Vibration perception threshold as a measure of distal symmetrical peripheral neuropathy in type 1 diabetes: results from the DCCT/EDIC study.
Vibration perception threshold as a measure of distal symmetrical peripheral neuropathy in type 1 diabetes: results from the DCCT/EDIC study.
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DOI：
10.2337/dc10-0616
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发表时间：
2010-12
期刊：
影响因子：
16.2
通讯作者：
DCCT/EDIC Research Group
中科院分区：
文献类型：
--
作者：
Martin CL;Waberski BH;Pop-Busui R;Cleary PA;Catton S;Albers JW;Feldman EL;Herman WH;DCCT/EDIC Research Group
描述振动感知阈值（VPT）测试相对于周围神经病变金标准评估在1型糖尿病受试者中的灵敏度、特异性、阳性预测值和阴性预测值。VPT在1，177名1型糖尿病成人患者中进行了测定，这些患者在参加了一项强化（INT）与常规（CONV）糖尿病治疗研究后13-14年。异常VPT定义为超过年龄特异性正常值2.5 SD的值。评估周围神经病变的体征和症状，并进行电诊断研究，以确定明确的临床神经病变、异常神经传导和确认的临床神经病变（同时存在明确的临床神经病变和异常神经传导）。37%的受试者有明确的临床神经病变，61%有异常神经传导，30%有确诊的临床神经病变。VPT异常在前CONV组比INT组更常见（64%比57%，P < 0.05），且与年龄较大有关。VPT是确诊的临床神经病变（87%）和明确的临床神经病变（80%）的敏感指标，也是异常神经传导（62%）的特异指标。较高的VPT临界点提高了检测灵敏度，较低的临界点提高了特异性。受试者工作特征曲线下面积范围为0.71-0.83，老年受试者高于年轻受试者，确诊为临床神经病变的受试者最高。VPT是周围神经病变的敏感指标。未来的研究者可能会选择VPT的切割点定义异常的基础上研究的人群和临床结果的兴趣。
To describe the sensitivity, specificity, positive predictive value, and negative predictive value of vibration perception threshold (VPT) testing in subjects with type 1 diabetes relative to gold standard assessments of peripheral neuropathy. VPT was determined in 1,177 adults with type 1 diabetes 13–14 years after participating in a study of intensive (INT) versus conventional (CONV) diabetes treatment. Abnormal VPT was defined by values exceeding 2.5 SD above age-specific normal values. Signs and symptoms of peripheral neuropathy were assessed and electrodiagnostic studies were performed to establish definite clinical neuropathy, abnormal nerve conduction, and confirmed clinical neuropathy (the presence of both definite clinical neuropathy and abnormal nerve conduction). Thirty-seven percent of subjects had definite clinical neuropathy, 61% had abnormal nerve conduction, and 30% had confirmed clinical neuropathy. Abnormal VPT was more common among former CONV than among INT subjects (64 vs. 57%, P < 0.05) and was associated with older age. VPT was a sensitive measure of confirmed clinical neuropathy (87%) and of definite clinical neuropathy (80%) and a specific measure of abnormal nerve conduction (62%). Higher VPT cut points improved test sensitivity and lower cut points improved specificity. Areas under the receiver operating characteristic curves ranged from 0.71–0.83 and were higher for older than for younger subjects and highest for those with confirmed clinical neuropathy. VPT was a sensitive measure of peripheral neuropathy. Future researchers may choose to select VPT cut points for defining abnormality based on the population studied and clinical outcome of interest.