İnce Lif Hasarı Olan Diabetik Nöropatili Hastalarda KDT (Kantitatif Duyusal Test) Değerlendirmesi

Year 2005, Volume: 22 Issue: 4, 141 - 145, 31.12.2009

F. Ülger G. Köknel Talu A. Yücel

Abstract

Diabetes mellitus sonucunda ortaya çıkan nöropatik ağrı yakınması, hastaların önemli klinik problemleri arasında yer almaktadır. Diabetik nöropatiye bağlı ağrı ince lif hasarından kaynaklanıyor ise elektromiyografi (EMG) ile gösterilememektedir. Bu hasta grubunda olası hasar "Kantitatif Duyusal Test" (KDT) ile gösterilebildiği gibi tedavi etkinliğinin izlemi için de kullanılabilmektedir.
Çalışmaya 22'si kadın, 22'si erkek olmak üzere toplam 44 hasta alındı. Eldiven ve çorap tarzında nöropatik ağrı şikayeti olan, EMG'si normal 44 hastanın soğuk duyarlılığı (CD), sıcak duyarlılığı (SD), soğuk ağrı eşiği (CAE) ve sıcak ağrı eşikleri (SAE) değerlendirildi. Hastaların yaşları 20-72 (48.9±13.0) arasındaydı. Nöropatik ağrı yakınmaları 3-18 aydır (10.40±5.27) devam etmekte olan hastaların, 39'u oral antidiabetik, 5'i ise insülin ile tedavi edilmekteydiler. Hastaların kan şekerleri 125-198 mg/dl (154±18.86) ölçülmüş ve VAS (Visual Analoge Skala) (0-10) değerleri ortalaması CAE için 6.50±1.73, SAE için 5.65±1.92 olarak değerlendirilmiştir.
KDT sonuçları incelendiğinde 44 hastanın 4'ünde (%9.1) CD, 7'sinde (%15.9) SD, 25'inde (%56.8) CD+SD saptanmıştır. Toplam 36 hastada (%81.8) algılama bozukluğu saptanmıştır. 2 hastada (%4.6) SAE, 28 hastada (%63.6) CAE ve 7 hastada (%15.9) SAE+CAE ile ağrı eşik değerlerinin bozulduğu belirlenmiştir. Sonuç olarak KDTnin nöropatik ağrı tanımı ve izle-minde EMG'nin yetersiz kaldığı durumlarda en az EMG kadar objektif bir değerlendirme yöntemi olduğu kanısına varılmıştır.


QST (Quantitative Sensorial Testing) Evaluation for the Diabetic Neuropathy Patients with Thin Fiber Damage

Evaluation of QST (Quantitative Sensorial Testing) who diabetic patients have neuropatic pain with thin fiber damage. Thin fiber damage doesn't show with EMG at the patients who have diabetes mellitus depends on clinic neuropatic pain. In this patient group probable damage can show with QST also it can use efficacy of treatment observation. The patient group of 44 with diabetes have glove and socket like neuropatic pain, patients have normal EMG with the practice aim of QST their CS (cold sensation), WS (warm sensation), CPT (cold pain threshold), HPT (hot pain threshold) follow-up. In studied for 44 patients, 22 women-22 men admitted to diabetic. The average age of patients was 20-72 (48.97±13.07), their neuropatic pains were continuing for 3-18 months (10.40±5.27). 39 patients treated with oral antidiabetic and 5 of them treated with insulin. The average of blood glucose values were 125bmg/dl-198 mg/dl (154±18.86). The average VAS values on admission were 0-10 for CPT (6.5±1.73), HPT (5.65±1.92). QST evaluations were performed when we followed-up the evaluation of QST it determined 9.1% CS at 4 patients, 15.9% WS at 7 patients, 56.8% CS+WS at 25 patients of 44 patients. At 36 of patients 81.8% determinated sensation damage. QST evaluations of 37 patients were performed, HPT 4.6% at 2 patients, CPT 63.6% at 28 patients, HPT+CPT 15.9% at 7 patients 15.9% HPT+CPT identified pain threshold.
As a result it's understood that follow-up and definition of neuropatic pain QST is an objective evaluation method as EMG.

Keywords

-

References

• Woolf CJ, Mannion RJ. Neuropathic Pain: etiology symptoms, mechanisms and management, The Lancet 1999; 353: 1695–700.
• Zaslansky R, Yarnitsky D. Clinical application of quantitative sensory testing (QST), Journal of the neurological Sciences 1998; 153: 215–238.
• Shy ME, Frohman EM. Quantitative sensory testing, Report of the Therapeutics and Technology Assessment Subcommittee of American Academy of Neurology Neurology 2003; 60: 898–904.
• Kramer HH, Rolke R. Bickel A, et al. Thermal Thresholds Predict Painfulness of Diabetic Neuropathies, Diabetes Care 2004; 27: 2386–2391.
• Young MJ, Boulton AJM, Mcleod AF, et al. A multicenter study of prevalence of diabetic peripheral neuropathy in the United Kingdom Hospital clinic population Diabetologia 1993; 36: 150–154.
• Navarro X, Kenedy WR, Fries TJ, et al. Small nerve fibre dysfunction in diabetic neuropathy. Muscle Nerve 1989;126: 498–507.
• Smith SJ, Ali Z, Fowler CJ, et al. Cutaneous thermal thresholds in patients with painful burning feet. J. Neurol. Neurosurg. Psychiatry 1991; 5410: 877–881. 8. Arezzo JC, Schamburg HH, Laudadio C, et al. Thermal sensitivity tester. Device for quantitative assessment of thermal sense in diabetic neuropathy. Diabetes1986; 355: 592.
• Ziegler D, Mayer P, Gries FA, et al. Evaluation of thermal pain, and vibration sensation thresholds in newly diagnosed type I diabetic patients. J. Neurol. Neurosurg. Psychiatry 1988; 5111: 420–1424.
• Navarro X, Kennedy WR. Evaluation of thermal and pain sensitivity in type I diabetic patients. J. Neurol. Neurosurg. Psychiatry 1991; 541: 60–64.
• Claus D, Hilz MJ, Neundorfer B, et al. Thermal d i s c r i m i n a t i o n threshold: a comparison of different methods. Acta Neurol. Scand. 1990; 816: 533–540.
• Levi D, Abraham R, Reid G, et al. A comparison of two methods for measuring thermal thresholds in diabetic neuropathy. J. Neurol. Neurosurg. Psychiatry 1989;52: 1072–1077.
• Veves A, Young MJ, Manes C, et al. Differences in peripheral and autonomic nerve function measurement in painful and painless neuropathy. A clinical study. Diabetes care 1994; 1710: 120–122.