不同评分量表在糖尿病周围神经病变筛查中的比较研究

Comparison study of different scoring systems on screening peripheral neuropathy of diabetic patients

目的 比较密歇根神经病变筛查评分系统（MNSI）、密歇根糖尿病神经病变评分（MDNS）、多伦多临床评分系统（TCSS）在糖尿病周围神经病变（DPN）筛查中的价值,寻求简单、快捷、准确的筛查手段.方法 选取我院327例2型糖尿病患者,对其分别行MNSI、MDNS、TCSS和神经电生理检查,以神经电生理检查为金标准,分析各量表的灵敏度、特异度、准确度、阳性预测值、阴性预测值、约登指数、K值及ROC曲线下面积,评价其诊断价值.结果 以神经电生理检查为标准,各量表的敏感度、特异度、准确度分别为MDNS 90.50％ （162/179）、68.92％（102/148）、80.73％ （264/327）,MNSI 87.71％ （157/179）、78.38％ （116/148）、83.49％ （273/327）,TCSS 79.33％（142/179）、65.54％ （97/148）、73.09％ （239/327）.MNSI、MDNS与神经电生理检查之间呈高度一致（K值分别0.6 648、0.6 045）,MNSI、TCSS一致性较差,呈中度一致（K值为0.4 524）.MNSI、MDNS、TCSS诊断DPN的ROC曲线下面积分别为0.757、0.719、0.667,MNSI的真实性最佳.结论 MNSI可靠性强,且简单、快捷、可行性好,更适用于DPN的早期大规模筛查.

Objective To evaluate the effectiveness of the Michigan neuropathy screening instrument （MNSI）,the Michigan Diabetic Neuropathy Score（MDNS） and the Toronto Clinical Scoring System（TCSS） in screening diabetic peripheral neuropathy （DPN） in order to find a rapid,simple and accurate way for DPN screening.Methods Three hundred and twenty-seven type 2 diabetic patients were enrolled in the study.All patients received the 4 simple tests including MNSI,MDNS,TCSS and neural electrophysiological test （NET）.Taking the results of NET as the golden criteria,the sensitivity,specificity,positive and negative predictive values,accuracy,Youden indexes and Kappa values of the scoring systems were analyzed to evaluate their clinical effectiveness.Results Compared with NET examination,sensitivity,specificity and accuracy of MDNS were 90.5% （162/179）,68.92% （102/148）,80.73% （264/327）,and 87.71% （157/179）,78.38% （116/148）,83.49% （273/327） for MNSI and 79.33% （142/179）,65.54% （97/148）,73.09% （239/327） for TCSS.MNSI and MDNS were better than TCSS in terms of effectiveness of DPN diagnosis and consistence with the result of NET （MDNS：0.6 045 ; MNSI：0.6 648 ; TCSS：0.4524）.The area under the ROC curve of MNSI,MDNS and TCSS were 0.757,0.719,0.667.Conclusion Among the three scales methods,MNSI is a better method in screening DPN for its simplicity and reliability.