感觉电流阈值检测在2型糖尿病周围神经病变诊断中的效果评价

Assessment of sensory current threshold in the diagnosis of type 2 diabetic peripheral neuropathy clinical application of current perception threshold in the diagnosis of diabetic peripheral neuropathy

目的探讨感觉电流阈值(CPT)在T2DM周围神经病变(DPN)中的诊断价值。方法选取T2DM患者437例,分为DPN组和非DPN组,比较两组各项指标。以"中国DPN诊疗规范"为"金标准",评估CPT、10g尼龙丝试验、多伦多临床评分(TCSS)量表,以及神经传导速度检查(NCV)的诊断价值。结果 DPN组年龄[(61.31±9.63)vs(58.09±10.38)岁]、糖尿病病程[(8.81±6.04)vs(6.93±5.65)年]、HbA1c[(8.60±2.05)%vs(8.09±2.01)%]及FPG水平[(9.67±3.92)vs(8.95±3.45)mmol/L]、吸烟率(30.0%vs 15.8%),以及DR的发生率(36.4%vs 22.2%)均高于非DPN组(P<0.05)。DPN组中,CPT感觉减退及感觉过敏者所占比例高于非DPN组(P<0.05)。相关分析显示,CPT 2000、250以及5Hz值与神经传导速度(NCV)呈负相关(r=-0.260、-0.155、-0.168,P<0.01);CPT 2000、250Hz值与TCSS分数呈正相关(r=0.105、0.142,P<0.05)。CPT 2000 Hz的受试者工作特征(ROC)曲线下面积最大(AUC=0.840),且其诊断DPN的敏感性(77.14%)及NCV特异性(98.32%)最高。结论 CPT可以选择性定量测定不同类型感觉神经受损的程度,为DPN的早期诊断提供了一种有用的评估手段。

Objective To evaluate the diagnostic value of current perception threshold（CPT）diabetic peripheral neuropathy（DPN）.Methods A total of 437 patients with type 2 diabetes（T2DM）were enrolled.The subjects were divided into DPN group and non-DPN group according to‘the criteria of diagnosis and treatment of diabetic peripheral neuropathy in China＇.The diagnostic value of CPT,10 g monofilament test,Toronto clinical scoring system（TCSS）and nerve conduction velocity（NCV）were evaluated.Results Compared with non-DPN group,the patients in DPN group were significantly older[（61.31±9.63）vs（58.09±10.38）year],with longer duration of diabetes [（8.81±6.04）vs（6.93±5.65）year],higher HbA1c [（8.60±2.05）% vs（8.09±2.01）%]and fasting plasma glucose（FPG）[（9.67±3.92）vs（8.95±3.45）mmol/L],more smokers（30.0% vs 15.8%）and more likely complicated with retinopathy（36.4% vs 22.2%）.The proportion of hypoesthesia and hyperesthesia detected by CPT at all frequencies in DPN group were much higher than non-DPN group（P〈0.05）.The correlation analysis showed that CPT values at each frequency were negatively correlated with NCV（r=-0.260,r=-0.155 and r=-0.168,respectively,P〈0.01）.CPT 2000 Hz and 250 Hz were positively correlated with TCSS scores（r=0.105 and 0.142,respectively,P〈0.05）.ROC analysis showed that CPT 2000 Hz had the largest areas under the curve（AUC=0.840）,with the highest sensitivity（77.14%）and NCV test had the highest specificity（98.32%）in diagnosing DPN.Conclusion CPT can selectively and quantitatively determine different types of sensory nerve damage,which providing a useful method for early-screening of DPN.