2012-08-012024-05-17https://scholars.lib.ntu.edu.tw/handle/123456789/685447摘要：小纖維神經包括小直徑有髓鞘及無髓鞘神經纖維，主要負責溫覺、疼痛及自律功能。小纖維神經病變是糖尿病常見的併發症。臨床上，糖尿病小纖維神經病變最擾人的症狀是神經痛，包各種自發性痛及誘發痛等。雖然目前可利用皮膚切片診斷糖尿病小纖維神經病變，但是並無客觀且可量化之檢查可以評估小纖維神經病變所造成神經痛之生理變化。接觸性熱刺激器是一項新的工具可以快速同步性地活化皮膚內之小纖維神經，藉由不同刺激溫度及位置，可以分別活化溫覺或是痛覺的神經。將之搭配多頻道腦波記錄，可以得到熱刺激感覺誘發電位及相關腦波頻譜之變化，可以用來評估溫痛覺的傳導路徑及與溫痛覺相關腦區之電生理變化。因為小纖維神經病變及神經痛可能與溫痛覺傳導及大腦對於溫痛刺激的反應之異常有關，因此接觸性熱刺激器搭配多頻道腦波記錄將提供一個新的檢查可以探討小纖維神經病變所致之神經痛。本計畫將結合皮膚切片、感覺神經功能測試、傳統神經生理檢查及接觸性熱刺激器併多頻道腦波記錄針對糖尿病小纖維神經病變併神經痛進行研究。藉由探討熱刺激感覺誘發電位及相關腦波頻譜之變化在有或無神經痛之糖尿病神經病變及正常人身上之差異，以瞭解神經痛之生理機制，並發展新的治療策略。<br> Abstract: Small-fiber neuropathy, of which the neuropathic pain is the predominant feature, is achallenge for the neurologists. It is a common component of neuropathy associated with manysystemic disorders including diabetes mellitus which is a prevalent and important disease topublic health in Taiwan. In the past, the diagnosis of diabetic small-fiber neuropathy is usuallybased on subjective symptoms and clinical findings. Recently skin biopsy with quantificationof intraepidermal nerve fiber density and quantitative sensory test are used for the evaluation,and small-fiber neuropathy is usually associated with skin denervation and abnormal thermalsensation. However the distinction between the diabetic neuropathy with and withoutneuropathic pain is not clear and there is no evaluating tool to provide the physiologicalconsequences of small-fiber nerve dysfunction.Contact heat evoked potential (CHEP) stimulator, using a newly developed heat-foiltechnology, can create a rapid heating and cooling rate (70 and 40 °C/sec). CHEP stimulatorcan deliver thermal stimuli repeatedly to skin and can activate the receptors of small-fibernerves including Ad or C fibers through different temperature of stimuli. When combinedwith multiple-channels electroencephalography, the brain evoked potentials and brainoscillating activities related to thermo-nociceptive stimulus can be recoded. It provides anon-invasive and objective tool to investigate the physiology of neurological pathwaymediating the thermal sense and pain transmission and perception.The current study is aimed to investigate the physiological changes of thermonociceptivepathway in diabetic small-fiber neuropathy with neuropathic pain. Combining skin biopsywith morphological evaluation, quantitative sensory test, conventional nerve conduction studyand by applying contact heat stimuli with multiple-channel EEG recording, we will explore (1)The differences in skin innervations and contact heat evoked potentials between diabeticneuropathy with and without neuropathic pain; (2) The physiological changes ofspinothalamic tracts in diabetic painful neuropathy; (3) The difference of frequency spectrumand power in resting EEG between diabetic neuropathy with and without neuropathic pain;and (4) the changes of brain oscillating activities under acute or tonic contact heat stimuli indiabetic painful neuropathy.小纖維神經病變糖尿病糖尿病神經病變神經痛皮膚切片接觸性熱刺激誘發 電位腦波small-fiber neuropathydiabetes mellitusdiabetic neuropathyneuropathic painskin biopsycontact heat evoked potentialselectroencephalograhy