in the diagnosis of diabetic peripheral neuropathy. 2. Determine the usefulness of SFEMG, compared to the standard NCS, in the early diagnosis of diabetic peripheral neuropathy. 3. Evaluate the correlation of the antioxidant/oxidant status in patients with and without diabetic peripheral neuropathy.Materials and methods : The study was conducted in the period from Nov. 2012 till Apr. 2014 and included 188 patients with type 2 DM that fall within age group of 45 - 65 years. Diabetics that suffer from clinical features of peripheral nerve dysfunction documented with abnormal electrophysiological findings were considered as patients with DPN (138 patients) and those who had no complaint of peripheral nerve dysfunction with normal electrophysiological study were considered as patients without DPN (50 patients). The study also included normal healthy persons who their age and gender matched that patients and considered as control subjects (50 persons). The patients and control enrolled in the study had undergone comprehensive assessment that included : clinical assessment (history and full examination), biochemical assessment (measurement of fasting blood sugar, glycated haemoglobin, total antioxidant capacity and advanced glycation end products) and electrophysiological assessment that included sensory and motor nerve conduction studies (NCS) with single fiber electromyography (SFEMG).Results : The study found that patients with DPN in comparison to patients without DPN and control subjects are older (p?0.05), had longer duration of DM (p?0.01), poorer glycemic control reflected by fasting blood sugar (p?0.01) and glycated haemoglobin (p?0.01), lower level of total antioxidant capacity (p?0.01) and higher advanced glycation end products level (p?0.01). Also, the study showed that the level of total antioxidant capacity and advanced glycation end products on one hand were correlated with the duration of the diabetes (p?0.01) and not correlated with glycated haemoglobin level on the other hand.The electrophysiological findings showed that patients with DPN had significant differences in NCS parameters when compared to patients without DPN and to control subjects in the form of axonal degeneration and demyelination with abnormal single fiber jitter and fiber density which were correlated with the duration of diabetes (p?0.01) but not correlated with glycemic control. Also the study demonstrated that SFEMG findings were correlated with NCS parameters (namely sural nerve) in patients with DPN. This study had concluded that the duration of diabetes, age, glycemic control and oxidative stress are important risk factors of DPN. Routine NCS is important mean for diagnosing DPN but it has limited sensitivity in the diagnosis of early stages of the disease and in assessing nerve degeneration and regeneration. Sensory nerves of lower limbs are helpful in discovering early stages of DPN when other tested nerves are normal. SFEMG examination in diabetic patients is important in showing the degree of re - innervation and nerve regeneration and in identification of subclinical nerve dysfunction.
