Quattrini C, Jeziorska M, Tavakoli M, Begum P, Boulton A J M, Malik R A
Division of Cardiovascular Medicine, Core Technology Facility, University of Manchester, 46 Grafton Street, Manchester M13 9NT, UK.
Diabetologia. 2008 Jun;51(6):1046-50. doi: 10.1007/s00125-008-0987-y. Epub 2008 Mar 27.
AIMS/HYPOTHESIS: The commercially available Neuropad test was developed as a simple visual indicator test to evaluate diabetic neuropathy. It uses a colour change to define the integrity of skin sympathetic cholinergic innervation. We compared the results of Neuropad assessment in the foot with established measures of somatic and autonomic neuropathy.
Fifty-seven diabetic patients underwent Neuropad assessment, quantitative sensory and autonomic function testing, and evaluation of intra-epidermal nerve fibre density in foot skin biopsies.
Neuropad responses correlated with the neuropathy disability score (r(s)=0.450, p<0.001), neuropathic symptom score (r(s)=0.288, p=0.03), cold detection threshold (r(s)=0.394, p = 0.003), heat-as-pain perception threshold visual analogue score 0.5 (r(s)=0.279, p=0.043) and deep-breathing heart rate variability (r(s)= -0.525, p<0.001). Intra-epidermal nerve fibre density (fibres/mm) compared with age- and sex-matched control subjects (11.06+/-0.82) was non-significantly reduced (7.37+/-0.93) in diabetic patients with a normal Neuropad response and significantly reduced in patients with a patchy (5.01+/-0.93) or absent (5.02+/-0.77) response (p=0.02). The sensitivity of an abnormal Neuropad response in detecting clinical neuropathy (neuropathy disability score >or=5) was 85% (negative predictive value 71%) and the specificity was 45% (positive predictive value 69%).
CONCLUSIONS/INTERPRETATION: The Neuropad test may be a simple indicator for screening patients with diabetic neuropathy.
目的/假设：市售的神经垫测试是作为一种简单的视觉指标测试开发的，用于评估糖尿病神经病变。它通过颜色变化来确定皮肤交感胆碱能神经支配的完整性。我们将足部神经垫评估的结果与躯体和自主神经病变的既定测量方法进行了比较。
57名糖尿病患者接受了神经垫评估、定量感觉和自主神经功能测试，以及足部皮肤活检中表皮内神经纤维密度的评估。
神经垫反应与神经病变残疾评分（r(s)=0.450，p<0.001）、神经病变症状评分（r(s)=0.288，p=0.03）、冷觉检测阈值（r(s)=0.394，p = 0.003）、热痛觉阈值视觉模拟评分0.5（r(s)=0.279，p=0.043）和深呼吸心率变异性（r(s)= -0.525，p<0.001）相关。与年龄和性别匹配的对照受试者（11.06±0.82）相比，神经垫反应正常的糖尿病患者表皮内神经纤维密度（纤维/mm）无显著降低（7.37±0.93），而反应斑驳（5.01±0.93）或无反应（5.02±0.77）患者的表皮内神经纤维密度显著降低（p=0.02）。神经垫反应异常检测临床神经病变（神经病变残疾评分≥5）时的敏感性为85%（阴性预测值71%），特异性为45%（阳性预测值69%）。
结论/解读：神经垫测试可能是筛查糖尿病神经病变患者的一种简单指标。
