神经症状/神经缺陷评分与神经传导速度诊断糖尿病周围神经病变的相关性

目的 研究神经症状/神经缺陷评分（NSS/NDS）与神经传导速度（NCV）在诊断糖尿病周围神经病变（DPN）中的相关性,并探讨NSS/NDS的临床使用价值.方法 以679例同时测定了NSS/NDS评分和NCV的2型糖尿病患者为研究对象,男性404例,女性275例,平均年龄（59±ll）岁.以NCV作为诊断DPN的金标准,分析NSS/NDS评分诊断DPN的敏感度、特异度、阳性预测值、阴性预测值、准确度、约登指数、Kappa值（一致性）及相关性等.采用Spearman相关和多因素logistic逐步回归进行相关性分析.结果 NSS/NDS评分诊断DPN的敏感度、特异度、阳性预测值、阴性预测值、准确度、约登指数、一致性及相关性分别为68.0％、77.2％、86.5％、53.5％、71.0％、45.2％、0.405、0.424.当NSS≥5分或NDS≥6分时,患者有较高的NCV异常率（77.8％ ～ 100％）.NSS、NDS评分与NCV均呈正相关（r=0.292、0.358,均P＜0.01）,患者神经症状或体征越严重,越容易引起NCV的减慢.Logistic回归分析显示NSS/NDS评分诊断DPN的危险因素是病程、年龄和UAlb/Cr比值比（OR）=1.085、1.051、1.002,均P＜0.01].与NCV诊断DPN的危险因素相关性较好.结论 NSS/NDS评分与NCV诊断DPN有相关性,尤其是神经症状、神经缺陷严重时相关性更好.NSS/NDS评分操作简单快速,方便有效,可在临床中作为DPN的筛查.

Comparison of neuropathy symptom score/neuropathy disability score and nerve conduction velocities in the diagnosis of diabetic peripheral neuropathy

Objective To evaluate the efficacy and clinical value of the neuropathy symptom score/ neuropathy disability score （NSS/NDS） compared with nerve conduction velocities （NCV） in the diagnosis of diabetic peripheral neuropathy （DPN）.Methods Observational study of 679 patients diagnosed with type 2 diabetes mellitus （404 males and 275 females,the average age was （59 ± 11） years） was performed using the standard NSS/NDS and NCV criteria for the diagnosis of DPN.Taking NCV as the gold standard,we compared NCV against NSS/NDS using the following parameters：sensitivity,specificity,positive and negative predictive values,Youden index,Kappa value and correlation.Correlation analysis was done by using Spearman correlation and multivariate logistic regression.Results The sensitivity,specificity,positive and negative predictive values,Youden index,Kappa value and correlation of NSS/NDS compared with NCV was 68.0％,77.2％,86.5％,53.5％,71.0％,45.2％,0.405,0.424,respectively.The abnormal rate of NCV of patients was more remarkable when NSS score ≥5 or NDS score ≥6 （77.8％-100％）.NSS and NDS demonstrated an obvious positive association with NCV（r =0.292,0.358,both P ＜ 0.01）.The NCV values for each nerve showed a negative correlation with the severity of symptoms and signs.Logistic regression analysis showed that the risk factors of DPN were disease duration,age and urinary albumin-to-creatinine ratio when NSS/NDS were considered as the diagnostic criteria （odds rations （OR） =1.085,1.051,1.002,all P ＜ 0.01）.A similar result was observed with NCV.Conclusions NSS/NDS demonstrates a positive association with NCV,especially when neurological symptoms and neurological signs became more serious.NSS/NDS analysis is a simple,rapid,cheap and powerful screening tool for the diagnosis of DPN.