多种物理检查方法对糖尿病周围神经病变早期诊断价值的评估

Evaluation of several physical methods in the early diagnosis of diabetic peripheral neuropathy

目的探讨足外观、针刺觉检查、温度觉检查、踝反射、10 g尼龙丝、128 Hz音叉(TF)、振动感觉阈值(VTP)检查单用及联合应用(足部综合评分)在糖尿病周围神经病变(DPN)早期诊断中的应用价值。方法选取符合入选条件的2型糖尿病患者115例及100例健康正常人作为对照进行神经传导速度(NCV)检查,同时行足外观、针刺觉检查、温度觉检查、踝反射、10 g尼龙丝、128 Hz TF及振动感觉阈值(VTP)检查。以NCV作为"金标准"计算各种检查单独应用及各联合应用的敏感度、特异度和相对危险度(RR)。结果以NCV检查为标准,足外观敏感度最高(97.30%),但特异度仅27.75%,10 g尼龙丝最低(13.51%),特异度为92.49%。结论足部综合评分(剔除踝反射、针刺觉)可以作为一种简便、易行的方法应用于DPN的早期筛查。

Objective To assess the value of foot appearance examination,pain sensation examination,temperature sensation examination,ankle-reflex examination,10g monofilament test,128 Hz tuning fork(TF),vibration perception threshold(VPT) alone or joint applications(combined foot score of diabetes) on the early diagnosis of diabetic peripheral neuropathy(DPN).Methods 115 random selected patients with type 2 diabetes and 100 healthy controls were measured with nerve conduction velocity(NCV),foot appearance,pain sensation,temperature sensation,ankle-reflex examination,10g monofilament test,128 Hz tuning fork(TF),vibration perception threshold(VPT).The nerve conducting velocity(NCV) detecting with electromyogram was used as standard criteria,the sensitivity,specificity,Relative Risk(RR) of these tests alone or joint applications were analyzed.Results Check the NCV as the standard,full appearance of the highest sensitivity(97.30%),but specificity of only 27.75%,10g Nylon lowest(13.51%),specificity was 92.49%.Conclusion Foot score of diabetes(Combined tests with foot appearance examination,temperature sensation examination,10g monofilament test and 128 Hz TF) can be well applicable in clinical screening for DPN.