定量感觉测试在2型糖尿病周围神经病变诊断中应用价值的研究

Diagnostic value of quantitative sensory testing in diabetic peripheral neuropathy in patients with type 2 diabetes mellitus

目的探讨定量感觉测试(QST)在2型糖尿病(T2DM)周围神经病变诊断中的应用价值。方法对2020年5月至2021年2月在南京鼓楼医院内分泌科住院的18~70岁T2DM患者进行回顾性分析,收集患者QST参数[热感觉阈值(WDT)、冷感觉阈值(CDT)],以及热痛觉阈值(HPT)和冷痛觉阈值(CPT)结果,测定患者双下肢神经传导速度(NCV)参数,包括腓总神经传导速度、腓肠神经传导速度、胫神经传导速度等。根据周围神经病变诊断标准,将患者分为非神经病变(NDPN)、小纤维神经病变(SFN)及混合纤维神经病变(MFN)组。采用t检验或单因素方差分析、Mann-WhitneyU或Kruskal-WallisH检验及χ^(2)检验进行组间一般临床资料的比较,采用多因素logistic回归分析法分析糖尿病周围神经病变(DPN)的危险因素,采用Spearman相关法分析QST参数和NCV之间的相关性,采用受试者工作特征曲线(ROC)评估QST参数诊断MFN的敏感性、特异性和诊断价值。结果共纳入279例患者,其中,NDPN组111例,SFN组116例,MFN组52例。与SFN组相比,MFN组的CDT及CPT均更低,WDT及HPT均更高(均P<0.05)。相关性分析结果显示,患者双下肢腓总神经传导速度、腓肠神经传导速度、胫神经传导速度与CDT(r值分别为0.264、0.366和0.288)及CPT(r值分别为0.226、0.253和0.236)均呈正相关(均P<0.05),与WDT(r值分别为-0.274、-0.338和-0.268)及HPT(r值分别为-0.246、-0.281和-0.192)均呈负相关(均P<0.05)。ROC模型结果提示,WDT+CDT诊断MFN时,曲线下面积达0.840,灵敏度为86.3%,特异度为71.8%(P<0.001)。结论QST对T2DM周围神经病变具有较高的诊断价值。

Objective To explore the diagnostic value of quantitative sensory testing(QST)in diabetic peripheral neuropathy in patients with type 2 diabetes mellitus(T2DM).Methods Patients with T2DM aged 18-70 years in Nanjing Drum Tower Hospital from May 2020 to February 2021 were retrospectively analyzed.QST parameters[warm detection threshold(WDT),cold detection threshold(CDT)],heat pain threshold(HPT)and cold pain threshold(CPT)were collected,and nerve conduction velocity(NCV)parameters of both lower limbs were measured,including common peroneal nerve conduction velocity,sural nerve conduction velocity,tibial nerve conduction velocity,etc.Patients received QST and NCV for allocation into different neuropathy groups according to the diagnostic criteria:nondiabetic peripheral neuropathy(NDPN)group,small fiber neuropathy(SFN)group and mixed fiber neuropathy(MFN)group.The t-test or one-way analysis of variance(ANOVA),Mann Whitney U or Kruskal Wallis H test,orχ^(2) test were used to compare the general clinical data between groups.Multivariate logistic regression analysis was used to analyze the risk factors of DPN.Spearman correlation method was used to analyze the correlation between QST parameters and NCV.Receiver operating characteristic curve(ROC)analysis was used to evaluate the sensitivity,specificity and diagnostic value of QST for MFN.Results A total of 279 patients were included,including 111 in NDPN group,116 in SFN group and 52 in MFN group.Compared with SFN group,MFN group presented lower CDT and CPT,higher WDT and HPT(all P<0.05).The results of correlation analysis showed that the common peroneal nerve conduction velocity,sural nerve conduction velocity and tibial nerve conduction velocity of both lower limbs were positively correlated with CDT(r=0.264,0.366 and 0.288 respectively)and CPT(r=0.226,0.253 and 0.236 respectively)(all P<0.05),They were negatively correlated with WDT(r=-0.274,-0.338 and-0.268 respectively)and HPT(r=-0.246,-0.281 and-0.192 respectively)(all P<0.05).The results of ROC model showed that when WDT+CDT was used to diagnose MFN,the product under the curve was 0.840,the sensitivity was 86.3%,and the specificity was 71.8%(P<0.001).Conclusion QST was able to exhibit a high early diagnostic value for diabetic peripheral neuropathy.