密歇根神经筛查量表在糖尿病神经病变中诊断截点的观察

Investigate the cut-off point of michigan neuropathy screening instrument in the diagnosis of type 2 diabetic neuropathy

目的观察密歇根神经筛查量表(MNSI)在糖尿病远端对称性多神经病变(DSPN)中的诊断截点。方法对293例T2DM患者施行MNSI及神经电生理检查、神经病变症状、体征检查,根据DSPN诊断标准分为合并DSPN者(DM+DSPN组)196例和单纯糖尿病者(DM组)97例。采用Logistic回归分析对MNSI量表各项指标进行双重权重后做出受试者工作特征曲线(ROC),比较曲线下面积(AUC)。结果以问卷7分作为截点,漏诊率为61.43%;以体格检查评分2分作为截点,漏诊率为1.37%;问题1、3、9、11和踝反射、振动觉检查与全项筛查的效果比较,差异无统计学意义(P=0.088)。结论可将MNSI问卷评分诊断截点定为4分,体格检查评分截点定为2分。

Objective To investigate the cutoff point of the michigan neuropathy screening instrument（MNSI）in the diagnosis of type 2diabetic distal symmetric polyneuropathy（DSPN）. Methods293 T2 DM patients accepted symptoms and physical neuropathy examinations,MNSI evaluation and electrophysiological examinations.Based on Toronto DSPN diagnosis standard,the participants were divided into DSPN group（n=196）and T2 DM without DSPN（DM group,n=97）.Weighted regression analysis was used to evaluate the diagnostic performance of each test and search for the possible cutoff points of MNSI by drawing receiver operating characteristic curve（ROC）and comparing the area under the ROC curve. Results When the questionnaire cutoff point was 7,the missed diagnosis rate will be61.43%.When the physical examination cutoff point was 2,the missed diagnosis rate will be 1.37%.The value of single question No.1,3,9,11,ankle reflex and vibration sensation was similar to the whole index.Conclusion This study recommended that MNSI questionnaire scores 4and physical examination scores 2may act as the cutoff points to screen diabetic neuropathy.