多伦多临床评分系统在糖尿病周围神经病变中的应用价值

Toronto clinical scoring system in diabetic peripheral neuropathy

目的:评价多伦多临床评分系统(Toronto clinical scoring system,TCSS)及其神经病变分级在糖尿病周围神经病变(DPN)中的应用价值,探讨TCSS神经病变分级与糖尿病肾病、糖尿病视网膜病变分期之间的关系。方法:对209例2型糖尿病患者均进行TCSS检查,以神经电生理检查作为诊断DPN的金标准,与TCSS≥6分的结果进行比较,确定在该人群中TCSS诊断DPN的合适截断点。结果:TCSS≥6分的诊断正确率、灵敏度、特异度分别为76.6%,77.2%,75.6%,对应的约登指数及Kappa值分别为0.53及0.52,提示TCSS≥6分与神经电生理检查的一致性较好;TCSS神经病变分级与糖尿病肾病、糖尿病视网膜病变的分期呈线性正相关(P<0.05);该评分合适的截断点为5分或6分。结论:TCSS对DPN的诊断价值较高,其神经病变分级有临床应用价值。

Objective To evaluate the application value of Toronto clinical scoring system （ TCSS ） and its grading of neuropathy for diabetic peripheral neuropathy （ DPN ） , and to explore the relationship between TCSS grading of neuropathy and the grading of diabetic nephropathy and diabetic retinopathy. Methods A total of 209 patients of Type 2 diabtes （ T2DM ） underwent TCSS. Taking electrophysiological examination as a gold standard for diagnosing DPN, We compared the results of TCSS score ≥ 6 with electrophysiological examination, and tried to select the optimal cut-off points of TCSS. Results The corresponding accuracy, sensitivity, and specificity of TCSS score ≥6 were 76.6% , 77.2% , and 75.6% , respectively. The Youden index and Kappa were 0.53 and 0.52,which implied TCSS score ≥ 6 had a moderate consistency with electrophysiological examination. There was a linear positive correlation between TCSS grading of neuropathy and the grading of diabetic nephropathy and diabetic retinopathy （ P 〈 0.05 ）. The optimal cut-off point was 5 or 6 among these patients. Conclusion TCSS is reliable in diagnosing DPN and its grading of neuropathy has clinical value.