Evaluation of three screening tests and a risk assessment model for diagnosing peripheral neuropathy in the diabetes clinic
Evaluation of three screening tests and a risk assessment model for diagnosing peripheral neuropathy in the diabetes clinic
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DOI：
10.1016/s0168-8227(01)00278-9
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发表时间：
2001-11-01
影响因子：
5.1
通讯作者：
Bril, V
中科院分区：
文献类型：
--
作者：
Olaleye, D;Perkins, BA;Bril, V
目的：探讨3种替代神经传导试验诊断糖尿病周围神经病变(DPN)的简易筛选试验的预测能力。筛查试验的结果，以及受试者的人口统计和临床特征，被计划作为开发预测DPN的风险评估工具的变量。设计：横断面多组对照研究。这项研究利用了来自研究人群的一个子集的预测模型，并在另一个子集进行了前瞻性测试，以预测神经病变的存在。单位：1998年6月至1999年8月在加拿大安大略省多伦多的多伦多综合医院和大学健康网络糖尿病神经病变研究诊所。样本人群：数据来自478名受试者，包括非糖尿病参考受试者，以及1型和2型糖尿病患者。结果指标：神经传导研究(NCS)包括初步确定的结果。研究中检查的三种筛选感觉测试是Semmes-Weinstein 10g单丝检查(SWME)、表面痛觉和开关方法的振动。结果：三种筛查试验与NCS呈显著正相关。筛查测试中无感觉反应的数量增加与异常NCS评分的增加有关。当受试者的神经病严重程度阶段被添加到模型中时，NCS和每项感觉测试之间的关联强度更大。SWME和振动法测试都显示出足够的统计能力来区分非糖尿病对照组受试者和糖尿病受试者，以及区分糖尿病伴和不伴神经病变的受试者。这两个测试与NCS相比，在高灵敏度和特异度、正确预测的病例总数和接收器-操作特征曲线方面也显示出可接受的诊断性能特征。结论：通过建立包含训练和验证集的模型，这些数据表明对临床危险因素的了解改变了对DPN感觉测试的解释。这一发现进一步支持了简单感觉测试操作在DPN条件诊断中的有效性。我们建议在初级保健和糖尿病诊所使用SWME或振动法进行年度筛查。(C)2001爱思唯尔爱尔兰科学有限公司。保留所有权利。
Objective: with the aim of evaluating predictive power, three simple screening tests as alternates to nerve conduction tests for diagnosing diabetic peripheral neuropathy (DPN) were investigated. Results of the screening tests, along with the subjects' demographic and clinical characteristics, were planned as the variables for the development of a risk assessment tool for predicting DPN. Design: this is a cross-sectional multi-group comparison study. The study utilized a predictive model derived from one subset of the study population, and prospectively tested in the other subset to predict the presence of neuropathy. Setting: Diabetic Neuropathy Research Clinic of the Toronto General Hospital and University Health Network in Toronto, Ontario, Canada from June 1998 to August 1999. Sample population: data come from 478 subjects consisting of non-diabetic reference subjects, and patients with type I and type 2 diabetes mellitus. Outcome measures: nerve conduction studies (NCS) comprised the primary defined outcome. The three screening sensory tests examined in the study were the Semmes-Weinstein 10 g monofilament examination (SWME), superficial pain sensation, and vibration by the on-off method. Results: the three screening tests are significantly and positively correlated with NCS. An increase in the number of insensate responses in the screening test is associated with an increase in the abnormal NCS score. The strength of the association between NCS and each sensory test was greater when the neuropathy severity stage of the subject was added to the model. Both the SWME and vibration by the on-off method tests demonstrated sufficient statistical power to differentiate non-diabetic control subjects from subjects with diabetes, as well as to differentiate subjects with diabetes with and without neuropathy. These two tests, when compared with NCS, also demonstrated acceptable diagnostic performance characteristics in terms of high sensitivity and specificity, total number of correctly predicted cases, and receiver-operating characteristic curves. Conclusion: this data, through the development of a model involving training and validation sets, demonstrates that the knowledge of clinical risk factors alters the interpretation of sensory tests for DPN. This finding lends further support to the validity of simple sensory testing maneuvers in the conditional diagnosis of DPN. We recommend annual screening with either the SWME or vibration by the on-off method in the primary care and diabetes clinics. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.