振动感觉阈值检查筛查糖尿病外周神经病变的价值评估

 目的 初步探讨振动感觉阈值检查（vibration perception thresholds test，VPT）与糖尿病外周神经病变临床常用检查的相关性。方法 对487例2型糖尿病者进行了VPT、10 g单纤维尼龙丝检查（10 g Semmes-Weinstein monofilament examination，SWME）、温度觉及128 Hz振动觉检查，分析各检查的相关性，同时比较各检查的差异。结果 多元回归分析显示影响VPT的因素为年龄（OR=1.062，95%CI：1.038-1.086，P<0.001）和空腹血糖水平（OR=1.085，95%CI：1.003-1.173，P=0.041）；VPT与SWME、温度觉检查及128 Hz振动觉检查均明显相关，相关系数分别为0.176、0.152及0.240（P值均<0.01）；VPT与SWME、温度觉检查及128 Hz振动觉检查的观察一致率分别为49.5%、59.8%及51.1%，Kappa值分别为0.106、0.151及0.138（P值均<0.01）；SWME及128 Hz振动觉检查异常但VPT检查正常的比例低，分别为2.7%及1.2%。结论 VPT也应作为临床筛查糖尿病外周神经病变的一线方法。

Evaluation of vibration perception thresholds test in screening diabetic peripheral neuropathy in type 2 diabetic patients

Objective To investigate the correlation between vibration perception thresholds test (VPT) and simple screening tests for peripheral neuropathy in the diabetes clinic in type 2 diabetic patients. Methods VPT and three simple screening tests including 10 g Semmes-Weinstein monofilament examination (SWME), vibration test by 128 Hz tuning fork, and temperature sensation test by Tip-Therm were completed in 487 Chinese patients diagnosed with type 2 diabetes aged over 30. The relationships between these simple screening tests and VPT were evaluated by Spearman correlation and observed agreement rate. Results Abnormal VPT was significantly associated with aging and fasting plasma glucose by binary logistic regression analysis. VPT was significantly correlated with SWME, temperature sensation test, vibration test by 128 Hz tuning fork, and the correlation coefficient was 0.176, 0.152 and 0.240, respectively (P<0.01). Observed agreement between VPT and three simple screening tests including SWME, temperature sensation test, vibration test by 128 Hz tuning fork was 49.5%, 59.8% and 51.1%, respectively. The percentage of abnormal results by SWME or vibration test by 128 Hz tuning fork with normal result by VPT was very low, only 2.7% and 1.2% respectively. Conclusions VPT should also be considered as a first-choice screening test for diabetic peripheral neuropathy.