Diagnosing diabetic peripheral neuropathies in pediatric practice: An in-place validation of a mechanical detection test

糖尿病是儿童和青春期最常见的代谢性疾病。糖尿病周围神经病变，即使它们本身可能是无痛的，也是发展成严重致残性并发症(足部溃疡和截肢)的重要风险因素，因此必须密切监测。神经传导研究是对周围神经病变的客观测试，并显示25%至59%的糖尿病儿童有周围神经病变。然而，神经传导研究是令人不快的，并不是在每一个实践中都有。对于成年人，Rydell-Seiffer音叉测试和10g Semmes-Weinstein单丝测试已被证明在筛查周围神经疾病方面是有用的。前者测试振动感知阈值，方法是将振动音叉放在骨质骨隆起上，患者必须指出他们什么时候感觉不到振动。后者通过对皮肤施加一定的力来测试触觉，方法是使用单丝在特定的力下弯曲。这些筛查方法也被德国现行的儿童糖尿病治疗S3指南推荐用于儿童。然而，对儿童和青少年的研究表明，这两种筛查测试在这一群体中都没有用。虽然音叉没有可行的替代品，但最近的一项研究表明，通过使用更敏感的单丝，单丝测试可能会得到改进。例如，目前使用的10g单丝施加的力为100毫牛顿，大约是健康儿童检测阈值的100倍。这种新型的更灵敏的单丝测试的有效比较仍然缺乏。拟议的研究的目的是比较新的单丝测试和目前在儿科实践中使用的音叉的诊断价值。

Diabetes Mellitus is the most prevalent metabolic disease in childhood and adolescence. Diabetic peripheral neuropathies, even though they themselves may be painless, are an important risk-factor for the development of severely disabling complications (foot ulcerations and amputations) and thus have to be closely monitored.Nerve-conduction studies are objective tests for peripheral neuropathies and show that between 25% and 59% of the children with diabetes have peripheral neuropathies. However Nerve-conduction-studies are unpleasant and are not available in every practice. For adults the Rydell-Seiffer tuning-fork test and the 10-g Semmes-Weinstein monofilament test have been proven useful in screening for peripheral neuropathies. The former tests the vibration perception threshold, by placing a vibrating tuning fork on a bony prominence and patients have to indicate when they cannot feel the vibration any more. The latter tests touch perception by a applying a defined force to the skin using a monofilament that bends at a specific force. These screening methods are also recommended for use in children by the current German S3 guidelines for treatment of children with diabetes mellitus. Studies in children and adolescents however indicate that neither are useful screeningtests in this group. While there are no practicable alternatives to the tuning fork, a recent study suggests, that the monofilament test may be improved by using more sensitive monofilaments. For example the currently used 10g monofilament exerts a force of 100 milliNewton, which is about 100 times stronger than the detection threshold of healthy children. A valid comparison of such a novel more sensitive monofilament test is still lacking.The aim of the proposed study is to compare the diagnostic utility of the novel monofilament test with the currently used tuning-fork in pediatric practice.