社区可行的糖尿病周围神经病变检查方法的诊断价值

Evaluation of diagnostic value of methods for the detection of diabetic peripheral neuropathy in community

目的 :探讨社区可行的糖尿病周围神经病变(DPN)的检查方法,对比这些检查方法在DPN中的诊断价值。方法 :对前来社区就诊符合条件的223例2型糖尿病患者进行神经缺陷评分(NDS)、密歇根神经病变筛选法检查(MNSI)、10 g尼龙单丝检查、震动感觉阈值检查(VPT)和肌电图(EMG)检查。以EMG作为"金标准",对比上述4种检查方法的敏感度、特异度、阳性预测值、阴性预测值、准确度以及k值。结果 :MNSI筛选法诊断DPN:MNSI>2.5分时其敏感度为92.11%、特异度为75.23%、阳性预测值为79.55%、阴性预测值为90.11%和准确度为59.19%[k值为(0.68±0.08)],与EMG检查之间呈高度一致;VPT检查诊断DPN:其敏感度为86.84%、特异度为76.15%,与EMG检查之间呈高度一致[k值为(0.63±0.03)];NDS评分诊断DPN:其敏感度为84.21%、特异度为61.47%、均低于MNSI筛选法和VPT检查,与EMG检查之间呈中度一致[k值为(0.46±0.05)];10 g尼龙丝检查结果显示,诊断DPN的敏感度、准确度及k值均较低,与EMG检查之间的一致性较差。结论 :MNSI筛选法(>2.5分)、VPT检查和NDS评分法简单、操作性好、可靠性好,易于推广,可用于社区门诊对糖尿病周围神经病变的初步筛查和流行病学调查。

Object： To explore a feasible method for the detection of diabetic peripheral neuropathy （DPN） in community and compare the value of these methods in diagnosis of diabetic peripheral nerve lesion. Methods： NDS, MNSI, VPT, l0 g monofilament and electromyogram（EMG） examination were performed in 223 patients with type 2 diabetes. The sensitivity, specificity, positive predictive inspection value, negative predictive value, accuracy and Kappa value （k value） of these four methods were compared by taking EMG as the ＂gold standard＂. Results： When MNSI screening method was used for the diagnosis of DPN and MNSI was more than 2.5 points, its sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 92.11%, 75.23%, 79.55%, 90.11% and 59.19% （k=-0.68±0.08）, respectively, which was highly consistent with EMG examination; in diagnosis of DPN with VPT examination, the sensitivity and specificity were 86.84% and 76.15%, which was also highly consistent with EMG examination （k=0.63±0.03） ; in diagnosis of DPN with NDS score, the sensitivity and specificity were 84.21% and 61.47%, which were lower than those of MNSI and VPT examination and showed moderate consistent with EMG examination （k=0.46~0.05） ; in diagnosis of DPN with 10 g nylon examination, the sensitivity, accuracy and k value were all lower, which showed poor consistency with EMG examination. Conclusion： MNSI method （〉2.5）, VPT examination and NDS method are simple, good operability, good reliability, easy popularization, can be used for the preliminary screening of diabetic peripheral neuropathy and epidemiological investigation.