糖尿病神経障害における大径-小径線維機能連関 スドスキャンと神経伝導検査による検討
【目的・方法】2型糖尿病 (T2DM) における小径線維 (SF) と大径線維障害 (LF) の関係を知るために, T2DM患者168名でスドスキャンSudoscan (SS) による電気化学皮膚コンダクタンス (ESC) と神経伝導検査 (NCS) による糖尿病神経障害重症度馬場分類 (BDC) の関係を調べた。SSはフランスで開発された末梢C線維機能検査で本邦未導入であるため, SSの有用性についても検討した。【結果】BDCで検討症例の75%にLF障害が把握された。SSによる足底ESC低下率は47%で, BDC-0度群の21%にESC低下があった。ESC低下度・低下頻度とBDC進行の間には...
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| Published in | 臨床神経生理学 Vol. 51; no. 3; pp. 96 - 104 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
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一般社団法人 日本臨床神経生理学会
01.06.2023
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| Online Access | Get full text |
| ISSN | 1345-7101 2188-031X |
| DOI | 10.11422/jscn.51.96 |
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| Abstract | 【目的・方法】2型糖尿病 (T2DM) における小径線維 (SF) と大径線維障害 (LF) の関係を知るために, T2DM患者168名でスドスキャンSudoscan (SS) による電気化学皮膚コンダクタンス (ESC) と神経伝導検査 (NCS) による糖尿病神経障害重症度馬場分類 (BDC) の関係を調べた。SSはフランスで開発された末梢C線維機能検査で本邦未導入であるため, SSの有用性についても検討した。【結果】BDCで検討症例の75%にLF障害が把握された。SSによる足底ESC低下率は47%で, BDC-0度群の21%にESC低下があった。ESC低下度・低下頻度とBDC進行の間には正の相関 (p<0.001) がみられた。【結論】T2DMではSFとLFが平行的に障害される。SSの診断感度はNCSにやや劣るが, SSはLF障害が軽度な神経障害初期のSF障害把握に有効である。本邦神経障害診療現場への速やかな導入が期待される。 |
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| AbstractList | 【目的・方法】2型糖尿病 (T2DM) における小径線維 (SF) と大径線維障害 (LF) の関係を知るために, T2DM患者168名でスドスキャンSudoscan (SS) による電気化学皮膚コンダクタンス (ESC) と神経伝導検査 (NCS) による糖尿病神経障害重症度馬場分類 (BDC) の関係を調べた。SSはフランスで開発された末梢C線維機能検査で本邦未導入であるため, SSの有用性についても検討した。【結果】BDCで検討症例の75%にLF障害が把握された。SSによる足底ESC低下率は47%で, BDC-0度群の21%にESC低下があった。ESC低下度・低下頻度とBDC進行の間には正の相関 (p<0.001) がみられた。【結論】T2DMではSFとLFが平行的に障害される。SSの診断感度はNCSにやや劣るが, SSはLF障害が軽度な神経障害初期のSF障害把握に有効である。本邦神経障害診療現場への速やかな導入が期待される。 |
| Author | 小川, 吉司 松井, 淳 樽澤, 武房 川嶋, 詳子 小林, 恵輔 三橋, 達郎 馬場, 正之 藤田, 朋之 |
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| References | 3) 馬場正之: 神経伝導検査による糖尿病神経障害の重症度診断. 臨床神経生理学 41: 143–150, 2013. 5) Novak P: Electrochemical skin conductance: a systemic review. Clin Auton Res 29: 17–29, 2019. 29) Lim LL, Fu AWC, Lau ESH, et al: Sudomotor dysfunction independently predicts incident of cardiovascular-renal events and all-cause death in type 2 diabetes: the Joint Asia Diabetes Evaluation register. Nephrol Dial Transplant 34: 1320–1328, 2019. 26) Lefaucheur J-P, Zouari HZ, Gorram F, et al: The value of electrochemical skin conductance measurement using Sudoscan in the assessment of patients with familial amyloid polyneuropathy. Clin Neurophysiol 129: 1565–1569, 2018. 6) Kim S, Cho J, Jun M, et al: Variability of electrochemical skin conductance for screening diabetes mellitus. Biomed Engineer Lett 9: 267–274, 2019. 28) Carbajal-Ramirez A, Hernandez-Dominguez JA, Molyna-Ayala MA, et al: Early identification of peripheral neuropathy based on sudomotor dysfunction in Mexican patients with type 2 diabetes. BMC Neurol 19: 109–115, 2019. 14) International Diabetes Federation: IDF Diabetes Atlas 10th ed. 2021. 21) Miki Y, Tomiyama M, Ueno T, et al: Clinical availability of skin biopsy in the diagnosis of Parkinson’s disease. Neurosci Lett 469: 357–359, 2010. 4) Casellini CM, Parson HK, Richardson MS, et al: Sudoscan, a noninvasive tool for detecting diabetic small fiber neuropathy and autonomic dysfunction. Diabetes Technol Ther 15: 948–953, 2013. 