Pourhamidi Kaveh, Dahlin Lars B, Englund Elisabet, Rolandsson Olov
Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden.
Department of Clinical Sciences, Hand Surgery, Skåne University Hospital, Lund University, Malmö, Sweden.
Prim Care Diabetes. 2014 Apr;8(1):77-84. doi: 10.1016/j.pcd.2013.04.004. Epub 2013 May 9.
To compare the diagnostic usefulness of tuning fork, monofilament, biothesiometer and skin biopsies in peripheral neuropathy in individuals with varying glucose metabolism.
Normoglycaemic, impaired glucose tolerance (IGT) and type 2 diabetes (T2DM) individuals were recruited. Nerve conduction studies (NCS) and thermal threshold tests were performed. Vibrotactile sense was tested with a biothesiometer and a 128-Hz tuning fork. Touch/pressure perception was examined with a 10-g monofilament. Skin biopsies were performed and intraepidermal nerve fibres were quantified. Distal symmetric polyneuropathy (DSPN) was defined as neuropathy disability score ≥2 and abnormal NCS. Thermal threshold tests were used to define small nerve fibre neuropathy (sDSPN) in cases where NCS (large nerve fibres) were normal.
The prevalence of DSPN and sDSPN in the whole group (n=119) was 18% and 23%, respectively. For the biothesiometer, a cut-off of ≥24.5V had a sensitivity of 82% and specificity of 70% (AUC=0.81, 95% CI 0.71-0.91) when evaluating DSPN. An intraepidermal nerve fibre density cut-off of ≤3.39fibres/mm showed a sensitivity of 74% and specificity of 70% in the detection of sDSPN, whereas the sensitivity of the tuning fork and the biothesiometer were relatively low, 46% and 67%, respectively. When combining skin biopsies with the tuning fork, 10 more sDSPN cases were identified. Adding skin biopsy to the combination of the tuning fork and biothesiometer increased the sensitivity of finding sDSPN cases, but not DSPN, from 81% to 93%.
Using a biothesiometer in clinical routine might be a sensitive method to detect large nerve fibre dysfunction in the lower extremity, whereas skin biopsies in combination with methods measuring vibrotactile sense could increase the diagnostic sensitivity of detecting peripheral neuropathy at an early stage.
比较音叉、单丝、生物感觉测量仪和皮肤活检在不同糖代谢个体周围神经病变中的诊断效用。
招募血糖正常、糖耐量受损（IGT）和2型糖尿病（T2DM）个体。进行神经传导研究（NCS）和热阈值测试。使用生物感觉测量仪和128赫兹音叉测试振动触觉。用10克单丝检查触觉/压力感知。进行皮肤活检并对表皮内神经纤维进行定量。远端对称性多发性神经病变（DSPN）定义为神经病变残疾评分≥2且NCS异常。在NCS（大神经纤维）正常的情况下，使用热阈值测试来定义小神经纤维神经病变（sDSPN）。
整个组（n = 119）中DSPN和sDSPN的患病率分别为18%和23%。对于生物感觉测量仪，在评估DSPN时，≥24.5V的截断值灵敏度为82%，特异性为70%（AUC = 0.81，95%CI 0.71 - 0.91）。表皮内神经纤维密度截断值≤3.39纤维/mm在检测sDSPN时灵敏度为74%，特异性为70%，而音叉和生物感觉测量仪的灵敏度相对较低，分别为46%和67%。将皮肤活检与音叉结合时，又发现了10例sDSPN病例。在音叉和生物感觉测量仪的组合中加入皮肤活检，发现sDSPN病例的灵敏度从81%提高到93%，但对DSPN的灵敏度没有提高。
在临床常规中使用生物感觉测量仪可能是检测下肢大神经纤维功能障碍的一种敏感方法，而皮肤活检与测量振动触觉的方法相结合可以提高早期检测周围神经病变的诊断灵敏度。
