·糖尿病神经病变·

　　【摘要】  目的   探讨神经症状/神经缺陷评分(NSS/NDS)、密歇根神经病变筛选法(MNSI)、多伦多临床评分系统(TCSS)在糖尿病周围神经病变(DPN)中的临床诊断价值。方法 T2DM患者188例行肌电图、NSS/NDS、MNSI、TCSS检查，以神经传导速度(NCV)作为“金标准”，分析3种检查方法的特异度、灵敏度、受试者工作特征(ROC)曲线下面积等，比较不同检查方法诊断DPN的准确性和诊断效率。 结果 受试者中DPN患者111例。MNSI评分≥2.5分及TCSS≥5分时与NCV相关性好(P<0.01)。MNSI、TCSS与NCV一致性高于NSS/NDS(Kappa值分别为0.524、0.547、0.534)。MNSI≥2.5分分别与TCSS≥5分和TCSS≥6分的诊断结果进行比较，差异无统计学意义(P>0.05)。NSS/NDS、MNSI、TCSS的ROC曲线下面积分别为0.579、0.794、0.814，MNSI、TCSS的诊断准确性中等，NSS/NDS的诊断准确性较低。结论 MNSI、TCSS与NCV有较高的一致性，诊断准确性均高于NSS/NDS。MNSI≥2.5分及TCSS≥5分时诊断DPN价值较好，且两者诊断价值相当，MNSI操作相对简单，耗时短。

　　【关键词】糖尿病周围神经病变;临床诊断;临床评分系统

Evaluation of the value of clinical diagnostic methods in diabetic peripheral neuropathy BAO Juan, TANG Yan, TAN Yue, et al. Department of Geriatrics, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, China

　　【Abstract】Objective To assess the values of neuropathy symptom score/neuropathy disability score (NSS/NDS), Michigan neuropathy screening instrument (MNSI), and Toronto clinical scoring system (TCSS) in the diagnosis of diabetic peripheral neuropathy (DPN). Methods The 188 T2DM patients were examined by electromyography, NSS/NDS, MNSI, and TCSS. Using the result of the nerve conduction velocity (NCV) examination as golden criteria, the sensitivity, specificity and the ROC curve of these examinations were analyzed to assess the accuracy and diagnostic efficacy of these methods for DPN. Results Of the 188 T2DM patients, 111 had DPN. When MNSI≥2.5 and TCSS≥5, there was a moderate correlation with NCV (P<0.01). The consistency of MNSI and TCSS with NVC was higher than with NSS/NDS (kappa were 0.524, 0.547, and 0.534 respectively). In comparing the diagnosis of MNSI≥2.5 with TCSS≥5 and TCSS≥6 respectively, there was no significant difference in the results (P>0.05). The area under the ROC curve of NSS/NDS, MNSI, and TCSS were 0.579, 0.794, and 0.814 respectively. The accuracy of diagnosis of MNSI and TCSS was moderate, however, that of NSS/NDS was lower. Conclusion MNSI and TCSS have a relatively higher consistency with the NCV examination and higher accuracy than NSS/NDS. When MNSI≥2.5 and TCSS≥5, the value of diagnosis of DPN is better, and they two have an equal value, but MNSI is relatively simple to operate and need a short time to finish.

　　【Key words】Diabetes peripheral neuropathy (DPN); Clinical diagnosis; Neuropathy symptom score/neuropathy disability score (NSS/NDS); Michigan neuropathy screening instrument (MNSI); Toronto clinical scoring system (TCSS)