简易神经查体在基层医院糖尿病性周围神经病变筛查中的应用价值

The value of simple neurological examination in the screening of diabetic peripheral neuropathy in primary hospitals

目的探讨简易神经查体在基层医院糖尿病性周围神经病变(diabetic peripheral neuropathy,DPN)筛查中的应用价值。方法选取500例2型糖尿病患者,所有患者均进行简易神经查体,观察DPN的发生情况,以神经电生理检查结果为标准,比较简易神经查体与踝反射、针刺痛觉、温度觉、振动觉、压力觉诊断DNP的灵敏度、特异度、准确度差异。将确诊DPN患者随机分为观察组与对照组,两组患者均严格控制血糖,观察组在严格控制血糖的基础上加用甲钴胺治疗,疗程3个月,观察两组治疗前后神经电生理指标的差异。结果简易神经查体诊断DPN的灵敏度、特异度、准确度明显高于踝反射、针刺痛觉、温度觉、振动觉、压力觉各项检查的诊断(P<0.05或<0.01)。两组治疗前正中神经、腓总神经及胫神经MCV、SCV比较无统计学差异(P>0.05),对照组治疗后正中神经、腓总神经及胫神经MCV、SCV与治疗前比较无明显变化(P>0.05),观察组治疗后正中神经、腓总神经及胫神经MCV、SCV与治疗前比较明显改善(P<0.05)。结论采用简易神经查体诊断DPN诊断准确性高,是一种筛查DPN的简单、有效的检查方法,适合在基层医院推广使用,早期药物干预治疗能改善DPN患者的预后。

Objective To explore the value of simple neurological examination in diabetic peripheral neuropathy （DPN） screening in primary hospitals. Methods 500 patients with type 2 diabetes mellitus were selected. All the patients were treated with simple neurological examination. The incidence of DPN was observed. The results of neurophysiological examination were referred as the standard. The difference in sensitivity, specificity and accuracy of DNP diagnosis between simple neurological examination and ankle reflex, acupuncture painsensation, temperature sensation, vibration sensation, pressure perception was compared. Patients diagnosed with DPN were randomly divided into observation group and control group, and the blood glucose of two groups was strictly controlled. The observation group was added with methicillamine treatmentbased on the strict control of blood glucose. And the treatment course was 3 months. The differencein electrophysiologieal indicators between the two groups before and after treatment was observed. Results The sensitivity, specificity and accuracy of simple neurological examination for diagnosing DPN were significantly higher than those of ankle reflex, acupuncture painsensation, temperature sensation, vibration sensation and pressure perception（P〈0.05 or 〈0.01）. There was no statistically significant difference in MCV and SCV between the two groups before treatment （P〉0.05）. There was no statistically significant difference in the MCV and SCV of the median nerve, peroneal nerve and tibial nerve in the control group（P〉0.05）. The MCV and SCV of the median nerve, peroneal nerve and tibial nerve in the observation group were significantly better than those before treatment （P〈0.05）. Conclusion Simple neu- rological examination for diagnosing of DPN has high accuracy, which is a simple and effective method to screen DPN, and suitable for the promotion of use in primary hospitals. Early drug intervention can improve the prognosis of DPN patients.