Franklin G M, Kahn L B, Baxter J, Marshall J A, Hamman R F
Department of Neurology, University of Colorado School of Medicine, Denver 80262.
Am J Epidemiol. 1990 Apr;131(4):633-43. doi: 10.1093/oxfordjournals.aje.a115547.
A screening neurologic examination capable of detecting distal symmetric (sensory) neuropathy in a large population-based study of non-insulin-dependent diabetes mellitus in San Luis Valley, Colorado, in 1984-1986 is described and validated. The examination, completed in 279 diabetics and 577 controls, had 90% agreement with a standard neurologic examination completed on a subsample of 38 patients. Independent validation of neuropathy status was obtained with the Optacon tactile (vibration) stimulator. Mean, age-adjusted vibration threshold was significantly greater in those with neuropathy than in those without. The subtests of the examination most sensitive in detecting neuropathy were a combination of a positive history of neuropathy symptoms and decreased or absent deep tendon reflexes in both ankles. Age-adjusted prevalence of neuropathy in controls, those with impaired glucose tolerance, and diabetics was 3.9%, 11.2%, and 25.8%, respectively. Prevalence odds ratios were 3.5 and 10.6 for the presence of neuropathy in persons with impaired glucose tolerance and diabetes, respectively, compared with persons with normal glucose tolerance. Neuropathy was significantly associated with age, duration of diabetes, male sex, and glycemic control, but not with Anglo/Hispanic status.
本文描述并验证了一种筛查神经系统检查方法，该方法用于在1984 - 1986年对科罗拉多州圣路易斯谷非胰岛素依赖型糖尿病进行的一项大型基于人群的研究中检测远端对称性（感觉）神经病变。这项检查在279名糖尿病患者和577名对照者中完成，与对38名患者的子样本进行的标准神经系统检查有90%的一致性。使用Optacon触觉（振动）刺激器对神经病变状态进行了独立验证。有神经病变者的平均年龄校正振动阈值显著高于无神经病变者。该检查中在检测神经病变方面最敏感的子测试是神经病变症状的阳性病史与双侧踝关节深部腱反射减弱或消失的组合。对照者、糖耐量受损者和糖尿病患者中神经病变的年龄校正患病率分别为3.9%、11.2%和25.8%。与糖耐量正常者相比，糖耐量受损者和糖尿病患者中神经病变的患病率比值比分别为3.5和10.6。神经病变与年龄、糖尿病病程、男性性别和血糖控制显著相关，但与盎格鲁/西班牙裔身份无关。
