Distal symmetrical polyneuropathy: Definition for clinical research
Distal symmetrical polyneuropathy: Definition for clinical research
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DOI：
10.1002/mus.20233
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发表时间：
2005-01-01
期刊：
影响因子：
3.4
通讯作者：
Sumner, AJ
中科院分区：
文献类型：
--
作者：
England, JD;Gronseth, GS;Sumner, AJ
这份报告的目的是制定“远端对称性多发性神经病”的病例定义，以标准化和促进临床研究和流行病学研究。在对文献中的证据进行系统审查和分类后，采用了正式的协商一致程序以达成一致意见。文献表明，在预测多发性神经病的存在方面，仅症状本身的诊断准确性相对较差；体征比症状更能预测多发性神经病的存在；在预测多发性神经病的存在方面，检查中的单一异常不如多项异常敏感。神经病变的症状、体征和电诊断结果相结合，可为远端对称性多发性神经病提供最准确的诊断。一组病例定义是按患病可能性排序的。多发性神经病(对临床试验有用)的最高可能性发生在多个症状、多个体征和异常电诊断检查的组合中。当电诊断研究的结果不可用时，多个症状和多个体征的组合发生多发性神经病的可能性不大(对现场或流行病学研究很有用)。当电诊断研究和体征不一致时，发生多发性神经病的可能性较低。出于研究目的，定义远端对称性多发性神经病的最佳方法是根据估计的疾病可能性排序的一套病例定义。将这一正式的病例定义纳入临床和流行病学研究将确保病例选择的更大一致性。
The objective of this report was to develop a case definition of "distal symmetrical polyneuropathy" to standardize and facilitate clinical research and epidemiological studies. A formalized consensus process was employed to reach agreement after a systematic review and classification of evidence from the literature. The literature indicates that symptoms alone have relatively poor diagnostic accuracy in predicting the presence of polyneuropathy; signs are better predictors of polyneuropathy than symptoms; and single abnormalities on examination are less sensitive than multiple abnormalities in predicting the presence of polyneuropathy. The combination of neuropathic symptoms, signs, and electrodiagnostic findings provides the most accurate diagnosis of distal symmetrical polyneuropathy. A set of case definitions was rank ordered by likelihood of disease. The highest likelihood of polyneuropathy (useful for clinical trials) occurs with a combination of multiple symptoms, multiple signs, and abnormal electrodiagnostic studies. A modest likelihood of polyneuropathy (useful for field or epidemiological studies) occurs with a combination of multiple symptoms and multiple signs when the results of electrodiagnostic studies are not available. A lower likelihood of polyneuropathy occurs when electrodiagnostic studies and signs are discordant. For research purposes, the best approach for defining distal symmetrical polyneuropathy is a set of case definitions rank ordered by estimated likelihood of disease. The inclusion of this formalized case definition in clinical and epidemiological research studies will ensure greater consistency of case selection.