糖尿病周围神经病变临床诊断方法的价值评估

目的 探讨神经症状/神经缺陷评分（NSS/NDS）、密歇根神经病变筛选法（MNSI）、多伦多临床评分系统（TCSS）在糖尿病周围神经病变（DPN）中的临床诊断价值. 方法 188例T2DM患者行神经肌电图、NSS/NDS、MNSI、TCSS检查,以神经传导速度（NCV）作为“金标准”,分析3种检查方法的特异性、敏感性、受试者工作特征（ROC）曲线下面积（Az）等,比较不同检查方法诊断DPN的准确性和诊断价值. 结果 MNSI≥2.5分及TCSS≥5分时与NCV相关性好（P＜0.01）.MNSI、TCSS与NCV一致性高于NSS/NDS （Kappa值分别为0.524、0.547、0.534）.MNSI≥2.5分分别与TCSS≥5分和TCSS≥6分的诊断结果进行比较差异无统计学意义.NSS/NDS、MNSI、TCSS的Az分别为（0.579±0.027）、（0.794±0.034）、（0.814±0.032）,MNSI、TCSS的诊断准确性中等,NSS/NDS的诊断准确性较低. 结论 MNSI、TCSS与NCV有较高的一致性,诊断准确性均高于NSS/NDS.MNSI≥2.5分及TCSS≥5分时,诊断DPN价值较好,且诊断价值相当,MNSI操作相对简单、耗时短.

Evaluation of the value of clinical diagnostic methods in diabetic peripheral neuropathy

Objective To assess the values of neuropathy symptom score/neuropathy disability score （NSS/NDS）, Michigan neuropathy screening instrument （MNSI）, and Toronto clinical scoring system （TCSS） in the diagnosis of diabetic peripheral neuropathy （DPN）. Methods The 188 T2DM patients were examined by electromyography, NSS/NDS, MNSI, and TCSS. Using the result of the nerve conduction velocity （NCV） examination as golden criteria and its diagnostic sensitivity and specificity for further diagnostic assess by the ROC curve were analyzed to assess the accuracy and diagnostic efficacy of these methods for DPN. Results When MNSI≥2.5 and TCSS≥5, there was a moderate correlation with NVC （P〈0.01）. The consistency of MNSI and TCSS with NVC was higher than with NSS/NDS （Kappa were 0. 524, 0. 547, and 0. 534 respectively）. In comparing the diagnosis of MNSI≥2.5 with TCSS≥5 and TCSS≥6 respectively, there was no significant difference in the results. The area under the ROC curve of NSS/NDS, MNSI, and TCSS were （0. 579 ±0. 027）, （0. 794 ±0. 034）, and （0. 814 ±0. 032） respectively. The accuracy of diagnosis of MNSI and TCSS was moderate, however, that of NSS/ NDS was lower. Conclusion MNSI and TCSS have a relatively higher consistency with the NCV examination and higher accuracy than NSS/NDS. When MNSI≥2.5 and TCSS≥5, the value of diagnosis of DPN is better, and the two parameters have an equal value, but MNSI is relatively simple to operate and need a short time to finish.