Costa Luciana A, Maraschin Jorge F, Xavier de Castro José H, Gross Jorge L, Friedman Rogério
Endocrine Division, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
Diabetes Res Clin Pract. 2006 Sep;73(3):292-7. doi: 10.1016/j.diabres.2006.02.005. Epub 2006 Mar 29.
To test a simplified protocol to screen type 2 diabetic patients (DM2) for distal polyneuropathy (DPN), 80 outpatients and 45 controls answered a symptom questionnaire, underwent a directed examination (pin-prick, tuning fork, monofilament, ankle jerk, cold spatula and walking on heels), autonomic tests, and an electroneurophysiological study (EMG). Symptoms were also analysed as scores. DPN was diagnosed in the presence of abnormal EMG (or autonomic neuropathy), plus one symptom or one abnormal objective finding. Symptoms were equally frequent in patients (56%) and controls (35%, P=0.20). Objective findings were more frequent in patients (62/80 versus 11/45; P<0.05). The 60 DM2 patients with DPN were older, with longer diabetes duration and more often hypertensive than those without DPN. The 15 patients unable to walk on heels had DPN (sensitivity 20.8%, specificity 100%, positive predictive value 100% and negative predictive value 12.3%). The 12 patients able to walk on heels but with three or more abnormal tests had DPN (sensitivity 21.1%, specificity 100%, positive predictive value 100% and negative predictive value 15.1%). Isolated signs and symptoms do not identify patients with DPN. Patients with higher degrees of impairment can be identified by six simple ambulatory tests, reducing in one-third the need for EMG.
为了测试一种简化方案，以筛查2型糖尿病患者（DM2）是否患有远端多发性神经病（DPN），80名门诊患者和45名对照者回答了症状问卷，接受了定向检查（针刺、音叉、单丝、跟腱反射、冷压舌板和足跟行走）、自主神经测试以及神经电生理研究（肌电图）。症状也以分数形式进行分析。当肌电图异常（或存在自主神经病变），加上一种症状或一项客观检查异常时，即可诊断为DPN。患者（56%）和对照者（35%，P=0.20）出现症状的频率相同。患者的客观检查异常更为常见（80例中有62例，而45例中有11例；P<0.05）。60例患有DPN的DM2患者比未患DPN的患者年龄更大，糖尿病病程更长，高血压更为常见。15例无法足跟行走的患者患有DPN（敏感性20.8%，特异性100%，阳性预测值100%，阴性预测值12.3%）。12例能够足跟行走但有三项或更多项检查异常的患者患有DPN（敏感性21.1%，特异性100%，阳性预测值100%，阴性预测值15.1%）。孤立的体征和症状无法识别患有DPN的患者。通过六项简单的门诊检查可以识别出损伤程度较高的患者，将肌电图检查需求减少三分之一。
