·糖尿病神经病变·糖尿病周围神经病变多种筛查方法诊断效率的比较侯瑞芳汤正义张炜凌丹芸吴景程张连珍毛羽丰王卫庆李小英宁光作者单位:200025上海交通大学医学院附属瑞金医院内分泌代谢病科,上海市内分泌代谢病临床医学中心通讯作者:汤正义,E2mail:zhypty@sh1631net【摘要】目的在2型糖尿病(T2DM)中评估多伦多临床神经病变评分(TCSS)、密西根神经病变筛查量表(MNSI)、糖尿病神经病变症状评分(DNS)及音叉、5107/10g单丝检查在筛查糖尿病周围神经病变(DPN)中的应用价值。方法对419名T2DM患者进行TCSS、MNSI、DNS评分的评估及音叉、5107/10g单丝检查,以神经系统检查、神经电生理检查、温度觉和振动觉检查的综合评估作为DPN的诊断标准,用ROC曲线评价这5种筛查法。结果年龄、糖尿病病程、出现神经病变症状的时间,DPN与非DPN组间均有显著差异(P均<01001)。TCSS、MNSI、DNS评分及音叉、5107/10g单丝检查与神经传导速度(NCV)、温度觉和振动觉均有显著相关性(P均<01001),其中TCSS与NCV及温度觉的相关性最好;5种筛查方法的ROC曲线下面积分别是01855、01679、01669、01716、01599,灵敏度分别为7919%、6014%、6213%、4317%、2015%,特异度分别为7715%、6819%、6715%、9913%、9913%,TCSS与临床客观检查符合性最好。结论筛查DPN的方法不能过于简单化,应综合症状、体检和简单辅助工具进行。【关键词】糖尿病周围神经病变;筛查试验;ROC曲线ComparisonofeffectivenessamongfivescreeningtestsfordiabeticperipheralneuropathyHOURui2fang,TANGZheng2yi,ZHANGWei,etal.DepartmentofEndocrinologyandMetabolism,ShanghaiClinicalCenterforEndocrineandMetabolicDiseases,RuijinHospital,affiliatedtoShanghaiJiaoTongUni2versitySchoolofMedicine,Shanghai200025,ChinaCorrespondingauthor:TANGZheng2yi,E2mail:zhypty@sh163.net【Abstract】ObjectiveFivesimplescreeningtests,includingTorontoclinicalscoringsystem(TC2SS),Michiganneuropathyscreeninginstrument(MNSI),Diabeticneuropathysymptomscore(DNS),vi2brationtestingbya1282Hztuningfork,and10gsemmes2weinsteinmonofilamentexamination(SWME),wereanalyzedinT2DMtoevaluatetheeffectivenessfordiabeticperipheralneuropathy(DPN).Methods419patientswithtype2diabetesmellitusunderwentthemeasurementsofDPNwithTCSS,MNSI,DNS,1282Hztuningforkand10g2SWME.DPNwasdiagnosedbyneurologicalexamination,motorandsensorynerveconductionvelocity,vibrationperceptionthreshold,andwarmandcoldthermalperceptionthreshold.TheeffectivenessofthefivetestswasassessedbyusingROCcurveanalysis.ResultsThereweresignificantdifferencesinage,durationofdiabetes,durationofsymptomsfordiabeticneuropathybe2tweentwogroups(allPvalue<01001).AllfivescreeningtestsweresignificantlyassociatedwithNCV,warmandcoldthermalperceptionthresholdandvibrationperceptionthreshold(allPvalue<01001).TCSSshowedthebestcorrelationwithNCVandthermalperceptionthreshold.AreaundertheROCcurvevaluesforTCSS,MNSI,DNS,tuningforkand10g2SWMEtestwere01855,01679,01669,01716,01599,respec2tively.Theoptimalcut2pointsofthemprovidedsensitivityof7919%,5111%,6213%,4317%,2015%,andspecificityof7715%,7915%,6715%,9913%,9913%,respectively.ConclusionsForscreeningDPN,simpletooltestsarenotalwaysreliableandtheresultsfromgeneralclinicalexaminationmaybeagoodway.·19·中国糖尿病杂志2008年第16卷第2期ChinJDiabetes,February2008,Vol16,No2【Keywords】Diabeticperipheralneuropathy;Screeningtests;ROCcurve;糖尿病周围神经病变(DPN)是糖尿病最常见的慢性并发症之一[1],目前DPN的筛查方法很多,如多伦多临床神经病变评分(TCSS)[2]、密西根神经病变筛查量表(MNSI)[3]、糖尿病神经病变症状评分(DNS)[4]及128Hz音叉检查[5]、单丝检查[6]等,经过大量临床使用论证,都有一定的应用价值,但由于各自的侧重点不同,实际诊断效率差别较大,且相互比较的...
