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

糖尿病是儿童和青少年最常见的代谢性疾病。糖尿病周围神经病变，尽管它们本身可能是无痛的，但却是严重致残并发症（足部溃疡和截肢）发展的重要危险因素，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，表明25%至59%的糖尿病患儿患有周围神经病变。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可用。对于成人，Rydell-Seiffer音叉试验和10g semms - weinstein单丝试验已被证明对周围神经病变的筛查有用。前者测试振动感知阈值，将振动音叉放在骨突上，患者必须指出何时不再感觉到振动。后者通过使用在特定力下弯曲的单丝向皮肤施加确定的力来测试触摸感知。这些筛查方法也被当前德国S3指南推荐用于治疗儿童糖尿病。然而，对儿童和青少年的研究表明，这两种方法都不是有效的筛查方法。虽然没有可行的替代音叉，但最近的一项研究表明，单丝测试可以通过使用更敏感的单丝来改进。例如，目前使用的10g单丝施加的力为100毫牛顿，比健康儿童的检测阈值强100倍左右。这种新型的更灵敏的单丝试验的有效比较仍然缺乏。本研究的目的是比较新型单丝测试与目前儿科实践中使用的音叉的诊断效用。

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.