Kamenov Z A, Petrova J J, Christov V G
Clinic of Neurology, Alexandrovska University Hospital, Medical University - Sofia, Bulgaria.
Exp Clin Endocrinol Diabetes. 2010 Apr;118(4):226-33. doi: 10.1055/s-0030-1247565. Epub 2010 Mar 3.
The global spread of diabetes (DM) and the importance of early therapeutic intervention determine the need of simple, inexpensive and sensitive methods for diagnosis of diabetic complications in the general practice. The aim of this study was to assess a new instrument - the plaster Neuropad in diagnosing the sudomotor diabetic dysfunction and to investigate the correlates of Neuropad data with diabetic complications.
In this cross-sectional study participated 264 inpatients (M/F=126/138) with DM type 1/2 (61/203), mean age 55.4+/-12.0 and DM duration of 9.3+/-7.1 years. According to hospital records were registered: anthropometric data; fasting plasma glucose and HbA1c; presence of micro-(retino-, nephro-, neuropathy), and macrovascular (arterial hypertension, coronary artery disease and/or brain vascular disease) complications, and neuropathic symptoms were evaluated. For investigation of somatic DN a modified Neuropathy Disability Score (NDS) and for sudomotor autonomic DN - Neuropad were used.
Neuropad showed the highest between-feet correlation of 0.91 compared to all other individual tests and the NDS. Neuropad was able to separate patients in groups with different general risk profile, including age, duration of DM, presence of coronary and/or brain vascular disease, nephropathy, and retinopathy. Moreover, Neuropad differentiated patient groups by their stage of DN, evaluated by symptoms, diagnosis, the individual somatic tests and with the highest significance - by NDS. Most sensitive for detecting DN was NDS > or = 3, followed by Achilles reflexes, vibration perception (128 Hz tuning fork) and Neuropad. A borderline or abnormal result of Neuropad showed sensitivity=76.3/79.3, specificity=56.1/42.9, positive=86.3/62.8 and negative=39.5/63.0 predictive values, and diagnostic accuracy 72.2/62.9%, compared to the indices for presence of somatic DN (NDS > or = 3)/foot at risk (NDS > or = 6) respectively.
Screening for DN must cover somatic and autonomic disturbances. Neuropad is a new sensitive and appropriate for everyday clinical use test for detecting sudomotor DN and identification of patients at higher risk for chronic diabetes complications.
糖尿病（DM）在全球范围内的传播以及早期治疗干预的重要性，决定了在普通医疗实践中需要简单、廉价且灵敏的方法来诊断糖尿病并发症。本研究的目的是评估一种新工具——Neuropad石膏，用于诊断糖尿病性汗腺运动功能障碍，并研究Neuropad数据与糖尿病并发症之间的相关性。
在这项横断面研究中，共有264名1/2型糖尿病住院患者（男/女=126/138）参与，平均年龄55.4±12.0岁，糖尿病病程9.3±7.1年。根据医院记录，登记了人体测量数据；空腹血糖和糖化血红蛋白；微血管（视网膜、肾脏、神经病变）和大血管（动脉高血压、冠状动脉疾病和/或脑血管疾病）并发症的存在情况，并对神经病变症状进行了评估。对于躯体性糖尿病神经病变的调查，使用了改良的神经病变残疾评分（NDS），对于汗腺运动自主神经病变，则使用了Neuropad。
与所有其他个体测试和NDS相比，Neuropad显示出两脚之间最高的相关性，为0.91。Neuropad能够将患者分为具有不同总体风险特征的组，包括年龄、糖尿病病程、冠状动脉和/或脑血管疾病、肾病和视网膜病变的存在情况。此外，Neuropad根据糖尿病神经病变的阶段对患者组进行区分，通过症状、诊断、个体躯体测试进行评估，并且最显著的是通过NDS进行评估。检测糖尿病神经病变最敏感的是NDS≥3，其次是跟腱反射、振动觉（128Hz音叉）和Neuropad。Neuropad的临界或异常结果显示敏感性=76.3/79.3，特异性=56.1/42.9，阳性预测值=86.3/62.8，阴性预测值=39.5/63.0，诊断准确性分别为72.2/62.9%，与有风险足部躯体性糖尿病神经病变（NDS≥3）/足部（NDS≥6）的指标相比。
糖尿病神经病变的筛查必须涵盖躯体和自主神经紊乱。Neuropad是一种新的灵敏且适用于日常临床使用的检测方法，用于检测汗腺运动性糖尿病神经病变并识别慢性糖尿病并发症风险较高的患者。
