音叉联合尼龙丝检查在糖尿病周围神经病变筛查中的价值

Value of 128 Hz tuning fork combined with 10 g monofilament in screening of diabetic peripheral neuropathy

目的探索128 Hz音叉检查、10 g尼龙丝检查及其联合检查在糖尿病周围神经病变(DPN)筛查中的适用性。方法对233例2型糖尿病患者进行神经传导速度(NCV)检查、密歇根神经病变筛选法(MNSI评分)、128 Hz音叉检查、10 g尼龙丝检查及10 g尼龙丝联合128 Hz音叉检查。以NCV检查作为"金标准",计算各种方法诊断DPN的敏感性、特异性、阳性预测值、阴性预测值、准确度及一致性。结果MNSI评分>2分、128 Hz音叉检查≥0.5分、10 g尼龙丝检查≥1分和10 g尼龙丝检查≥1分联合128 Hz音叉检查≥0.5分与NCV诊断DPN的一致性κ值分别为0.69、0.55、0.33及0.57。结论128 Hz音叉联合10 g尼龙丝检查有望DPN早期筛查中得以推广,其推广次序依次是MNSI评分、128 Hz音叉联合10 g尼龙丝检查、128 Hz音叉检查和10 g尼龙丝检查。

Objective To investigate the efficiency of 128 Hz tuning fork, 10 g monofilament test, and the combination of both in screening of diabetic peripheral neuropathy （DPN）. Methods A total of 233 patients with type 2 diabetes underwent the following tests： Nerve conduct velocity （NCV） examination, Michigan neuropathy screening instrument （MNSI）, 128 Hz tuning fork, 10 g monofilament, and the combination of the latter 2. The outcomes of NCV were taken as the golden standard, and the sensitivity, specificity, positive and negative predictive values, accuracy, Youden＇s index and kappa values were analyzed for each test. Results MNSI, 128 Hz tuning fork, 10g monofilament examination, and the combination of the latter 2 had a kappa value of 0.69, 0. 55, 0. 33 and 0. 57, respectively. The scores of the 3 test were MNSI〉2, 128 Hz tuning for κ≥0.5, 10 g monofilament examinational. Conclusion The combination of 128 Hz tuning fork and 10 g monofilament should be popularized in diagnosis of DPN. The efficacies of the tests, from high to low, are MNSI, 128 Hz tuning fork combined with 10 g monofilament, 128 Hz tuning fork and 10 g monofilament.