感觉电流阈值检测在2型糖尿病周围神经病变诊断中的效果评价

摘要

Objective To evaluate the diagnostic value of current perception threshold (CPT)diabetic peripheral neuropathy (DPN).Methods A total of 437 patients with type 2 diabetes (T2DM) were enrolled.The subjects were divided into DPN group and non-DPN group according to'the criteria of diagnosis and treatment of diabetic peripheral neuropathy in China'.The diagnostic value of CPT,10 g monofilament test,Toronto clinical scoring system (TCSS) and nerve conduction velocity (NCV) were evaluated.Results Compared with non-DPN group,the patients in DPN group were significantly older [(61.31±9.63) vs (58.09±10.38) year],with longer duration of diabetes [(8.81±6.04) vs (6.93±5.65) year],higher HbA1c [(8.60±2.05)％ vs (8.09±2.01) ％] and fasting plasma glucose (FPG) [(9.67± 3.92) vs (8.95 ± 3.45) mmol/L],more smokers (30.0％ vs 15.8％) and more likely complicated with retinopathy (36.4％ vs 22.2％).The proportion of hypoesthesia and hyperesthesia detected by CPT at all frequencies in DPN group were much higher than non-DPN group (P＜0.05).The correlation analysis showed that CPT values at each frequency were negatively correlated with NCV (r=-0.260,r=-0.155 and r=-0.168,respectively,P＜0.01).CPT 2000 Hz and 250 Hz were positively correlated with TCSS scores (r=0.105 and 0.142,respectively,P＜0.05).ROC analysis showed that CPT 2000 Hz had the largest areas under the curve (AUC=0.840),with the highest sensitivity (77.14％)and NCV test had the highest specificity (98.32％) in diagnosing DPN.Conclusion CPT can selectively and quantitatively determine different types of sensory nerve damage,which providing a useful method for early-screening of DPN.%目的 探讨感觉电流阈值(CPT)在T2DM周围神经病变(DPN)中的诊断价值.方法 选取T2DM患者437例,分为DPN组和非DPN组,比较两组各项指标.以“中国DPN诊疗规范”为“金标准”,评估CPT、10 g尼龙丝试验、多伦多临床评分(TCSS)量表,以及神经传导速度检查(NCV)的诊断价值.结果 DPN组年龄(61.31±9.63)vs(58.09±10.38)岁]、糖尿病病程[(8.81±6.04)vs(6.93±5.65)年]、HbA1 c[(8.60±2.05)％vs(8.09±2.01)％]及FPG水平(9.67±3.92) vs(8.95±3.45)mmol/L]、吸烟率(30.0％vs15.8％),以及DR的发生率(36.4％vs22.2％)均高于非DPN组(P＜0.05).DPN组中,CPT感觉减退及感觉过敏者所占比例高于非DPN组(P＜0.05).相关分析显示,CPT 2000、250以及5 Hz值与神经传导速度(NCV)呈负相关(r=0.260、-0.155、-0.168,P＜0.01);CPT 2000、250 Hz值与TCSS分数呈正相关(r=0.105、0.142,P＜0.05).CPT 2000 Hz的受试者工作特征(ROC)曲线下面积最大(AUC=0.840),且其诊断DPN的敏感性(77.14％)及NCV特异性(98.32％)最高.结论 CPT可以选择性定量测定不同类型感觉神经受损的程度,为DPN的早期诊断提供了一种有用的评估手段.