The value of the Rydel-Seiffer tuning fork as a predictor of diabetic polyneuropathy compared with a neurothesiometer
The value of the Rydel-Seiffer tuning fork as a predictor of diabetic polyneuropathy compared with a neurothesiometer
复制标题
DOI：
10.1111/j.1464-5491.2004.01205.x
复制
发表时间：
2004-06-01
影响因子：
3.5
通讯作者：
Irsigler, K
中科院分区：
文献类型：
--
作者：
K채stenbauer, T;Sauseng, S;Irsigler, K
目的研究Rydel-Seiffer音叉对糖尿病神经病变的预测价值，并将其与电子神经测量仪进行比较。方法对2022例连续的糖尿病患者，采用128 hz音叉和神经测量仪，通过简单的床边检查和有无神经病变症状，对两大趾尖的振动感知阈值（VPT）进行诊断。这些评估进一步结合诊断周围神经功能障碍（异常床边检查）和症状性神经病变。同时测量175名非糖尿病对照组的VPT，以确定正常值。结果音叉法测VPT正常者1917例，异常者105例（5.2%）。振动试验异常的患者比振动感正常的患者年龄明显（P < 0.0001），而前者的糖尿病病程和HbA（1c）也明显升高。10-g单丝试验异常的百分比（66.7% vs. 7.2%, P < 0.0001）和跟腱反射缺失的百分比（68.6% vs. 24.8%, P < 0.0001）也是如此。最后，在音叉测试异常的患者中，神经测量仪测量的VPT高2.5倍（32.0 +/- 9.8 vs. 12.5 +/- 6.4 V, P < 0.0001）。两种方法对其平均值的差异图显示了两种VPT测量值的良好一致性，音叉对异常床边检查和症状性神经病变的诊断具有高灵敏度和阳性预测价值。结论与神经测量仪相比，音叉能可靠地检测周围神经病变。音叉是一种有用的糖尿病神经病变筛查试验。
Aims The aim of the study was to investigate the predictive value of the Rydel-Seiffer tuning fork for detecting diabetic neuropathy and to compare it with an electronic neurothesiometer.Methods In 2022 consecutive diabetic subjects, peripheral polyneuropathy was diagnosed by vibration perception threshold (VPT) at the tip of both great toes using a 128-Hz tuning fork and a neurothesiometer, by simple bedside tests and by the presence of neuropathic symptoms. These evaluations were further combined to diagnose peripheral nerve dysfunction (abnormal bedside tests) and symptomatic neuropathy. VPT was also measured in 175 non-diabetic control subjects to define normal values.Results VPT was normal in 1917 subjects and abnormal in 105 (5.2%) patients when measured by the tuning fork. Patients with an abnormal vibration test were significantly (P < 0.0001) older than subjects with a normal vibration sense, while diabetes duration and HbA(1c) of the former were also significantly elevated. The same was true for the percentages of an abnormal 10-g monofilament test (66.7% vs. 7.2%, P < 0.0001) and a missing Achilles' tendon reflex (68.6% vs. 24.8%, P < 0.0001). Finally, the VPT measured by the neurothesiometer was 2.5 times higher in patients with an abnormal tuning fork test (32.0 +/- 9.8 vs. 12.5 +/- 6.4 V, P < 0.0001). The plot of the difference of both methods against their mean yielded a good agreement of the two VPT measurements, and the tuning fork had a high sensitivity and positive predictive value for the diagnosis of abnormal bedside tests and for symptomatic neuropathy.Conclusion The tuning fork reliably detected peripheral neuropathy in comparison with the neurothesiometer. A tuning fork is a useful screening test for diabetic neuropathy.