Department of Endocrinology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
Indian J Med Res. 2011 Jun;133(6):645-9.
BACKGROUND & OBJECTIVES: Vibration perception threshold (VPT) is considered as a gold standard for diagnosis of diabetic peripheral neuropathy. However, the data are sparse comparing the VPT with commonly used bedside modalities. This study was carried out to evaluate the usefulness of simple bed side screening modalities for peripheral neuropathy in patients with diabetes mellitus.
A total of 1044 patients with diabetes mellitus attending the Diabetes clinic from January 2007 to May 2008, were included in this study. All subjects had a detailed clinical assessment including Diabetic Neuropathy Symptom (DNS) score, Diabetic Neuropathy Examination (DNE) score, ankle reflex, vibration sensation with a 128 Hz tuning fork, 10 g Semmes-Weinstein monofilament and vibration perception threshold (VPT).
The prevalence of peripheral neuropathy was 34.9 per cent with VPT. Foot care practices were followed by only 214 (20.5%) of the study population. When compared with VPT, ankle reflex was the most sensitive (90.7%) but least specific (37.3%). The tuning fork and monofilament tests respectively had lower sensitivity (62.5 and 62.8%) but better specificity (95.3 and 92.9%) and accuracy (78.9 and 77.9%). Significant correlations were observed between the VPT score and the DNE (r = 0.532, P<0.001) and DNS (r = 0.546, P<0.001) scores and absent tuning fork sensation (r = 0.590; P<0.001), monofilament sensation (r = 0.573; P<0.001) and ankle reflex (r = 0.377, P = 0.01).
INTERPRETATION & CONCLUSIONS: The present findings show that simple bed side tests are useful for assessing peripheral diabetic neuropathy, even in those subjects in whom foot care practices are not followed.
振动感觉阈值（VPT）被认为是诊断糖尿病周围神经病变的金标准。然而，与常用的床边检测方法相比，有关 VPT 的数据仍然较少。本研究旨在评估简单床边筛查方法在糖尿病患者周围神经病变中的作用。
本研究共纳入 2007 年 1 月至 2008 年 5 月在糖尿病门诊就诊的 1044 例糖尿病患者。所有患者均接受详细的临床评估，包括糖尿病神经病变症状评分（DNS）、糖尿病神经病变检查评分（DNE）、踝反射、128Hz 音叉振动觉、10g Semmes-Weinstein 单丝和 VPT。
周围神经病变的患病率为 34.9%，VPT 阳性率为 34.9%。仅 214 例（20.5%）患者遵循足部护理实践。与 VPT 相比，踝反射的敏感性最高（90.7%），但特异性最低（37.3%）。音叉和单丝检测的敏感性分别为 62.5%和 62.8%，但特异性分别为 95.3%和 92.9%，准确性分别为 78.9%和 77.9%。VPT 评分与 DNE（r=0.532，P<0.001）和 DNS（r=0.546，P<0.001）评分以及无音叉感觉（r=0.590；P<0.001）、单丝感觉（r=0.573；P<0.001）和踝反射（r=0.377，P=0.01）呈显著相关。
本研究结果表明，即使在未遵循足部护理实践的患者中，简单的床边检查也可用于评估糖尿病周围神经病变。
