The diagnostic yield of a standardized approach to idiopathic sensory-predominant neuropathy
The diagnostic yield of a standardized approach to idiopathic sensory-predominant neuropathy
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DOI：
10.1001/archinte.164.9.1021
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发表时间：
2004-05-10
影响因子：
--
通讯作者：
Singleton, JR
中科院分区：
文献类型：
--
作者：
Smith, AG;Singleton, JR
背景：周围神经病变是一种常见问题，通常需要进行漫长且昂贵的诊断评估。需要一种合理的、基于证据的周围神经病变诊断方法。之前的研究主要集中在所有被三级转诊中心诊断为未分类神经病的患者。然而，大多数周围神经病变患者主要有感觉症状。这项研究的重点是感觉主导神经病患者。目标是开发一种可轻松应用于一般医疗环境的重点诊断算法。方法：纳入以感觉症状为主且之前没有明确病因的患者，并使用标准诊断方法进行评估。结果：在 138 名患者中，25% 的患者至少有 1 名一级亲属患有提示神经病的症状。在实验室研究中，2 小时口服葡萄糖耐量试验的诊断率最高 (61%)，并且比其他葡萄糖代谢指标更敏感。 2 名患者被发现缺乏维生素 B-12。不到 5% 的患者的血清蛋白电泳、免疫固定和抗核抗体检测结果出现异常，这些比率与一般人群中发现的相似。使用这种方法，完成推荐评估的患者中只有 31% 被发现患有特发性神经病。结论：感觉主导神经病患者应检测葡萄糖耐量和维生素 B-12 浓度。血清蛋白电泳和抗核抗体异常的意义尚不确定。仅当临床情况有提示时才应进行其他测试。具有非典型特征的患者可能会受益于转诊至周围神经病中心。
Background: Peripheral neuropathy is a common problem that often prompts a lengthy and expensive diagnostic evaluation. A rational, evidence-based diagnostic approach to peripheral neuropathy is desirable. Prior studies have focused on all patients presenting to a tertiary referral center with a diagnosis of unclassified neuropathy. However, most patients with peripheral neuropathy have primarily sensory symptoms. This study focuses on patients with sensory-predominant neuropathy. The goal was to develop a focused diagnostic algorithm that can be easily applied in a general medical setting.Methods: Patients referred with predominantly sensory symptoms and no previously defined cause were included and evaluated using a standard diagnostic approach.Results: Among 138 patients, 25% had at least 1 first-degree relative with symptoms suggestive of neuropathy. Among laboratory studies, a 2-hour oral glucose tolerance test had the highest diagnostic yield (61%) and was more sensitive than other measures of glucose metabolism. Vitamin B-12 deficiency was identified in 2 patients. Results of serum protein electrophoresis, immunofixation, and antinuclear antibody testing were abnormal in less than 5% of patients, and these rates are similar to those found in the general population. Using this approach, only 31% of patients completing the recommended evaluation were found to have an idiopathic neuropathy.Conclusions: Patients with sensory-predominant neuropathy should be tested for glucose tolerance and vitamin B-12 concentration. The significance of abnormalities of serum protein electrophoresis and antinuclear antibodies is uncertain. Other tests should be performed only when the clinical scenario is suggestive. Patients with atypical features may benefit from referral to a peripheral neuropathy center.