VARIABLES INFLUENCING NEUROPATHIC END-POINTS - THE ROCHESTER DIABETIC NEUROPATHY STUDY OF HEALTHY-SUBJECTS
VARIABLES INFLUENCING NEUROPATHIC END-POINTS - THE ROCHESTER DIABETIC NEUROPATHY STUDY OF HEALTHY-SUBJECTS
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DOI：
10.1212/wnl.45.6.1115
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发表时间：
1995-06-01
期刊：
影响因子：
9.9
通讯作者：
OBRIEN, PC
中科院分区：
文献类型：
--
作者：
DYCK, PJ;LITCHY, WJ;OBRIEN, PC
我们确定了健康受试者各种神经病理学检查的正常范围。这项研究是罗切斯特糖尿病神经病变研究（RDNS），值得注意的是，其规模（超过400例受试者）、随机选择受试者以及从规定地区（罗切斯特，MN）人群中选择至少15名男性和15名女性，这些受试者均无神经病变、神经系统疾病或神经病变易感性疾病，年龄在18至74岁之间。受试者被分为患有（非健康受试者，RDNS-NS）和不患有（健康受试者，RDNS-HS）神经病变、神经系统或精神疾病或已知易患神经病变的疾病的受试者。该研究为RDNS中使用的测试提供了正常限值，但它也有更广泛的用途。我们发现：（1）不到10%的受试者在第三个十年，约20%在第四个十年，约30%在第五个十年或以上被放置到RDNS-NS类别;（2）健康受试者（RDNS-HS）保持他们用脚趾和脚跟行走的能力，而不管年龄、超重或缺乏身体健康，但跪姿起身的能力没有下降--超过5%的60岁及以上的人失去了这种能力;（3）在50岁以上的健康受试者中，踝反射减少或缺失的频率超过5%-限制了它们作为糖尿病性多发性神经病的标志的价值，并需要神经病损害评分随年龄的分级变化。我们还发现：（1）年龄以外的身体变量影响神经病终点;（2）神经病终点之间的变量不同;（3）现在可以自动计算给定患者神经病终点的特定百分位数。我们发现，改进的估计的正常限度，有时提供一个不同的估计的正态性，从一个是从年龄的考虑。我们认为，百分位数的方法，考虑物理变量影响神经病变终点可能会通过临床肌电图，感觉，和自主实验室。继续使用仅按年龄校正的正常限值表，提供的参考值非常不充分，特别是对于神经传导的某些属性以及身高和体重的极端值。
We determined the normal limits for various neuropathic tests in healthy subjects. The study, the Rochester Diabetic Neuropathy Study (RDNS), is noteworthy because of its size (more than 400 subjects), random selection of subjects, and selection of at least 15 men and 15 women without neuropathy, neurologic disease, or diseases predisposing to neuropathy from each hemidecade between 18 and 74 years of age from the population of a defined region (Rochester, MN). Subjects were classified into those with (nonhealthy subjects, RDNS-NS) and without (healthy subjects, RDNS-HS) neuropathy, neurologic or psychiatric disease, or diseases known to predispose to neuropathy. The study provides normal limits for tests used in the RDNS but it has broader uses as well. We found that (1) less than 10% of subjects in the third decade, approximately 20% in the fourth decade, and approximately 30% in the fifth or older decades were placed into the RDNS-NS category; (2) healthy subjects (RDNS-HS) retain their ability to walk on toes and heels regardless of age, excessive weight, or lack of physical fitness, but not their ability to arise from a kneeled position-lost in more than 5% of persons 60 years and older; (3) the frequency of decreased or absent ankle reflexes exceeds 5% in healthy subjects older than 50 years-limiting their value as a sign of diabetic polyneuropathy and necessitating a grading change with age in the neuropathy impairment score. We also found that (1) physical variables other than age influence neuropathic endpoints; (2) the variables are different among neuropathic endpoints; and (3) it is now possible to compute specific percentile values automatically for neuropathic endpoints for a given patient. We found that the improved estimates of normal limits sometimes provide a different estimate of normality from the one that was available from age consideration only. We suggest that the percentile approach considering physical variables influencing neuropathic endpoints might be adopted by clinical EMG, sensory, and autonomic laboratories. Continued use of normal limits tables, which are corrected only for age, provides quite inadequate reference values, especially for some attributes of nerve conduction and for the extremes of height and weight.