糖尿病周围神经病变的检测方法及其诊断价值的评估

目的探讨神经症状／神经缺陷评分（NSS／NDS）、密歇根神经病变筛选法（MNSI）、振动感觉阈值检查（Vfrr）及10g尼龙丝检查在糖尿病周围神经病变（DPN）中的诊断价值。方法对符合人选标准的2型糖尿病患者240例进行神经传导速度（NCV）检查、NSS／NDS评分、MNSI评分、VPT检查及10g尼龙丝检查。以NCV作为“金标准”,计算四种简易方法的敏感度、特异度、阳性预测值、阴性预测值、准确度以及Kappa值（K值）。结果MNSI〉2分的敏感度、特异度和准确度分别为78．15％,88．43％和83．33％,与NCV检查之间呈高度一致（K值为0．67）。NSS／NDS评分及VPT检查的敏感度、准确度低于MNSI筛选法,与NCV检查的一致性较好（K值分别为0．52和0．60）、但低于MNSI筛选法。10g尼龙丝检查的敏感度、准确度最低,与NCV检查的一致性较差。结论MNSI筛选法简单、易行且可靠性好,可用于门诊及住院DPN初步筛查以及流行病学调查。

Evaluation of the four simple methods in the diagnosis of diabetic peripheral neuropathy

Objective To evaluate the efficacy of neuropathy symptom score/neuropathy disability score (NSS/NDS),Michigan Neuropathy Screening Instrument (MNSI),vibration perception threshold (VPT) and 24010 g monofilament examination in the diagnosis of diabetic peripheral neuropathy (DPN). Methods 240 patients with type 2 diabetes underwent the 4 simple tests:NSS/NDS,MNSI,VPT,and 10 g monofilament examination and nerve conduction velocity (NCV) examination.Using the results of NCV as golden criteria,the sensitivity,specificity,positive and negative predictive values,accuracy and kappa values of these tests were analyzed.Results The sensitivity,specificity,accuracy,and k value of MNSI score over 2 were 78.15%,88.43%,83.33%,and 0.67 respectively.The validity could be ranked in the following order with respect to the diagnosis of DPN:MNSI>VPT>NSS/NDS>10 g monofilament examination.Conclusion MNSI is a rapid,simple and reliable test for screening DPN in both diabetes clinics and epidemiological surveys.