18) Tabako S, Harada M, Sugiyama K, et al: Association of left ventricular myocardia dysfunction with diabetic polyneuropathy. Med Ultrasonogr 46: 69–79, 2019. 2) 日本糖尿病学会: 糖尿病 (性) 足病変. 糖尿病診療ガイドライン2019, 南江堂, 東京, pp 183–193, 2019. 25) Li Y, Yan Z, Han L, et al: The association between phosphorylated neurofilament heavy chain and small fiber neuropathy in patients with impaired glucose tolerance. Diabetes Ther 11: 71–81, 2020. 8) 馬場正之, 鈴木千恵子, 小川吉司: 神経伝導検査による2型糖尿病神経障害の重症度分類: 重症度別に見た足病変, 大血管障害および突然死の発生に関する5年間の前向き研究. 臨床神経生理学 46: 71–77, 2018. 22) Yan A, Issar T, Tummanapalli, et al: Relationship between corneal confocal microscopy and markers of peripheral nerve structure and function in the type 2 diabetes. Diabet Med 37: 326–334, 2020. 1) 佐藤 譲, 馬場正之, 八木橋操六ら: 糖尿病神経障害の発症頻度と臨床診断におけるアイレス腱反射の意義. 糖尿病 50: 799–806, 2007. 20) Verdugo RJ, Matamala J, Inui K, et al: Review of techniques useful for the assessment of sensory small fiber neuropathies: Report from and IFCN expert group. Clin Neurophysiol 136: 13–18, 2022. 19) Mikura K, Kodama E, Iida H, et al: Association between sarcopenia and the severity of diabetic polyneuropathy assesses by nerve conduction studies in Japanese patients with type 2 diabetes mellitus. J Diabetes Invest 13: 1357–1365, 2022. 10) 糖尿病性神経障害を考える会: 糖尿病性多発神経障害 (distal symmetric polyneuropathy) の簡易診断基準. 末梢神経 29: 363, 2018. 13) Vinik A, Smith AG, Singleton R, et al: Normative values for electrochemical skin conductance and impact of ethnicity on quantitative assessment of sudomotor function. Diabetes Technol Ther 18: 391–399, 2016. 12) Smith AG, Lessard M, Reyna S, et al: The diagnostic utility of Sudoscan for distal symmetric peripheral neuropathy. J Diabetes Compl 28: 511–516, 2014. 7) Hussein II, Alshammary SH, Al-Nimer MSM: Assessment of sudomotor function in hypertensive with/without type-2 diabetes patients using SUDOSCAN: An electrophysiological study. Clinical Neurophysiol Pract 6: 22–28, 2021. 15) Suzuki C, Baba M, Kon T, et al: An electrophysiological severity classification system for diabetic polyneuropathy and small fiber dysfunction. Clin Neurophysiol 128: e174, 2017. 16) Iwamoto Y, Nakanishi S, Itoh T, et al: Correlation of Baba’s diabetic neuropathy classification with various diabetes-related complications. Front Endocrinol 13: 1054934. doi: 10.3389/fendo.2022.1054934 9) Himeno T, Kamiya H, Nakamura J: Lumos for the long trail: Strategies for clinical diagnosis and severity staging for diabetic polyneuropathy and future directions. J Diabetes Investig 11: 5–16, 2020. 24) Kennedy WR, Sakuta M, Sutherland D, et al: Quantitation of the sweating deficiency in diabetes mellitus. Ann Neurol 15: 482–488, 1984. 30) Gatev T, Gateva A, Assyov Y, et al: The role of Sudoscan feet asymmetry in the diabetic foot. Prim Care Diab 14: 47–52, 2020. 27) Krieger S-M, Reimann M, Haase R, et al: Sudomotor testing of diabetes polyneuropathy. Front Neurol 9: 803–811, 2018. 17) Fitri A, Sjahrir H, Ichwan M, et al: Predictive model of diabetic polyneuropathy severity based on vitamin D level. Macedonian J Med Sci 30: 2626–2629, 2019. 23) Suzuki C, Kon T, Funamizu Y, et al: Elevated pain threshold in patients with asymptomatic diabetic neuropathy: an intraepidermal electrical stimulation study. Muscle Nerve 54: 146–149, 2016. 