神经量表对糖尿病周围神经病变的诊断价值评估  

Evaluation of four neuropathy scales in the diagnosis of diabetic peripheral of neuropathy

作　　者：魏薇[1] 董敬坚[1] 汪娥[1] 吕晓玉[1] 毛红[1] 赵湜[1] 

机构地区：[1]武汉市中心医院内分泌科,430014

出　　处：《临床内科杂志》2017年第2期96-99,共4页Journal of Clinical Internal Medicine

基　　金：湖北省自然科学基金资助项目（2010CDB09001）

摘　　要：目的探讨多伦多临床评分系统（TCSS）、密西根神经病变筛查法（MNSI）、神经缺陷评分（NIS）、神经症状评分（NSC）在糖尿病周围神经病变（DPN）中的诊断价值。方法对106例2型糖尿病患者行神经传导速度（NCV）检查及四类量表评估，以NCV为DPN诊断的金标准，将患者分为DPN组（56例）和无DPN组（50例），对两组患者的临床资料进行比较分析。采用受试者工作特性曲线（ROC）评价四类量表的诊断效能，并分析其敏感性、特异性、阳性及阴性预测值、准确度、约登指数及Kappa值。结果DPN组较无DPN组男性患者比例及年龄更高（P〈0．05）。TCSS、NIS及NSC评分与NCV呈负相关（P〈0．05），其中TCSS与NCV的一致性最高（Kappa值为0．637）。TCSS、MNSI、NIS及NSC的ROC曲线下面积分别为0．788、0．623、0．723、0．571，提示TCSS与NIS的诊断准确性中等，MNSI及NSC的诊断准确性较低。结论TCSS对DPN的诊断效率及与NCV的一致性优于其他量表，可用于DPN的临床评估和筛查。Objective To assess the values of Toronto clinical scoring system（TCSS）, Michigan neuropathy screening instrument （ MNSI）, neuropathy impairment score （NIS） and neuropathy symptom and change （NSC） in the diagnosis of diabetic peripheral neuropathy （DPN）. Methods A total of 106 patients with type 2 diabetes mellitus（T2DM） were examined by electromyography,TCSS, MNSI, NIS and NSC. Taking nerve conduction velocity （NCV） test as the golden criteria for diagnosis of DPN. Patients were divided into DPN group（ n = 56） and non-DPN group（ n = 50）. The data were compared between two groups. We evaluated the effectiveness of the neuropathy scales by the receiver operator characteristic curve（ROC）. Correlations between NCV test and neurological scales, and their sensitivity, specificity, positive and negative predictive values, accuracy, Kappa value and Youden indexes were analyzed. Results Compared to the non-DPN group, patients with DPN were significantly older and more males（ P 〈0.05 ）. The scores of TCSS,NIS and NSC were negative correlated with NCV（ P 〈 0.05 ）. TCSS had the highest consistency with NCV（ Kappa = 0.637） in all neuropathy scales. The area under the ROC curve of TCSS, MNSI, NIS and NSC were 0. 788,0. 623,0.723 and 0. 571 respectively, indicating the diagnostic accuracy of TCSS and NIS was moderate and that of MNIS and NSC were lower. Conclusion TCSS has the best diagnosis accuracy and consistency among these four scales, so the application of TCSS is recommended in the diagnosis and screening of DPN.

关 键 词：糖尿病周围神经病变 神经传导速度 神经量表 

分 类 号：R587.2[医药卫生—内分泌]