5种检查方法在糖尿病周围神经病变诊断中的效能评估
The performance evaluation of the five inspection methods in the diagnosis of peripheral neuropathy in diabetes

摘要：目的 评估10g尼龙丝、振动觉阈值、温度觉、针刺痛觉、踝反射检查对糖尿病周围神经病变(DPN)的诊断价值，寻找经济、简便、快捷、准确的DPN诊断方法。方法 分别对151例于辽宁中医药大学附属医院内分泌科住院的糖尿病(DM)患者进行神经传导速度(NCV)测定、10g尼龙丝、振动觉阈值、温度觉、针刺痛觉、踝反射检查，以敏感度、特异度、阳性预测值、阴性预测值、约登指数(Youden指数)和Kappa值(k值)来评估各检查方法的诊断价值。结果 5种检查方法中踝反射的敏感度、特异度、阳性预测值、阴性预测值、约登指数及k值分别为66.04%、95.56%、97.22%、54.43%、61.60%、0.51，与诊断标准的一致性最好，呈中度一致；压力觉的敏感度、一致性最差；其中温度觉+振动觉+踝反射组合的敏感度、特异度、阳性预测值、阴性预测值、约登指数与k值分别为86.79%、91.11%、95.83%、74.55%、77.90%和0.73，与诊断标准呈中高度一致。结论 5种检查方法中温度觉+振动觉+踝反射组合与诊断标准呈中高度一致，且经济、简便、易行，临床上可用于对DPN的筛查。
ABSTRACT: Objective To evaluate the diagnostic value of the 10g nylon silk, vibration threshold value, sense of temperature, pain sense and ankle reflex in the diagnosis of diabetic peripheral neuropathy (DPN) and to search an exact diagnostic method of DPN not only economical but also easy to handle. Methods To carry out the measurements of the NCV, 10g nylon silk, vibration threshold value, sense of temperature, pain sense and ankle reflex on the patients who have been diagnosed with diabetes (DM) between April 2014 and June 2014 in the endocrinology department of our hospital. The sensitivity, specificity, positive forecast value, negative forecast value, Youden index and K value serve as assessments of the diagnostic efficiency of clinically diagnostic criteria. Results The sensitivity, specificity, positive forecast value, negative forecast value, Youden index and K value of the ankle reflex are 66.04%, 95.56%, 97.22%, 54.43%, 61.60%, and 0.51 in mediate accordance with the diagnostic criteria and it is the best one among the five methods. While the sensitivity and accordance of the pressure sense are of the least accordance with the diagnostic criteria. The correspondent value of the combination of vibration threshold sense, temperature sense and ankle reflex are respectively 86.79%, 91.11%, 95.83%, 74.55%, 77.90% and 0.73, in positive accordance with the diagnostic criteria. Conclusion Among the five methods the consistency between the combination of vibration threshold sense, temperature sense and ankle reflect and diagnostic criteria is of positive accordance and can be applied in screening DPN clinically