不同检查方法在糖尿病周围神经病变筛查中的应用  

Application of two different methods for diabetic peripheral neuropathy screening

作　　者：史晓阳[1] 袁慧娟[1] 张凯[2] 张晶[1] 马跃华[1] 张菱[1] 赵志刚[1] 

机构地区：[1]河南省人民医院内分泌科,郑州450003 [2]郑州大学第三附属医院术后监护室,郑州450052

出　　处：《医药论坛杂志》2014年第7期19-20,23,共3页Journal of Medical Forum

摘　　要：目的评价两种不同的方法在糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)诊断中的临床价值。方法以神经电生理检查作为金标准,分别对706例于2009年12月—2012年12月在河南省人民医院内分泌科住院的2型糖尿病(type 2 diabetes mellitus,T2DM)患者进行多伦多临床评分系统(Toronto Clinical Scoring System,TCSS)评分和糖尿病周围神经病变筛查流程(diabetic peripheral neuropathy screening process,DPN-SP)。评价二者筛查DPN敏感性与特异性的异同。结果 706例患者中,神经电生理检查阳性者384例(54.39%),阴性者322例(45.61%);TCSS评分>5分者377例,TCSS评分≤5分者329例,该检查方法灵敏度、特异度、阳性预测值、阴性预测值分别为:78.57%、77.82%、82.38%、81.42%,约登指数为0.56。DPN-SP阳性者418例,阴性者288例,该检查方法灵敏度、特异度、阳性预测值、阴性预测值分别为:85.49%、66.92%、78.93%、76.52%,约登指数为0.52。两种筛查方法无统计学差异(P>0.05)。结论 DPN-SP与TCSS在诊断DPN时均具有较高的灵敏度与特异度,可作为DPN筛查的有效的方法。Objective To evaluate the application of two different methods for diabetic peripheral neuropathy. Methods Totally 706 patients with T2DM in Henan Provincial People＇ s Hospital was performed electrophysiological examination, TCSS and DPN screening process at the same time. We compared the differences of DPN - SP and TCSS in the diabetic peripheral neuropathy screening. Results With electro - physiological examination, 384 patients were positive, while 322 patients negative. With TCSS ,377 patients＇ scores were above 5,329 patients less than 5. With DPN - SP ,418 patients were positive, while 288 patients negative. Taken electro - physiological examination as gold standard, Sensibili- ty,specificity, positive predictive value, negative predictive value and Youden index of TCSS and DPN - SP were 78.57% vs85.49% ,77.82% vs66. 92% ,82. 38% vs78.93% ,81.42% vs76. 52% and 0. 56vs0. 52. There were not statistical significant differences between DPN - SP and TCSS （ P 〉 0.05）. Conclusion DPN - SP and TCSS both have high sensibility and specificity to screen DPN, and both of them could be used for early screening of DPN in T2DM.

关 键 词：多伦多临床评分系统 DPN筛查流程 糖尿病 周围神经病变 

分 类 号：R587.2[医药卫生—内分泌]