应用孟菲斯神经功能评分筛选糖尿病周围神经病变的特异性及敏感性

Specificity and sensitivity of diabetic peripheral neuropathy screened by Michigan neuropathy screening instrument

目的:探讨孟菲斯神经功能评分检查评估糖尿病周围神经病变的作用,并与神经传导速度检查结果进行比较。方法:①选择2003-02/2004-04昆明医学院第二附属医院内三科住院及门诊就诊的糖尿病患者80例,男38例,女42例;2型糖尿病67例,1型糖尿病13例。均对检测项目知情同意。②在入院时对80例患者进行孟菲斯神经功能评分:足部外观:正常为0分,异常为1分,异常包括包括足部畸形、皮肤干燥、裂开、感染;踝反射:足跖屈为阳性(1分),无反应为阴性(0分),两者之间为可疑(0.5分);大拇趾振动觉:如患者完全感受不到音叉振动则为振动觉缺失(1分)。左右两侧合计总分>2分为阳性。③采用五通道肌电诱发电位仪测定80例患者神经传导速度检查。孟菲斯神经功能评分检查敏感性=孟菲斯神经功能评分阳性患者中经神经传导速度检查有2条或2条以上神经病变患者数/神经传导速度检查有2条或2条以上神经病变患者总数×100%。特异性=孟菲斯神经功能评分阴性患者中无周围神经病变患者数/神经传导速度检查无神经病变患者总数×100%。④结果以百分比形式表示。结果:糖尿病周围神经病变患者80例均进入结果分析。①孟菲斯神经功能评分检测中,足背振动觉异常率最高(包括振动觉减退与缺失),达55%(44/80);足部外观异常及有溃疡者共约占11%(9/80),而且一般伴有足背振动觉或踝反射的异常。②在神经传导速度检查中腓肠神经与腓总神经病变率最高,分别达59%(41/80),38%(30/80)。③80例糖尿病患者中,在41例孟菲斯神经功能评分检查阳性的患者中,37例有糖尿病周围神经病变(神经传导速度检查有2条或2条以上神经病变),4例正常(神经传导速度检查有1条或无神经病变)。39例评分阴性的患者中,9例患有糖尿病周围神经病变,30例正常。孟菲斯神经功能评分检查诊断糖尿病周围神经病变的敏感性为80%,特异性为88%。结论:①足部外观的异常和足部溃疡可能是糖尿病周围神经病变渐趋严重的表现。②糖尿病周围神经病变时下肢神经最易受累。③孟菲斯神经功能评分检查诊断糖尿病的敏感性和特异性好,分别为80%和88%。

AIM： To discuss the role of Michigan neuropathy screening instrument （MNSI） in evaluating diabetic peripheral neuropathy, and compare with the results of nerve conduction velocity examination. METHODS： Eighty diabetic patients （38 males and 42 females）, including 67 type 2 diabetic patients and 13 type 1 diabetic patients, were selected from the outpatients and inpatients hn the Second Affiliated Hospital of Kunming Medical College from February 2003 to May 2004. All the 80 patients were evaluated with MNSI at admission： Appearance of feet： 0 for normal appearance, and 1 for abnormal appearance, the latter included deformed, dry skin, callus, infection; Ankle reflexion： foot flexion as negative （0 point）, irresponsivity as positive（1 point）, between the above two as doubtful （0.5 point）; Vibration perception at great toe： 1 for apallesthesia （patient could not feel fork vibration）. When the total score was over 2, the result of MNSI was taken as positive. The nerve conduction velocity was examined with 5-passage electromyograph and evoked instrument. Sensibility of MNSI=number of patients with positive MNSI and at least 2 abnormal nerves through performed nerve conduction/number of patients who at least had 2 abnormal nerves through performed nerve conduction ×100%. Specificity of MNSI= number of patients with negative MNSI/number of patients with normal nerve conduction ×100%.RESULTS： All the 80 patients with diabetic peripheral neuropathy were involved in the analysis of results. ①Among the indices of MNSI, vibration perception at great toe had the highest abnormal rate （55%, 44/80）; 11% of the patients （9/80） had abnormal appearance of feet and/or ulceration, and they always had abnormal ankle retlexion or abnormal vibration perception at great toe at the same time. ②Among the nerve conduction velocity examination, sural nerve and peroneal nerve had the highest abnormal rate, which were 59% （41/80） and 38% （30/80）. ③Of the 80 diabetic patients, the MNSI was positive in 41 cases, including 37 patients had diabetic peripheral neuropathy with the score of MNSI 〉 2, and 9 patients had diabetic peripheral neuropathy with score of MNSI ≤ 2; The MNSI score was negative in 39 cases, including 9 cases had diabetic peripheral neuropathy and 30 cases were normal. The sensitivity of MNSI for diagnosis of diabetic peripheral neuropathy was 80%, and the specificity was 88%. CONCLUSION： ①lt is suggested that diabetic peripheral neuropathy is more serious when the abnormal appearance of feet and/or ulceration appears. ② Nerves of lower limbs have the most probability of being damaged in diabetic patients. ③MNSI has good sensitivity and specificity in the diagnosis of diabetic peripheral neuropathy, which are 80% and 88% respectively.