臺灣博碩士論文加值系統

背景與目的：糖尿病周邊神經病變好發於糖尿病病患，據文獻指出，高達50%的糖尿病患者會出現此併發症。糖尿病周邊神經病變的發生與罹患糖尿病的時間以及血糖控制有關，症狀多為麻木感、針刺感、灼熱感等等，好發區域多為手腳末梢。時至今日，醫學上並沒有一個良好的方式處理糖尿病周邊神經病變所造成的問題，將血糖控制在良好的範圍是病患最核心的目標，近年來亦有許多研究著墨在藥物控制以及運動介入等方式。神經鬆動術是物理治療臨床上常用的技術之一，多被用來處理腰椎神經疾患、腕隧道症候群以及其他有關周邊神經病變的問題。先前的研究指出，糖尿病周邊神經病變之病患接受神經鬆動術一次以及維持十五天，振動閾值皆有顯著的改善。因此，本篇研究希望探討神經鬆動術對於糖尿病周邊神經病變病患的神經病變症狀以及神經生理學等改善效益。
研究方法：研究中共收錄16名第二型糖尿病及周邊神經病變之病患。受試者被分為兩組，神經鬆動術組接受物理治療師的神經鬆動術治療，兩側皆治療一組十五次，一次治療中共會做三組，每週三次維持六週；藥物治療組的受試者則服用由神經科醫師所開立的藥物美可敏（Mecomin），每天服用三次維持六週。受試者在治療前後都會接受評估，其中項目包括密西根神經病變量表（MNSI）、直膝抬腿測試（SLR test）、神經傳導測試檢查（NCV tests）以及發炎物質檢測（Cytokine Analysis）。
結果：經過六週的介入治療後，我們可以發現到在神經鬆動術組的受試者，在密西根神經病變量表的得分有顯著性的下降(p〈0.05)；在兩腳的直膝抬腿測試中，關節活動度（Range of Motion）也有顯著性的增加(p〈0.05)，然而，在藥物治療組的右腿卻在治療後有顯著性的下降(p〈0.05)。神經傳導測試的部分，脛神經的傳導速度僅在神經鬆動術組的左腳有顯著性的改善(p〈0.05)，右腳僅有些微上升而未達統計上的顯著差異(p〉0.05)；然而，我們在神經鬆動術組的腓神經則發現了雙側的顯著性改善(p〈0.05)。在發炎物質的檢測中，腫瘤壞死因子-α（TNF-α）以及介白素-1β（IL-1β）並未在治療前後抑或是兩組間發現顯著差異(p〉0.05)，另一方面，在介白素-6（IL-6）的檢測中則發現到神經鬆動術組在治療前後有顯著的增加(p〈0.05)。
結論：透過密西根神經病變量表、直膝抬腿測試、神經傳導測試檢查以及發炎物質檢測等等結果，研究中發現六週的神經鬆動術後可以改善糖尿病周邊神經病變患者的神經病變症狀以及神經傳導速度，神經鬆動術將是未來具有潛力的治療選項之一，在未來的研究中期望能夠更進一步探究神經鬆動術改善糖尿病周邊神經病變之機制。

Background and Purpose: Diabetic peripheral neuropathy (DPN) is quite common in patients with Diabetes mellitus (DM) over long period of courses. The symptoms are numbness, tingling, burning pain and so on. To date, there is still no decisive intervention for the DPN patients. Neural mobilization is commonly applied on the patients with lumbar radiculopathy, carpal tunnel syndrome and other problems of peripheral nerve. Previous studies showed the improvements in vibration perception threshold (VPT) while DPN patients received neural mobilization immediately and for 15 times, respectively. Therefore, the purpose of this study was to investigate the effects of neural mobilization on neuropathic symptoms and neurophysiologic functions in DPN patients.
Methods: This study recruited 16 type 2 patients with DPN. Participants received a 6-week intervention program, of which contained two types of treatment. One was the Neural mobilization (NM group) of L/E, 3 sessions per week for 6 weeks. The other one was the Mecomin (500mcg/cap) (MED group) TID for 6 weeks prescribed by neurological physician.
Results: NM group had lower score in Michigan Neuropathy Screening Instrument (MNSI) after intervention (p〈0.05). In Straight-Leg Raise (SLR) test, both legs of NM group had significantly increased in range of motion (ROM), while ROM of right side of MED group decreased post-intervention (p〈0.05). According to Nerve Conduction Velocity (NCV) tests, the left tibial nerve conduction velocity had significantly improved in NM group, nevertheless, we didn’t find statistically significant difference in right side of NM group. For the common peroneal nerve, there was significantly improved in both sides of NM group after intervention. In cytokines analysis, we didn’t note significant change in TNF-α and IL-1β in both groups. However, IL-6 had statistically significant reduction in NM group post-intervention.
Conclusion: Depending on the results in MNSI, SLR test, NCV tests and cytokines analysis, we suggested neural mobilization would be a potential modality for managing problems of DPN. Further study is required for precise mechanism of neural mobilization affecting the pathophysiology of DPN.

摘要.............i
Abstract.............iii
誌謝.............v
List of figures.............vii
List of tables.............viii
List of appendices.............ix
Abbreviation.............x
Introduction.............1
Methods.............8
Results.............12
Discussion.............18
Conclusions.............23
References.............24
Figures.............31
Tables.............38
Appendices.............41

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