糖尿病周围神经病变筛查方法的比较

Comparative studies on screening methods of diabetic peripheral neuropathy

目的:在踝反射、振动觉、压力觉、温度觉及刺痛觉5项简单筛查糖尿病周围神经病变(DPN)指标的基础上,探索最佳指标组合,指导临床应用。方法:以神经电生理检查(NET)为金标准,对816例糖尿病患者同时进行NET和5项简单筛查,分析各项指标单用及其组合用于DPN筛查的灵敏度、特异度和约登指数,进而选出最佳组合。结果:5项简单筛查方法和选2项、3项、4项方法的最优组合以及5项全选筛查DPN的灵敏度、特异度和约登指数如下,踝反射分别为34.05%、69.54%、0.035 9,振动觉分别为77.82%、60.93%、0.387 5,压力觉分别为19.46%、95.70%、0.151 6,温度觉分别为35.21%、89.07%、0.242 8,刺痛觉分别为31.52%、84.77%、0.162 9,踝反射+振动觉分别为86.77%、60.93%、0.477 0,踝反射+振动觉+温度觉分别为89.69%、58.94%、0.486 3,踝反射+振动觉+压力觉+温度觉分别为90.86%、58.28%、0.491 4,5项全选分别为92.22%、57.95%、0.501 7。结论:踝反射、振动觉和温度觉组合与NET符合性好,可作为筛查DPN简便、有效的方法。

Aim：To explore the best combination of diabetic peripheral neuropathy （ DPN） simple screening methods from the ankle reflex , vibration perception , pressure sensation , temperature sensation and pinprick .Methods：A total of 816 diabetic patients performed neural electrophysiological test （ NET ） and DPN five simple screening methods .The NET was used as the gold standard to analyze the sensitivity , specificity and Youden＆#39;s index of the DPN five simple screening methods as well as their combinations .The effectiveness of various combination was assessed by Youden′s index.Results：The sensitivity, specificity and Youden＆#39;s index of the five simple screening methods were as follows：ankle reflex（34.05%, 69.54%and 0.035 9）, vibration perception（77.82%, 60.93% and 0.387 5）, pressure sensation（19.46%, 95.70%and 0.151 6）, temperature sensation（35.21%, 89.07% and 0.242 8）, pinprick（31.52%, 84.77% and 0.162 9）, ankle reflex ＋vibration perception（86.77%, 60.93%and 0.477 0）, ankle reflex ＋vibration perception ＋temperature sensation（89.69%, 58.94% and 0.486 3）, ankle reflex ＋vibration perception ＋pressure sensation ＋temperature sensation（90.86%, 58.28%and 0.491 4）, and 5 screening methods in combination （92.22%, 57.95%and 0.501 7）. Conclusion：The combination of ankle reflex , vibration perception and temperature sensation has a good compliance with NET, and can be used as a simple and effective method during DPN screening .