NTSS-6评分在糖尿病周围神经病变中的诊断价值

The value of NTSS-6 score in diagnosis of diabetic peripheral neuropathy

目的探讨NTSS-6评分在糖尿病周围神经病变中的诊断价值。方法 283例2型糖尿病患者,依据神经肌电图检查是否异常分为DPN组和NDPN组。用ROC曲线评价NTSS-6评分在DPN中的诊断价值,并比较单独用神经肌电图以及联合NTSS-6评分后DPN的检出率的变化。结果①在收集的病例中DPN发生率为53.4%,其中合并DPN组有更长的病程、较高的血糖、HbA1c、BMI、WHR、TG、hsCRP及NTSS-6评分,较低的INS和DBP;②下肢腓总神经感觉神经传导速度与WHR、病程、FBS、HbA1c呈负相关。Logistic回归分析显示,病程、WHR、HbA1c为糖尿病周围神经病变的独立危险因素;③ROC曲线示NTSS-6评分的最佳切割点为3.995分(灵敏度=0.848,特异度=0.561),其曲线下面积为0.703;④联合神经肌电图和NTSS-6评分DPN的检出率高于单独使用神经肌电图的检出率。结论①病程、WHR、HbA1c为糖尿病周围神经病变的独立危险因素;②NTSS-6评分可作为早期筛查糖尿病周围神经病变的方法之一;③神经肌电图检查联合NTSS-6评分可提高DPN检出率。

【Objective】 To evaluate the value of NTSS-6 score in diagnosis of diabetic peripheral neuropathy（DPN）.【Methods】 283 patients with type 2 diabetes were divided into two groups according to the ADA diagnosis criteria of DPN.Receiver operation curve（ROC） was used to measure the value of NTSS-6 score in diagnosis of DPN.【Results】 ①Disease duration,FBS,PBS,HbA1c,BMI,WHR,TG and hsCRP were higher in patients with DPN than those in patients without DPN.In contrast,concentration of serum insulin and level of diastolic blood pressure were lower than those in patients without DPN.② There was a negative association among the nerve conduction velocity（NCV） of nervus peroneus communis and disease duration,FBS,HbA1c,WHR.Logistic regression analysis showed that Disease duration,WHR and HbA1c were independent risk factors of DPN.③ ROC showed that NTSS-6 score ≥3.955 may be used as the threshold for diagnosis DPN（sensitivity=0.848,specificity=0.561）.The area under curve（AUC） of NTSS-6 score was 0.703.④ In our study,ratio of DPN diagnosed by combining impaired NCV and NTSS-6 score was significantly higher than the ratio of DPN diagnosed only by impaired NCV（P =0.000）.【Conclusions】 ① Disease duration,WHR and HbA1c were correlated with the incidence of DPN.② NTSS-6 score ≥3.995 may be one of the early clue for diagnosing DPN.③ Combined using the methods of NCV and NTSS-6 score was helpful in improving the diagnosis rate of DPN.