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目的 探讨泌汗神经功能与外周动脉疾病(PAD)的关系,评估与踝臂指数(ABI)、趾臂指数(TBI)相比,使用泌汗神经功能检测筛查PAD的有效性.方法 选取2014年8月-2015年4月在解放军第306医院糖尿病诊疗中心就诊的263例糖尿病患者,采用多普勒法检测ABI、TBI.Sudoscan仪检测患者手足掌电化学皮肤传导率(ESC)评估泌汗神经功能,同时检测患者心血管自主神经病变(CAN)并记录心脏自主神经病变风险评分(CAN-RS).结果 患者的手ESC、足ESC值与ABI、TBI值呈正相关.ABI、TBI异常的糖尿病患者手ESC[(45.63±12.87) μS,(59.17±19.58) μS]、足ESC[(44.54±25.48) μS,(59.21±24.52) μS]较ABI、TBI值正常患者的手ESC[(68.10±17.40) μS,(68.57±17.11) μS]、足ESC[(70.92±19.46) μS,(71.71±19.02) μS]低(P＜0.05),ABI、TBI异常的糖尿病患者CAN-RS值较ABI、TBI值正常者高[(49.17±15.41)％比(36.33±16.25)％,(44.90±16.09)％比(35.39±16.05)％;P＜o.05].以ABI作为PAD的诊断标准,手ESC、足ESC及CAN-RS的受试者工作特征曲线(ROC)下面积分别为0.87,0.84和0.74(P＜0.001).结论 泌汗神经功能检测有助于筛查糖尿病患者的外周动脉疾病.

Objective To explore the relationship between sudomotor function and peripheral artery disease (PAD),and to evaluate the effectiveness of sudomotor function testing to screen diabetic patients at high risk of PAD comparing to ankle-brachial index (ABI) and toe-brachial index (TBI).Methods A total of 263 diabetes mellitus (DM) outpatients in the 306th Hospital of PLA from August 2014 to April 2015 were enrolled in the study.ABI and TBI were measured by the Doppler method.Sudomotor function was evaluated by measuring the electrochemical skin conductance (ESC) of the hands and feet using the Sudoscan instrument.Cardiovascular autonomic neuropathy (CAN) was assessed and recorded as cardiac autonomic neuropathy risk-score (CAN-RS) by Sudoscan.Results ESC values of the feet and hands were positively correlated with ABI and TBI.The diabetes patients with abnornal ABI and TBI had significantly lower hand ESC [(45.63±12.87) μS vs.(68.10±17.40) μS,(59.17±19.58) μS vs.(68.57±17.11) μS;P＜ 0.05] and feet ESC [(44.54±25.48) μS vs.(70.92±19.46) μS,(59.21±24.52) μS vs.(71.71±19.02) μS;P＜ 0.05],and higher CAN-RS[(49.17± 15.41)％ vs.(36.33±16.25)％,(44.90±16.09)％ vs.(35.39±16.05)％;P＜ 0.05],than diabetes patients with normal ABI and TBI.Using ABI as the gold standard,the areas under the receiver operating characteristics (ROC) curve of the diagnostic performance of hands ESC,feet ESC and CAN-RS to identify PAD were 0.87,0.84 and 0.74,respectively (P＜0.001).Conclusion Sudomotor function testing can be helpful and beneficial to identify PAD in patients with diabetes.