Does This Patient With Diabetes Have Large-Fiber Peripheral Neuropathy?
Does This Patient With Diabetes Have Large-Fiber Peripheral Neuropathy?
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DOI：
10.1001/jama.2010.428
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发表时间：
2010-04-21
影响因子：
120.7
通讯作者：
Panju, Akbar
中科院分区：
文献类型：
--
作者：
Kanji, Jamil N.;Anglin, Rebecca E. S.;Panju, Akbar
研究背景糖尿病周围神经病变使患者容易出现足部溃疡，愈合不良，并经常导致截肢。大纤维周围神经病变(LFPN)是糖尿病神经病变的一种常见形式，一旦被早期发现，就会促使采取积极的措施来防止足部溃疡的进展及其相关的发病率和死亡率。目的系统地回顾文献，以确定在足部溃疡发生之前预测无症状LFPN的临床检查结果。数据来源、研究选择和数据提取MEDLINE(1966-2009)和EMBASE(1980-2009[Week 50])数据库中关于糖尿病周围神经病变的床边诊断的文章。包括以神经传导测试为参考标准比较病史或体格检查元素的研究。数据综合1388篇文章，9篇关于诊断准确性，3篇关于精确度符合纳入标准。糖尿病LFPN的患病率从23%到79%不等。意大利糖尿病学会开发的症状问卷得分大于4会增加LFPN的可能性(似然比[LR]，4.0；95%可信区间[CI]，2.9-5.6；阴性LR，0.19；95%CI，0.10-0.38)。最有用的检查结果是128赫兹音叉的振动感知(LR范围，1635)和5.07塞姆斯-温斯坦单丝的压力感觉(LR范围，11-16)。振动测试(LR范围为0.33-0.51)或单丝(LR范围为0.09-0.54)的正常结果会降低LFPN的可能性。综合体征表现并不比这两项单独发现更好。结论体格检查是评估糖尿病患者LFPN最有用的方法。单丝测试和振动感觉的异常结果(单独或结合足部外观、溃疡和脚踝反射)是最有帮助的迹象。贾玛2010；303(15)：1526-1532 www.jama.com
Context Diabetic peripheral neuropathy predisposes patients to foot ulceration that heals poorly and too often leads to amputation. Large-fiber peripheral neuropathy (LFPN), one common form of diabetic neuropathy, when detected early prompts aggressive measures to prevent progression to foot ulceration and its associated morbidity and mortality.Objective To systematically review the literature to determine the clinical examination findings predictive of asymptomatic LFPN before foot ulceration develops.Data Sources, Study Selection, and Data Extraction MEDLINE (January 1966-November 2009) and EMBASE (1980-2009 [week 50]) databases were searched for articles on bedside diagnosis of diabetic peripheral neuropathy. Included studies compared elements of history or physical examination with nerve conduction testing as the reference standard.Data Synthesis Of 1388 articles, 9 on diagnostic accuracy and 3 on precision met inclusion criteria. The prevalence of diabetic LFPN ranged from 23% to 79%. A score greater than 4 on a symptom questionnaire developed by the Italian Society of Diabetology increases the likelihood of LFPN (likelihood ratio [LR], 4.0; 95% confidence interval [CI], 2.9-5.6; negative LR, 0.19; 95% CI, 0.10-0.38). The most useful examination findings were vibration perception with a 128-Hz tuning fork (LR range, 1635) and pressure sensation with a 5.07 Semmes-Weinstein monofilament (LR range, 11-16). Normal results on vibration testing (LR range, 0.33-0.51) or monofilament (LR range, 0.09-0.54) make LFPN less likely. Combinations of signs did not perform better than these 2 individual findings.Conclusions Physical examination is most useful in evaluating for LFPN in patients with diabetes. Abnormal results on monofilament testing and vibratory perception (alone or in combination with the appearance of the feet, ulceration, and ankle reflexes) are the most helpful signs. JAMA. 2010;303(15):1526-1532 www.jama.com