Hu Hong, Li Hong, Zheng Fen-ping, Cheng Yi, Miao Jing, Zhang Wei
Department of Endocrinology, School of Medicine of Zhejiang University, Hangzhou, China.
Zhonghua Nei Ke Za Zhi. 2012 Jan;51(1):13-7.
To evaluate the clinical effectiveness in screening asymptomatic diabetic peripheral neuropathy (ADPN) by the Michigan neuropathy screening instrument (MNSI) and the Toronto clinical scoring system (TCSS).
MNSI, TCSS and neural electrophysiological test (NET) were conducted in 232 neurologically asymptomatic type 2 diabetes patients. By using the results of NET as the golden criteria for diagnosis of ADPN, we evaluated the effectiveness of the two different scoring system by the receiver operator characteristic curve. The sensitivity, specificity, positive and negative predictive values, accuracy, Youden indexes and kappa values on different diagnostic cut-off points of MNSI and TCSS were analyzed. The correlation between the two different scoring system and the risk factors of diabetic peripheral neuropathy (DPN) were also analyzed.
The area under the ROC curve of MNSI and TCSS were 0.792, 0.704, respectively. The sensitivity, specificity, accuracy, Youden indexes and kappa values of MNSI over 2 and TCSS over 2 were 66.2%vs 73.3%, 90.4% vs 63.7%, 78.3% vs 68.5%, 0.566 vs 0.370, and 0.588 vs 0.345, respectively. MNSI was better than TCSS in the effectiveness of diagnosing ADPN and consistence with the result of NET. Moreover, MNSI was associated with the most related risk factors of DPN including age, glycosylated hemoglobin (HbA1c), HbA1c × disease duration, islet function and HDL-C.
MNSI could be used as a relatively simple and reliable method for clinical and epidemiological screening and assessment of ADPN.
通过密歇根神经病变筛查量表（MNSI）和多伦多临床评分系统（TCSS）评估无症状糖尿病周围神经病变（ADPN）筛查的临床有效性。
对232例无神经症状的2型糖尿病患者进行MNSI、TCSS及神经电生理检查（NET）。以NET结果作为ADPN诊断的金标准，通过受试者工作特征曲线评估两种不同评分系统的有效性。分析MNSI和TCSS在不同诊断切点的敏感性、特异性、阳性和阴性预测值、准确性、约登指数及kappa值。同时分析两种不同评分系统与糖尿病周围神经病变（DPN）危险因素的相关性。
MNSI和TCSS的ROC曲线下面积分别为0.792、0.704。MNSI总分>2分和TCSS总分>2分的敏感性、特异性、准确性、约登指数及kappa值分别为66.2%对73.3%、90.4%对63.7%、78.3%对68.5%、0.566对0.370、0.588对0.345。在诊断ADPN的有效性及与NET结果的一致性方面，MNSI优于TCSS。此外，MNSI与DPN的大多数相关危险因素有关，包括年龄、糖化血红蛋白（HbA1c）、HbA1c×病程、胰岛功能及高密度脂蛋白胆固醇（HDL-C）。
MNSI可作为ADPN临床及流行病学筛查和评估的一种相对简单可靠的方法。
