Valk G D, Grootenhuis P A, van Eijk J T, Bouter L M, Bertelsmann F W
Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, The Netherlands.
Diabetes Res Clin Pract. 2000 Feb;47(2):87-95. doi: 10.1016/s0168-8227(99)00111-4.
The usefulness of sensory symptoms in the assessment of diabetic polyneuropathy is unclear. In the present study, we studied the hypothesis that pain is associated with small nerve fibre function, and that sensory alteration is associated with large nerve fibre function. In addition, we assessed the reproducibility and the ability to detect changes in clinical status over time of the nerve function tests currently used in clinical trials. Patients (78) with stable diabetic polyneuropathy were examined on three separate occasions with a test-retest interval of 17 and 52 weeks. Small nerve fibre function was measured using temperature discrimination thresholds for warmth (TDTwarmth) and cold (TDTcold). Large nerve fibre function was measured by testing sensory and motor nerve conduction velocities (SNCV and MNCV) and vibration perception thresholds (VPT). Neuropathic pain was only significantly associated with TDTcold, and with the MNCV of the tibial nerve. Sensory alteration was associated with almost all nerve function tests except the SNCV and MNCV of the ulnar nerve. The measurements of symptom severity and the nerve function tests all proved to be sufficiently reproducible. The standardized smallest detectable difference on group level (SDD) of the measurement of sensory alteration and neuropathic pain were almost the same (9% and 12%, respectively). Among the nerve function tests, the SNCV and MNCV had the smallest SDD (3-4%), and were, therefore, potentially the most responsive instruments. The SDD of the TDT was greater than the VPT (9-14% vs 21-28%, respectively). In conclusion, neuropathic pain was not associated with small nerve fibre function, and sensory alteration was associated with both large and small fibre function. In addition, the standardized measurement of symptom severity, the SNCV and MNCV tests, and the VPT test appear to be useful for monitoring the course of polyneuropathy in clinical trials.
感觉症状在评估糖尿病性多发性神经病中的作用尚不清楚。在本研究中，我们探讨了以下假设：疼痛与小神经纤维功能相关，而感觉改变与大神经纤维功能相关。此外，我们评估了目前临床试验中使用的神经功能测试的可重复性以及检测临床状态随时间变化的能力。对78例患有稳定型糖尿病性多发性神经病的患者进行了三次单独检查，重测间隔为17周和52周。使用温暖温度辨别阈值（TDTwarmth）和寒冷温度辨别阈值（TDTcold）测量小神经纤维功能。通过测试感觉和运动神经传导速度（SNCV和MNCV）以及振动觉阈值（VPT）来测量大神经纤维功能。神经性疼痛仅与TDTcold以及胫神经的MNCV显著相关。感觉改变与几乎所有神经功能测试相关，但尺神经的SNCV和MNCV除外。症状严重程度的测量和神经功能测试均被证明具有足够的可重复性。感觉改变测量和神经性疼痛测量在组水平上的标准化最小可检测差异（SDD）几乎相同（分别为9%和12%）。在神经功能测试中，SNCV和MNCV的SDD最小（3 - 4%），因此可能是最敏感的指标。TDT的SDD大于VPT（分别为9 - 14%和21 - 28%）。总之，神经性疼痛与小神经纤维功能无关，而感觉改变与大、小神经纤维功能均相关。此外，症状严重程度的标准化测量、SNCV和MNCV测试以及VPT测试似乎对监测临床试验中多发性神经病的病程有用。
