中国糖尿病杂志
中國糖尿病雜誌
중국당뇨병잡지
CHINESE JOURNAL OF DIABETES
2008年
2期
91-94
,共4页
侯瑞芳%汤正义%张炜%凌丹芸%吴景程%张连珍%毛羽丰%王卫庆%李小美%宁光
侯瑞芳%湯正義%張煒%凌丹蕓%吳景程%張連珍%毛羽豐%王衛慶%李小美%寧光
후서방%탕정의%장위%릉단예%오경정%장련진%모우봉%왕위경%리소미%저광
糖尿病周围神经病变%筛查试验%ROC曲线
糖尿病週圍神經病變%篩查試驗%ROC麯線
당뇨병주위신경병변%사사시험%ROC곡선
ROC curve
目的 在2型糖尿病(T2DM)中评估多伦多临床神经病变评分(TCSS),密西根神经病变筛查量表(MNSI)、糖尿病神经病变症状评分(DNS)及音叉、5.07/10g单丝检查在筛查糖尿病周围神经病变(DPN)中的应用价值.方法 对419名T2DM患者进行TCSS、MNSI、DNS评分的评估及音叉、5.07/10g单丝检查,以神经系统检查、神经电生理检查、温度觉和振动觉检查的综合评估作为DPN的诊断标准,用ROC曲线评价这5种筛查法.结果 年龄、糖尿病病程、出现神经病变症状的时间,DPN与非DPN组间均有显著差异(P均＜0.001).TCSS、MNSI、DNS评分及音叉、5.07/10g单丝检查与神经传导速度(NCV)、温度觉和振动觉均有显著相关性(P均＜0.001),其中TCSS与NCV及温度觉的相关性最好;5种筛查方法的ROC曲线下面积分别是0.855、0.679、0.669、0.716、0.599,灵敏度分别为79.9%、60.4%、62.3%,43.7%、20.5%,特异度分别为77.5%、68.9%,67.5%、99.3%、99.3%,TCSS与临床客观检查符合性最好.结论 筛查DPN的方法不能过于简单化,应综合症状、体检和简单辅助工具进行.
目的 在2型糖尿病(T2DM)中評估多倫多臨床神經病變評分(TCSS),密西根神經病變篩查量錶(MNSI)、糖尿病神經病變癥狀評分(DNS)及音扠、5.07/10g單絲檢查在篩查糖尿病週圍神經病變(DPN)中的應用價值.方法 對419名T2DM患者進行TCSS、MNSI、DNS評分的評估及音扠、5.07/10g單絲檢查,以神經繫統檢查、神經電生理檢查、溫度覺和振動覺檢查的綜閤評估作為DPN的診斷標準,用ROC麯線評價這5種篩查法.結果 年齡、糖尿病病程、齣現神經病變癥狀的時間,DPN與非DPN組間均有顯著差異(P均＜0.001).TCSS、MNSI、DNS評分及音扠、5.07/10g單絲檢查與神經傳導速度(NCV)、溫度覺和振動覺均有顯著相關性(P均＜0.001),其中TCSS與NCV及溫度覺的相關性最好;5種篩查方法的ROC麯線下麵積分彆是0.855、0.679、0.669、0.716、0.599,靈敏度分彆為79.9%、60.4%、62.3%,43.7%、20.5%,特異度分彆為77.5%、68.9%,67.5%、99.3%、99.3%,TCSS與臨床客觀檢查符閤性最好.結論 篩查DPN的方法不能過于簡單化,應綜閤癥狀、體檢和簡單輔助工具進行.
목적 재2형당뇨병(T2DM)중평고다륜다림상신경병변평분(TCSS),밀서근신경병변사사량표(MNSI)、당뇨병신경병변증상평분(DNS)급음차、5.07/10g단사검사재사사당뇨병주위신경병변(DPN)중적응용개치.방법 대419명T2DM환자진행TCSS、MNSI、DNS평분적평고급음차、5.07/10g단사검사,이신경계통검사、신경전생리검사、온도각화진동각검사적종합평고작위DPN적진단표준,용ROC곡선평개저5충사사법.결과 년령、당뇨병병정、출현신경병변증상적시간,DPN여비DPN조간균유현저차이(P균＜0.001).TCSS、MNSI、DNS평분급음차、5.07/10g단사검사여신경전도속도(NCV)、온도각화진동각균유현저상관성(P균＜0.001),기중TCSS여NCV급온도각적상관성최호;5충사사방법적ROC곡선하면적분별시0.855、0.679、0.669、0.716、0.599,령민도분별위79.9%、60.4%、62.3%,43.7%、20.5%,특이도분별위77.5%、68.9%,67.5%、99.3%、99.3%,TCSS여림상객관검사부합성최호.결론 사사DPN적방법불능과우간단화,응종합증상、체검화간단보조공구진행.
Objective Five simple screening tests, including Toronto clinical scoring system(TCSS), Michigan neuropathy screening instrument(MNSI), Diabetic neuropathy symptom score(DNS) , vibration testing by a 128-Hz tuning fork,and 10g semmes-weinstein monofilament examination(SWME), were analyzed in T2DM to evaluate the effectiveness for diabetic peripheral neuropathy(DPN). Methods 419 patients with type 2 diabetes mellitus underwent the measurements of DPN with TCSS,MNSI,DNS,128-Hz tuning fork and 10g-SWME. DPN was diagnosed by neurological examination,motor and sensory nerve conduction velocity,vibration perception threshold,and warm and cold thermal perception threshold. The effectiveness of the five tests was assessed by using ROC curve analysis. Results There were significant differences in age,duration of diabetes , duration of symptoms for diabetic neuropathy between two groups(all P value <0.001).All five screening tests were significantly associated with NCV,warm and cold thermal perception threshold and vibration perception threshold(all P value <0.001).TCSS showed the best correlation with NCV and thermal perception threshold. Area under the ROC curve values for TCSS,MNSI,DNS,tuning fork and 10g-SWME test were 0.855,0.679,0.669,0.716,0.599,respectively.The optimal cut-points of them provided sensitivity of 79.9%,51.1%,62.3%,43.7%,20.5%, and specificity of 77.5%,79.5%,67.5%,99.3%,99.3%, respectively. Conclusions For screening DPN, simple tool tests are not always reliable and the results from general clinical examination may be a good way.