11) 成田祥耕: 脛骨神経と腓骨神経の最短F波潜時ノモグラム. 青県病誌 31: 97–100, 1986. 32) Rajan S, Campagnolo M, Callaghan B, et al: Sudomotor function testing by electrochemical skin conductance. Does it really measure sudomotor function? Clin Autonom Res 29: 31–39, 2019. 31) D’Amato C, Greco C, Lombardo G, et al: The diagnostic usefulness of the combined COMPAS 31 questionnaire and electrochemical skin conductance for diabetic cardiovascular autonomic neuropathy and diabetic neuropathy. J Peripher Nerv Syst 25: 44–53, 2020. |
| References_xml | – reference: 24) Kennedy WR, Sakuta M, Sutherland D, et al: Quantitation of the sweating deficiency in diabetes mellitus. Ann Neurol 15: 482–488, 1984. – reference: 8) 馬場正之, 鈴木千恵子, 小川吉司: 神経伝導検査による2型糖尿病神経障害の重症度分類: 重症度別に見た足病変, 大血管障害および突然死の発生に関する5年間の前向き研究. 臨床神経生理学 46: 71–77, 2018. – reference: 27) Krieger S-M, Reimann M, Haase R, et al: Sudomotor testing of diabetes polyneuropathy. Front Neurol 9: 803–811, 2018. – reference: 1) 佐藤 譲, 馬場正之, 八木橋操六ら: 糖尿病神経障害の発症頻度と臨床診断におけるアイレス腱反射の意義. 糖尿病 50: 799–806, 2007. – reference: 31) D’Amato C, Greco C, Lombardo G, et al: The diagnostic usefulness of the combined COMPAS 31 questionnaire and electrochemical skin conductance for diabetic cardiovascular autonomic neuropathy and diabetic neuropathy. J Peripher Nerv Syst 25: 44–53, 2020. – reference: 6) Kim S, Cho J, Jun M, et al: Variability of electrochemical skin conductance for screening diabetes mellitus. Biomed Engineer Lett 9: 267–274, 2019. – reference: 2) 日本糖尿病学会: 糖尿病 (性) 足病変. 糖尿病診療ガイドライン2019, 南江堂, 東京, pp 183–193, 2019. – reference: 21) Miki Y, Tomiyama M, Ueno T, et al: Clinical availability of skin biopsy in the diagnosis of Parkinson’s disease. Neurosci Lett 469: 357–359, 2010. – reference: 16) Iwamoto Y, Nakanishi S, Itoh T, et al: Correlation of Baba’s diabetic neuropathy classification with various diabetes-related complications. Front Endocrinol 13: 1054934. doi: 10.3389/fendo.2022.1054934 – reference: 29) Lim LL, Fu AWC, Lau ESH, et al: Sudomotor dysfunction independently predicts incident of cardiovascular-renal events and all-cause death in type 2 diabetes: the Joint Asia Diabetes Evaluation register. Nephrol Dial Transplant 34: 1320–1328, 2019. – reference: 26) Lefaucheur J-P, Zouari HZ, Gorram F, et al: The value of electrochemical skin conductance measurement using Sudoscan in the assessment of patients with familial amyloid polyneuropathy. Clin Neurophysiol 129: 1565–1569, 2018. – reference: 25) Li Y, Yan Z, Han L, et al: The association between phosphorylated neurofilament heavy chain and small fiber neuropathy in patients with impaired glucose tolerance. Diabetes Ther 11: 71–81, 2020. – reference: 28) Carbajal-Ramirez A, Hernandez-Dominguez JA, Molyna-Ayala MA, et al: Early identification of peripheral neuropathy based on sudomotor dysfunction in Mexican patients with type 2 diabetes. BMC Neurol 19: 109–115, 2019. – reference: 14) International Diabetes Federation: IDF Diabetes Atlas 10th ed. 2021. – reference: 5) Novak P: Electrochemical skin conductance: a systemic review. Clin Auton Res 29: 17–29, 2019. – reference: 22) Yan A, Issar T, Tummanapalli, et al: Relationship between corneal confocal microscopy and markers of peripheral nerve structure and function in the type 2 diabetes. Diabet Med 