振动感觉阈值检查筛查糖尿病外周神经病变的价值评估  

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

作　　者：鹿斌[1,2,3] 王妹[1,2,3] 龚伟[1,2,3] 杨震[1,2,3] 杨叶虹[1,2,3] 杨志红[1,2,3] 周丽诺[1,2,3] 李益明[1,2,3] 闻杰[1,2,3] 胡仁明[1,2,3] 

机构地区：[1]复旦大学附属华山医院内分泌科 [2]复旦大学上海医学院内科学系 [3]复旦大学内分泌糖尿病研究所,上海200040

出　　处：《复旦学报（医学版）》2010年第2期127-130,161,共5页Fudan University Journal of Medical Sciences

基　　金：国家自然科学基金重点项目(30230380);上海市科学技术委员会重大项目(04dz19504);上海市卫生局青年基金(2006Y06);复旦大学青年科学基金(08FQ37);复旦大学附属华山医院青年基金(Y186)

摘　　要：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、10g单纤维尼龙丝检查(10gSemmes-Weinstein monofilament examination,SWME)、温度觉及128Hz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128Hz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128Hz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128Hz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。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 （P0.01）; 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.

关 键 词：2型糖尿病 外周神经病变 振动感觉阈值检查 

分 类 号：R587.1[医药卫生—内分泌]