泌汗功能检测对糖尿病周围神经病变的早期诊断价值

目的 评估汗印法检测周围自主神经泌汗功能对2型糖尿病周围神经病变(DPN)早期诊断的价值.方法 采用密歇根糖尿病神经病变积分(DNS)将98例住院2型糖尿病患者分为有周围神经病变组(DN组)和无周围神经病变组(DC组),40例健康人志愿者为对照组(NC组).采用汗印法诊断膏贴(欧米诺,德国Miro VerbaDNStofie GmbH公司)对3组进行周围自主神经泌汗功能评估,观察3组膏贴变色时间,计算汗印法相对于DNS检测结果的灵敏度和特异度及变色时间与DNS评分的相关性.结果 NC、DC、DN组平均变色时间(min)分别为4.0±0.6、4.3±1.2和23.0±6.1,3组间比较均有显著性差异(P＜0.05).使用汗印法诊断膏贴DPN检出率为62.2%,高于DNS测得的57.1%(P＞0.05).相对于DNS评分法,汗印法诊断DPN的灵敏度为92.8%,特异度为78.5%,阳性预告值为93.2%,阴性预告值78.6%,诊断符合率达86.7%.DNS评分与汗印法诊断膏贴变色时间呈显著正相关(r=0.46,P＜0.05).结论 汗印法是一种客观、简易、可靠的检测方法,对糖尿病患者足部泌汗功能的检测有助于预测和早期发现DPN;汗印膏贴的量化特点可能用于评估DPN的严重程度.

Sweat function evaluation for early diagnosis of diabetic peripheral neuropathy

OBJECTIVE: To evaluate the clinical value of sweat function examination in early diagnosis of diabetic peripheral neuropathy (DPN). METHODS: Ninety-eight hospitalized type 2 diabetic patients with or without DPN (DN and DC groups) according to Michigan Diabetic Neruopathy Score (DNS) and 40 healthy volunteers (NC group) were evaluated for their sweat function of the feet in relation to the peripheral autonomic nerve with sweat printing method using Neuropad. The Neuropad color-changing time was recorded to assess the sensitivity and specificity of sweat printing methods relative to DNS for DNP evaluation, and the correlation of the Neuropad color-changing time to DNS score was analyzed. RESULTS: The average Neuropad color-changing time was 4.0-/+0.6, 4.3-/+1.2 and 23.0-/+6.1 min in NC, DC, and DN groups, respectively, showing significant differences between the 3 groups (P<0.05). The morbidity rate detected by sweat printing method was 62.2%, similar to that detected by DNS (57.1%, P>0.05). The sensitivity of the sweat printing method for DPN diagnosis was 92.8%, with specificity of 78.5%, positive predictive value of 93.2%, and negative predictive value of 78.6%. DNS showed significant positive correlation with the Neuropad color-changing time (r=0.46, P<0.05). CONCLUSION: Sweat printing method provides an objective, simple and reliable method for sweat function evaluation of the feet of type 2 diabetic patients to help in early DPN diagnosis, and quantification of the results of sweat printing method can be indicative of the DPN severity.