CAJ | 학술논문

目的比较密歇根神经病变筛查评分系统(MNSI)和多伦多临床评分系统(TCSS)在无症状糖尿病周围神经病变(ADPN)筛查中的临床应用价值.方法对2008年4月至2009年6月在浙江大学医学院附属邵逸夫医院住院的232例无糖尿病周围神经病变症状的2型糖尿病患者分别行MNSI、TCSS及神经电生理检查(NET)筛查,以NET为诊断ADPN的金标准,用受试者工作特性曲线(ROC)评价两种评分系统的诊断效能及分析它们不同切点诊断ADPN的敏感度、特异度、准确度、阳性预测值、阴性预测值、约登指数及κ值；同时用logistic回归分析探讨两种评分系统与糖尿病周围神经病变( DPN)危险因素的相关性.结果 MNSI及TCSS诊断ADPN的ROC曲线下面积分别为0.792、0.704,MNSI及TCSS诊断ADPN的最佳切点均为＞2,此时它们的敏感度、特异度、准确度、约登指数、κ值分别为66.2％、90.4％、78.3％、0.566、0.588及73.3％、63.7％、68.5％、0.370、0.345.MNSI对ADPN的诊断效率及与NET的一致性较好且优于TCSS.Logistic回归分析得出DPN的大部分相关危险因素[年龄、糖化血红蛋白(HbA1c)、HbA1c×病程、胰岛功能、HDL-C]同样与MNSI评分相关.结论 MNSI是一项相对快速、可靠性较好的筛查方法,因此可用于对ADPN的临床及流行病学的筛查和评估.
목적 비교밀헐근신경병변사사평분계통(MNSI)화다륜다림상평분계통(TCSS)재무증상당뇨병주위신경병변(ADPN)사사중적림상응용개치.방법 대2008년4월지2009년6월재절강대학의학원부속소일부의원주원적232례무당뇨병주위신경병변증상적2형당뇨병환자분별행MNSI、TCSS급신경전생리검사(NET)사사,이NET위진단ADPN적금표준,용수시자공작특성곡선(ROC)평개량충평분계통적진단효능급분석타문불동절점진단ADPN적민감도、특이도、준학도、양성예측치、음성예측치、약등지수급κ치；동시용logistic회귀분석탐토량충평분계통여당뇨병주위신경병변( DPN)위험인소적상관성.결과 MNSI급TCSS진단ADPN적ROC곡선하면적분별위0.792、0.704,MNSI급TCSS진단ADPN적최가절점균위＞2,차시타문적민감도、특이도、준학도、약등지수、κ치분별위66.2％、90.4％、78.3％、0.566、0.588급73.3％、63.7％、68.5％、0.370、0.345.MNSI대ADPN적진단효솔급여NET적일치성교호차우우TCSS.Logistic회귀분석득출DPN적대부분상관위험인소[년령、당화혈홍단백(HbA1c)、HbA1c×병정、이도공능、HDL-C]동양여MNSI평분상관.결론 MNSI시일항상대쾌속、가고성교호적사사방법,인차가용우대ADPN적림상급류행병학적사사화평고.
Objective To evaluate the clinical effectiveness in screening asymptomatic diabetic peripheral neuropathy(ADPN) by the Michigan neuropathy screening instrument (MNSI) and the Toronto clinical scoring system(TCSS).Methods MNSI,TCSS and neural electrophysiological test (NET) were conducted in 232 neurologically asymptomatic type 2 diabetes patients.By using the results of NET as the golden criteria for diagnosis of ADPN,we evaluated the effectiveness of the two different scoring system by the receiver operator characteristic curve.The sensitivity,specificity,positive and negative predictive values,accuracy,Youden indexes and kappa values on different diagnostic cut-off points of MNSI and TCSS were analyzed.The correlation between the two different scoring system and the risk factors of diabetic peripheral neuropathy (DPN) were also analyzed.Results The area under the ROC curve of MNSI and TCSS were 0.792,0.704,respectively.The sensitivity,specificity,accuracy,Youden indexes and kappa values of MNSI over 2 and TCSS over 2 were 66.2％ vs 73.3％,90.4％ vs 63.7％,78.3％ vs 68.5％,0.566 vs 0.370,and 0.588 vs 0.345,respectively.MNSI was better than TCSS in the effectiveness of diagnosing ADPN and consistence with the result of NET.Moreover,MNSI was associated with the most related risk factors of DPN including age,glycosylated hemoglobin (HbA1c),HbA1c × disease duration,islet function and HDL-C.Conclusions MNSI could be used as a relatively simple and reliable method for clinical and epidemiological screening and assessment of ADPN.