震动感觉阈值检查对老年糖尿病周围神经病变的诊断价值

Clinical Application of Vibration Perception Threshold in Diagnosis of elderly Diabetic Peripheral Neuropathy

目的:糖尿病周围神经病变(DPN)是糖尿病最常见的慢性并发症之一,危害严重,而大部分患者早期无症状,以致延误了早期诊断,失去了早期治疗的机会。目前DPN的筛查方法众多,但尚无确定有效的筛查方法。震动感觉阈值检查(VPT)在发达国家已广泛应用于糖尿病神经病变的临床筛查,但目前国内很少应用。本文旨在探讨VPT对老年糖尿病周围神经病变的临床应用价值。方法:采用数字震动感觉阈值检查仪、128 Hz音叉检测40例老年2型糖尿病患者(DM组)和36例非糖尿病老年人(对照组)的VPT和音叉震动觉,与神经传导速度(NCV)进行对比分析。结果:40例DM组中有周围神经病症状18人(45%),音叉震动觉减弱17例(42.5%),VPT异常21例(52.5%),NCV异常24例(60%)。以NCV检查结果作为诊断金标准,评价VPT的敏感性79.2%,特异性87.5%。结论:VPT检查是一种特异、敏感、有效、简便的DPN早期筛查方法,能及早发现严重并发症的高风险人群,适合常规的门诊筛查。VPT检测结合临床症状、体征,能更方便、可靠地诊断老年糖尿病周围神经病变,对于DPN的疾病风险、早期干预、评价预后非常重要。

Objective：Diabetic peripheral neuropathy（DPN） is one of the most frequent complications of diabetes with severely harmful consenquences.Most of the patients have no symptoms in the early prophase with the result that early diagnosis wes delayed and chances of early treatment were lost.There are many screening methods of DPN,but none effective has been found.We intended to investigate the diagnostic value of vibration perception threshold（VPT） in elderly diabetic peripheral neuropathy.Methods：VPT and tuning fork vibration sense of 40 cases of elderly type 2 diabetes mellitus and 36 cases of control group were studied and contrastive analysis was done between VPT and nerve conductive velocity（NCV）.Results：18 cases presented with peripheral nerve disorder,17 cases had decreased tuning fork vibration sense.21 patients demonstrated decreased VPT and 24 had abnormality of NCV.Sensibility of VPT was 79.2 % and specificity was 87.5 % based on the gold diagnostic criteria.Conclusions：VPT is a convenient and accurate screening method with high specificity and sensitivity to detect DPN in its early periods.It is helpful to find the severe complications in high risk population and fit to apply in out-patients.The early diagnosis of DPN can be determined by VPT combined with other symptoms and signs which are very important for the risk prediction,early intervention and prognosis evaluation.