Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Distal Simetrik Nöropati Tanısı Almış Diyabetik Hastalarda Otonom Nöropatinin Klinik ve Elektrofizyolojik Testler ile Araştırılması
Investigation of Autonomic Neuropathy in Diabetic Patients with Distal Symmetric Neuropathy Via Clinical and Electrophysiological Tests
Gülten TUNALIa, Zeynep BEBEK YILMAZa, Yüksel BEKb
aNöroloji AD,
bBiyoistatistik ve Tıp Bilişimi AD, Ondokuz Mayıs Üniversitesi Tıp Fakültesi, Samsun
Turkiye Klinikleri J Med Sci. 2014;34(2):152-64
doi: 10.5336/medsci.2013-35210
Article Language: TR
Full Text
ÖZET
 Amaç: Otonom nöropati; diyabetin sık rastlanan, ciddi, hatta ölümcül bir komplikasyonudur. Bu çalışmanın amacı, otonomik fonksiyonları diyabete bağlı distal simetrik polinöropatisi olan hastalarda, klinik ve elektrofizyolojik testlerle araştırmaktır. Gereç ve Yöntemler: Bu çalışma, diyabete bağlı distal simetrik nöropati tanısı alan 50 hasta (hasta grubu) ile sağlıklı gönüllülerden oluşan 30 bireyde (kontrol grubu) yapıldı. Hasta ve kontrol grubundaki bireylere otonomik fonksiyonları değerlendirmek üzere sempatik deri yanıtı (SDY), ve RR interval değişkenliği (RRIV) çalışıldı, ve elektrokardiyografi (EKG) ile düzeltilmiş QT (QTc) ve düzeltilmiş QT dispersiyonu (QTcd) hesaplandı. Kontrol ile hasta grubunun verileri kıyaslandı. Otonomik testlerin duyarlılık ve özgüllük oranları ölçüldü. Bulgular: SDY'si sadece ayaktan/hem ayak ve hem de elden kayıtlanamadığı 44 hastanın %98'inde otonomik fonksiyon bozukluğuna ait yakınma mevcuttu. SDY kaydedilemeyen olgularda ''Survey of Autonomic Symptom (SAS)'' skorlarının, SDY kaydedilen gruba kıyasla daha yüksek olduğu gözlendi. Hasta grubunda, RRIV'nin tüm parametreleri kontrol grubuna kıyasla çok belirgin olarak düşük bulundu (p<0,001). Tüm parametreler arasında duyarlılık ve özgüllük oranları en yüksek olan parametreler; RRIVD ve RRIVD- RRIVR Idi. QTc ve QTcd değerlerinin kıyaslamasında, hasta grubunda kontrol grubuna göre istatistiksel yönden çok anlamlı (p<0,001) artışlar saptandı. Gerek QTc ve gerekse QTcd'nin duyarlılık ve özgüllük oranları yüksek saptandı. Ayrıca gerek RRIV ve gerekse QTc/QTcd ile SAS puanları arasında anlamlı korelasyonlar saptandı. Sonuç: Sonuç olarak; diabetes mellitus hastalarında otonomik fonksiyonların değerlendirilmesinde SDY, RRIV ve QTc-QTcd çok değerli elektrofizyolojik testlerdir. Çalışmamız bu testlerin birlikte uygulanmasının daha yararlı olacağını göstermiştir.

Anahtar Kelimeler: Diabetes mellitus; diyabetik nöropatiler; polinöropatiler
ABSTRACT
 Objective: Diabetic autonomic neuropathy is a common, serious and even fatal complication. The aim of this study was to investigate the autonomic functions in diabetic patients with distal symmetric polyneuropathy, via clinical and electrophysiological tests. Material and Methods: This study was performed on 50 patients with diabetic distal symmetric neuropathy (patient group) and 30 healthy volunteer subjects (control group). To assess autonomic functions, sympathetic skin response (SSR) and RR interval variability (RRIV) were studied, and the corrected QT interval (QTc) and QT dispersion (QTcd) were calculated with electrocardiography (ECG) in both patient and control groups. Data obtained from the control and the patient groups were compared. The sensitivity and specificity of the autonomic tests were measured. Results: In 98% of 44 patients, foot or both foot and hand SSR could not be registered. Survey of autonomic symptoms (SAS) scores were higher in the patient group in whom SSR could not be recorded when compared to the patient group in whom SSR could be recorded. Almost all the parameters of RRIV (RR interval variation) were significantly lower in the patient group when compared to the control group (p<0.001) The highest sensitivity and specificity among all RRIV parameters belonged to RRIVD and RRIVD- RRIVR. Highly statistically significant (p<0.001) increases in QTc and QTcd values were detected in the patient group in comparison with the control group. The specificity and sensitivity rates of both QTc and QTcd were higher. In addition, significant correlations were found between both RRIV and QTc/QTcd, and the scores of SAS. Conclusion: Our results have shown that SSR, RRIV and QTc-QTcd are very valuable electrophysiological tests for evaluation of autonomic functions in diabetes mellitus patients. Our study also showed that application of these tests together would be more useful.

Keywords: Diabetes mellitus; diabetic neuropathies; polyneuropathies

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