Bril Vera, Perkins B A
Toronto General Hospital, University of Toronto, University Health Network, 200 Elizabeth Street, Toronto, Ontario, Canada M5G 2C4.
Diabet Med. 2002 Aug;19(8):661-6. doi: 10.1046/j.1464-5491.2002.00759.x.
Vibration perception thresholds (VPTs) are used frequently to assess somatosensory pathways in clinical trials. Different equipment, testing paradigms, and stimulation sites produce varying results which make comparisons between trials and patient populations challenging. Information comparing the VPT obtained with the Neurothesiometer with that with the Vibratron is available, but not for a similar comparison with the CASE IV (computer-assisted sensory examination device).
Subjects (n = 478) including reference, non-neuropathic subjects with diabetes mellitus (DM), and diabetic patients with mild, moderate and severe diabetic sensorimotor polyneuropathy (DSP) had VPTs measured with the CASE IV and Neurothesiometer, as well as standard sural nerve conduction studies (NCS), all performed during the same half-day. The dorsum of the foot was used as the site of stimulation for the CASE IV VPT determination and the distal phalanx of the first toe for the Neurothesiometer.
VPTs by the CASE IV and the Neurothesiometer compared moderately by linear regression analyses (R2 = 0.547, P < 0.0001), and by 95% confidence intervals. Sensitivity for the diagnosis of mild DSP was 70% with the Neurothesiometer and 49% with the CASE IV. VPTs determined by either the Neurothesiometer or the CASE IV correlated with similar agreement to the sural nerve action potential amplitude as determined by nerve conduction studies (NCS) (R2 = 0.456 and 0.461, respectively, P < 0.0001).
The results demonstrated a significant correlation of VPT values in different stages of DSP obtained by the two methods. The Neurothesiometer was more sensitive for the diagnosis of DSP, particularly in those with mild neuropathy. Similar correlations between VPTs and electrophysiological parameters were observed, indicating that both methods are valid, and thus the Neurothesiometer may be preferable due to the ease and rapidity of testing by this method.
在临床试验中，振动觉阈值（VPT）常被用于评估躯体感觉通路。不同的设备、测试范式和刺激部位会产生不同的结果，这使得不同试验和患者群体之间的比较具有挑战性。目前已有关于用神经感觉测量仪和振动仪获得的VPT进行比较的信息，但尚无与CASE IV（计算机辅助感觉检查设备）进行类似比较的信息。
纳入包括参照组、非神经病变的糖尿病（DM）患者以及患有轻度、中度和重度糖尿病感觉运动性多发性神经病变（DSP）的糖尿病患者在内的478名受试者，在同一个半天内，使用CASE IV和神经感觉测量仪测量其VPT，并进行标准的腓肠神经传导研究（NCS）。将足背作为CASE IV测定VPT的刺激部位，将第一趾的远端指骨作为神经感觉测量仪的刺激部位。
通过线性回归分析（R2 = 0.547，P < 0.0001）以及95%置信区间，对CASE IV和神经感觉测量仪测得的VPT进行了适度比较。神经感觉测量仪诊断轻度DSP的敏感性为70%，CASE IV为49%。神经感觉测量仪或CASE IV测定的VPT与神经传导研究（NCS）测定的腓肠神经动作电位幅度具有相似的一致性相关性（分别为R2 = 0.456和0.461，P < 0.0001）。
结果表明，两种方法获得的不同阶段DSP的VPT值具有显著相关性。神经感觉测量仪对DSP的诊断更敏感，尤其是对轻度神经病变患者。观察到VPT与电生理参数之间存在相似的相关性，表明两种方法均有效，因此由于该方法测试简便快捷，神经感觉测量仪可能更具优势。
