振动感觉阈值(VPT)在糖尿病周围神经病变(DPN)中的诊断价值

 目的 探讨以振动感觉阈值(vibrating perception threshold,VPT)检查为主联合糖尿病神经病变症状评分(diabetic neuropathy symptom,DNS)、足外观、温度觉、痛觉及触觉5种简易检查方法在糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)中的诊断价值。方法 217例2型糖尿病患者记录DNS,同时行足外观检查、VPT、温度觉、痛觉、半定量音叉、10g尼龙丝检查和肌电图神经传导速度(nerve conducting velocity,NCV)测定。按神经电生理检查结果,分为不合并周围神经病变组(n=130),合并周围神经病变组 (n=87),比较两组的基本情况和代谢指标。计算5种联合检查方法的敏感度、特异度、阳性预测值、阴性预测值、准确度、Youden指数以及 Kappa值(κ值),与NCV检查进行相关性和一致性分析。结果 两组间年龄、糖尿病病程、VPT值有显著差异,DPN组明显高于无DPN组(P<0.05)。VPT与正中运动神经传导速度(motor conducting velocity,MCV)、尺神经MCV、腓总神经MCV、腓浅神经感觉性传导速度(sensory conducting velocity,SCV)、胫神经MCV之间均呈负相关(P<0.05)。5种联合检查方法与NCV检查的秩相关分析均呈显著正相关(P<0.01),VPT联合DNS检查与NCV的相关性最好(r=0.799)。VPT联合DNS检查的敏感度、特异度、准确度分别为74.4%、100%、89.9%,与NCV检查高度一致(κ值为0.780)。结论 VPT联合DNS是准确筛查和诊断DPN的适用方法。

The value of vibration perception threshold (VPT) in the diagnosis of diabetic peripheral neuropathy (DPN)

Objective To investigate the diagnostic values of different evaluating methods on the diabetic peripheral neuropathy (DPN).These methods include the vibrating perception threshold (VPT) combined diabetic neuropathy symptom (DNS),foot appearance inspection,temperature sensation,pain sensation and touch sensation in the patients.Methods Totally 217 patients with type 2 diabetes were recruited.They were divided into two groups including one group without peripheral neuropathy (non PN group,n=130) and the other group complicated with peripheral neuropathy (PN group,n=87) according to the results of electromyography.DNS,foot appearance,nerve conducting velocity (NCV),VPT,temperature sensation,pain sensation,128Hz tuning fork and10g monofilament examination were performed in all the patients,and the clinical characteristics,biochemical parameters and VPT were compared between the two groups.Sensitivity,specificity,positive predictive value,negative predictive value,accuracy,Youden index and the Kappa value (κ value),and the correlation of the above assessment means were evaluated compared with the “gold standard” NCV.Results There was significant difference of age,duration of diabetes and VPT between the non PN group and PN group.The values in the PN group were significantly higher than those in the non PN group (P <0.05).There were negative correlations between VPT and median nerve motor conducting velocity (MCV),ulnar nerve MCV,peroneal nerve MCV,the superficial peroneal nerve sensory conducting velocity (SCV) and tibial nerve MCV (P<0.05).The Spearman correlation analysis showed the five methods were positively associated with NCV (All P<0.01).There was the best association (r=0.799,P<0.01) between NCV and the combination with VPT and DNS.The sensitivity,specificity and accuracy of the combined evaluation with VPT and DNS were 74.4%,100%,89.9% respectively,and was highly consistent with NCV examination (κ value was 0.780).Conclusions The combined evaluation of VPT and DNS of lower extremity was a practical and accurate method for diagnosing and screening DPN in type 2 diabetic populations.