利用ROC曲线评价振动觉阈值检查在糖尿病周围神经病变诊断中的意义  

Vibration perception threshold in diagnosing diabetic peripheral neuropathy by receiver operating characteristic curve

作　　者：侯宇[1] 刘莎[1] 朱婷婷 张奂[1] 刘刚[1] 朱艳[1] 陈慧玲[1] 

机构地区：[1]中南大学湘雅医院内分泌科,长沙410008 [2]湖南省常德澧县澧州医院,湖南常德415500

出　　处：《中南大学学报（医学版）》2012年第9期951-956,共6页Journal of Central South University ：Medical Science

基　　金：国家自然科学基金(30771025)~~

摘　　要：目的:利用受试者工作特征曲线(receiver operating characteristic curve,ROC)评价振动觉阈值(vibrationperception threshold,VPT)检查在糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)中的诊断价值,并寻找最佳诊断点。方法:分别对283例2型糖尿病患者行神经肌电图、VPT检查,以神经肌电图结果作为诊断金标准将研究对象分为有周围神经病变组(DPN组,n=151)和无周围神经病变组(NDPN组,n=132),根据敏感性、特异性、Youden指数及ROC曲线评估VPT的诊断效能,并寻找最佳诊断点。结果:1)2型糖尿病患者中,与NDPN组相比,DPN组神经传导速度(nerve conduction velocity,NCV)明显减慢,而VPT值明显增加,差异均有统计学意义(均P<0.05);2)所有受试者双侧NCV和VPT无明显差异;3)以NCV为诊断标准,各检查点VPT平均值的ROC曲线的曲线下面积为0.707,最佳诊断切割点为10.54 V,此时敏感性为0.596,特异性为0.848,Youden指数为0.445;4)采用NCV为诊断标准,DPN的检出率为53.4%,联合VPT后DPN的检出率为60.4%,两者差异有统计学意义(P<0.05)。结论:与NCV检查相比,VPT检查有较好的诊断效能,提示它可作为临床上诊断DPN的方法之一,其最佳诊断切割点为10.5 V。Objective： To evaluate the diagnostic value of vibration perception threshold （VPT） in diabetic peripheral neuropathy （DPN） by the receiver operating characteristic curve （ROC） and to establish its cut-offthreshold. Methods： All patients had the VPT examination and nerve conduction velocity （NCV） examination. NCV examination showed that 283 patients with Type 2 diabetes were divided into a DPN group （n=151） and an NDPN group （n=132）. The VPT diagnosis was evaluated by Youdenindex, sensitivity, specificity and the area under ROC curve. The best cut-offthreshold was defined by the Youden index. Results： 1） The NCV was significantly slower, while the VPT was higher in the DPN group than those in the NDPN group （both P values 〈0.05）. 2） The VPT and NCV of both sides of the limb had no difference in all patients. 3） With NCV as the golden diagnosis criterion, the area under ROC of VPT was 0.707, the best cut-off threshold was 10.54 V, the sensitivity was 0.596, the specificity was 0.848, and the Youden index was 0.445.4） The diagnosis ratio of NCV combined with VPT was 60.4%, significantly higher than that of NCV alone （P〈0.05）. Conclusion： Compared with NCV examination, VPT has good diagnostic value for DPN. The best cut-off：value is 10.54 V.

关 键 词：2型糖尿病 糖尿病周围神经病变 神经传导速度 振动觉阈值检查 受试者工作特征曲线 

分 类 号：R587.2[医药卫生—内分泌]