定量感觉检查在糖尿病周围神经病变诊断中的应用价值

目的旨在探讨Rydel—Seiffer分级音叉和10g单尼龙丝检查在糖尿病周围神经病变诊断中的应用价值。方法选择无脑血管病及腰椎病病史的2型糖尿病患者289例。入选时双足无溃疡、感染及水肿。所有对象用上述仪器进行定量感觉检查，部分患者同时进行神经电生理检查，计算两种检查的敏感性和特异性。结果在分级音叉检查中，当以一点的分级音叉测量值≤5为阳性标准时，如果用神经传导速度（NCV）作为金标准，以第Ⅰ跖趾关节或拇趾趾骨间关节为测量点，或两者联合判断，其敏感性分别为69．1％、72．3％和76．6％，特异性分别为73．0％、63．5％和63．5％。如用体感诱发电位（SEP）作为标准，敏感性分别为86．2％、82．8％和89．7％，特异性分别为78．9％、73．7％和73．7％。单尼龙丝检查以NCV检查结果为标准，其敏感性为27．7％，特异性为92．1％；以SEP检查结果为标准，其敏感性为34．5％，特异性为94．7％。结论Rydel—Seiffer分级音叉检查有很好的临床应用前景。

Clinical usefulness of quantitative sensory testing in diagnosis of diabetic peripheral neuropathy

Objective To evaluate the clinical usefulness of graduated Rydel-Seiffer tuning fork(RSTF) and 10 g monofilament exam(ME) in the diagnosis of diabetes peripheral neuropathy.Methods The clinical data of 289 patients with type 2 diabetes and without cerebral vascular and(lumbar) vertebra disorders and feet ulceration,infection or edema were analysed.Graduated Rydel-(Seiffer) tuning fork and 10 g monofilament examinations were carried out in all the patients,with(electrophysiological) examination in some of them. Results At the measured points of hallux-metatasus joint,the first hallux interphalangeal joint,or the both,the diagnostic sensitivities of RSTF exam were 69%,72% and 77% respectively versus nerve conduction velocity(NCV) exam,and 86%,83% and 90% respectively versus somatosensory evoked potential(SEP) exam;and their specificities were 73%,64% and 64% respectively versus NCV,and 79%,74%,and 74% respectively versus SEP exam.The sensitivity and specificity of 10 g monofilament exam were 28% and 92% respectively versus NCV exam;and 35% and 95% respectively versus SEP exam. Conclusion Graduated Rydel-Seiffer tuning fork has a good prospect in clinic use,especially in out-patient clinic.