37: 326–334, 2020. – reference: 9) Himeno T, Kamiya H, Nakamura J: Lumos for the long trail: Strategies for clinical diagnosis and severity staging for diabetic polyneuropathy and future directions. J Diabetes Investig 11: 5–16, 2020. – reference: 20) Verdugo RJ, Matamala J, Inui K, et al: Review of techniques useful for the assessment of sensory small fiber neuropathies: Report from and IFCN expert group. Clin Neurophysiol 136: 13–18, 2022. – reference: 4) Casellini CM, Parson HK, Richardson MS, et al: Sudoscan, a noninvasive tool for detecting diabetic small fiber neuropathy and autonomic dysfunction. Diabetes Technol Ther 15: 948–953, 2013. – reference: 13) Vinik A, Smith AG, Singleton R, et al: Normative values for electrochemical skin conductance and impact of ethnicity on quantitative assessment of sudomotor function. Diabetes Technol Ther 18: 391–399, 2016. – reference: 19) Mikura K, Kodama E, Iida H, et al: Association between sarcopenia and the severity of diabetic polyneuropathy assesses by nerve conduction studies in Japanese patients with type 2 diabetes mellitus. J Diabetes Invest 13: 1357–1365, 2022. – reference: 7) Hussein II, Alshammary SH, Al-Nimer MSM: Assessment of sudomotor function in hypertensive with/without type-2 diabetes patients using SUDOSCAN: An electrophysiological study. Clinical Neurophysiol Pract 6: 22–28, 2021. – reference: 12) Smith AG, Lessard M, Reyna S, et al: The diagnostic utility of Sudoscan for distal symmetric peripheral neuropathy. J Diabetes Compl 28: 511–516, 2014. – reference: 30) Gatev T, Gateva A, Assyov Y, et al: The role of Sudoscan feet asymmetry in the diabetic foot. Prim Care Diab 14: 47–52, 2020. – reference: 17) Fitri A, Sjahrir H, Ichwan M, et al: Predictive model of diabetic polyneuropathy severity based on vitamin D level. Macedonian J Med Sci 30: 2626–2629, 2019. – reference: 3) 馬場正之: 神経伝導検査による糖尿病神経障害の重症度診断. 臨床神経生理学 41: 143–150, 2013. – reference: 10) 糖尿病性神経障害を考える会: 糖尿病性多発神経障害 (distal symmetric polyneuropathy) の簡易診断基準. 末梢神経 29: 363, 2018. – reference: 15) Suzuki C, Baba M, Kon T, et al: An electrophysiological severity classification system for diabetic polyneuropathy and small fiber dysfunction. Clin Neurophysiol 128: e174, 2017. – reference: 23) Suzuki C, Kon T, Funamizu Y, et al: Elevated pain threshold in patients with asymptomatic diabetic neuropathy: an intraepidermal electrical stimulation study. Muscle Nerve 54: 146–149, 2016. – reference: 32) Rajan S, Campagnolo M, Callaghan B, et al: Sudomotor function testing by electrochemical skin conductance. Does it really measure sudomotor function? Clin Autonom Res 29: 31–39, 2019. – reference: 18) Tabako S, Harada M, Sugiyama K, et al: Association of left ventricular myocardia dysfunction with diabetic polyneuropathy. Med Ultrasonogr 46: 69–79, 2019. – reference: 11) 成田祥耕: 脛骨神経と腓骨神経の最短F波潜時ノモグラム. 青県病誌 31: 97–100, 1986. |
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| Snippet | 【目的・方法】2型糖尿病 (T2DM) における小径線維 (SF) と大径線維障害 (LF) の関係を知るために, T2DM患者168名でスドスキャンSudoscan (SS) による電気化学皮膚コンダクタンス (ESC) と神経伝導検査 (NCS) による糖尿病神経障害重症度馬場分類 (BDC)... |
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| Subtitle | スドスキャンと神経伝導検査による検討 |
| Title | 糖尿病神経障害における大径-小径線維機能連関 |
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