不同评分法在糖尿病周围神经病变诊断中的应用价值  

Application Value of Different Scoring Methods in Diagnosis of Diabetic Peripheral Neuropathy

作　　者：常湛[1] 冯红[1] 孟令华[2] 谷春芳[1] 

机构地区：[1]石家庄市第二医院内分泌科,石家庄050051 [2]石家庄市第二医院消化科,石家庄050051

出　　处：《成都医学院学报》2016年第1期65-68,共4页Journal of Chengdu Medical College

基　　金：河北省卫生厅课题(No:20150873);中国高校医学期刊临床专项资金(No:11524328)

摘　　要：目的评价神经症状/神经缺陷评分(NSS/NDS)、多伦多临床评分系统(TCSS)和密歇根神经病变筛选法(MNSI)对糖尿病周围神经病变(DPN)的诊断价值。方法选取2013年5月至2015年5月石家庄市第二医院门诊或住院收治的2型糖尿病(T2DM)患者167例,均进行NSS/NDS、MNSI及TCSS检查,并以神经传导速度(NCV)检查结果作为评价诊断结果的"金标准"。比较3种评分法的检出率,与NCV检查的相关性,评价3种诊断性能及所用时间。结果NSS/NDS、MNSI、TCSS与NCV诊断结果均呈正相关(P<0.001)。MNSI≥2分与NCV诊断结果的相关性最好(r=0.751,P=0.000 1);TCSS≥6分与NCV诊断结果的相关性最好(r=0.653,P=0.000 2)。MNSI、TCSS和NSS/NDS诊断DPN的曲线下面积(AUC)分别为0.826、0.864和0.734,MNSI与TCSS的AUC大于NSS/NDS的AUC(P=0.024,P=0.017),但MNSI与TCSS的AUC比较,差异无统计学意义(P=0.100)。3组比较,TCSS评分≥6分对DPN诊断的灵敏度(77.21%)及特异度(96.59%)较高,与NCV检查一致性较高(κ=0.680)。MNSI评分平均耗时最短,而TCSS评分平均耗时最长。结论MNSI≥2分、TCSS≥6分对DPN诊断与NCV有较高的相关性,TCSS≥6分与NVC检查一致性较高,MNSI评分法操作简单,耗时较短。Objective To evaluate the value of neurologic symptoms/nerve functional defect score（NSS/NDS）,Toronto clinical scoring system（TCSS）and Michigan neuropathy screening instrument（MNSI）in the diagnosis of diabetic peripheral neuropathy（DPN）.Methods A total of 167 patients with type 2diabetes mellitus（T2DM）underwent NSS/NDS,MNSI and TCSS examinations were selected with the results of nerve conduction velocity（NCV）test as the golden standard for evaluating diagnostic results.The detection rates of three scoring methods,correlations with NCV test,their respective diagnostic performance and diagnostic time were compared.Results NSS/NDS,MNSI and TCSS were all positively correlated with the diagnostic results of NCV（P〈0.001）.Both MNSI≥2points and TCSS≥6points respectively had the best correlation with the diagnostic results of NCV（r=0.751,P=0.000 1）;P=0.653,P=0.000 2）.The area under the curve（AUC）of MNSI,TCSS and NSS/NDS in the diagnosis of DPN were 0.826,0.864 and 0.734 respectively.The AUC of MNSI and TCSS were larger than that of NSS/NDS（P=0.024,P=0.017）,but there was no statistical significance regarding the AUC of MNSI and TCSS（P=0.100）.Among three groups,the sensitivity（77.21%）and specificity（96.59%）of TCSS≥6points were relatively high,and had a higher consistency with NVC test（κ=0.680）.The average diagnostic time of MNSI score was the shortest,while that of TCSS score was the longest.Conclusion Both MNSI≥2points and TCSS≥6points have higher correlations with NCV in the diagnosis of DPN,and TCSS≥6points has a higher consistency with NVC test.MNSI scoring method is simple in operation and short in diagnosis.

关 键 词：糖尿病周围神经病变 神经症状/神经缺陷评分 密歇根神经病变筛选法 多伦多临床评分系统 神经传导速度 

分 类 号：R587.2[医药卫生—内分泌]