[四种温度觉测试对老年2型糖尿病周围神经病变的联合诊断价值]

[Joint diagnostic value of four temperature sensation tests in elderly patients with type 2 diabetic peripheral neuropathy].

作者信息

Guo Wei, Li Yun-Ming, Ai Zhi-Hua, You Zhi-Qing, Wan Yong, Cheng Ying, Lang Hong-Mei

机构信息

Department of Endocrinology, General Hospital of People's Liberation Army Chengdu Military Region, Chengdu 610083, China.

出版信息

Sichuan Da Xue Xue Bao Yi Xue Ban. 2013 Jul;44(4):673-6.

PMID:24059130

Abstract

OBJECTIVE

To explore the joint diagnostic value of four temperature sensation tests in elderly patients with type 2 diabetic peripheral neuropathy.

METHODS

Thermal sensory analyzer-II were applied to measure cool sensation (CS), warm sensation (WS), cold pain sensation (CP)and heat pain sensation (HP) of 308 elderly patients with type 2 diabetes. Logistic regression model was adopted to create the new variable Temp4 from four temperature sensation tests to diagnose type 2 diabetic peripheral neuropathy. The ROC curve analysis was used to determine the best cut-off points of the four temperature sensation and Temp4, and the diagnostic value of it was evaluated.

RESULTS

The means of temperature sensation tests of the diabetic peripheral neuropathy (DPN) group were significantly different from those of the non-DPN group (P < 0.05). According to the current reference intervals of the four temperature sensation tests to diagnose the DPN, the sensitivity of WS test was the highest, and the value was 0.710; but the specificity, positive predictive value, negative predictive value, Youden index, diagnostic accuracy and Kappa value of cold sensation test were the highest, and the values were 0.842, 0.746, 0.799, 0.528, 77.92% and 0.535, respectively; the Kappa values of the other three temperature sensation tests were all greater than 0.4 (P < 0.05). The area under the ROC curve of the new variable Temp4 was 0.93 (95% CI 0.91-0.96), and was larger than the four temperature sensation tests (P < 0.05). The sensitivity, specificity, Youden index and diagnostic accuracy of Temp4 were 0.823, 0.897, 0.719 and 86.69%, respectively. The new best cut-off points of the CS test, WS test, CP test, HP test and Temp4 was 27.5 degrees C, 34.7 degrees C, 20.5 degrees C, 43.5 degrees C and 0.416, respectively.

CONCLUSION

The results of the four temperature sensation quantitative tests were in good agreementand could be applied to diagnose DPN; the new variable Temp4 could be used for diagnosis of DPN with a higher diagnostic accuracy.

摘要

目的

探讨四种温度觉测试对老年2型糖尿病周围神经病变的联合诊断价值。

方法

应用Thermal sensory analyzer-II测量308例老年2型糖尿病患者的冷觉（CS）、温觉（WS）、冷痛觉（CP）和热痛觉（HP）。采用Logistic回归模型将四种温度觉测试创建新变量Temp4以诊断2型糖尿病周围神经病变。采用ROC曲线分析确定四种温度觉及Temp4的最佳截断点，并评估其诊断价值。

结果

糖尿病周围神经病变（DPN）组温度觉测试均值与非DPN组差异有统计学意义（P<0.05）。按照四种温度觉测试目前的参考区间诊断DPN，WS测试的敏感度最高，为0.710；而冷觉测试的特异度、阳性预测值、阴性预测值、约登指数、诊断准确性及Kappa值最高，分别为0.842、0.746、0.799、0.528、77.92%及0.535；其他三种温度觉测试的Kappa值均大于0.4（P<0.05）。新变量Temp4的ROC曲线下面积为0.93（95%CI 0.91-0.96），大于四种温度觉测试（P<0.05）。Temp4的敏感度、特异度、约登指数及诊断准确性分别为0.823、0.897、0.719及86.69%。CS测试、WS测试、CP测试、HP测试及Temp4的新最佳截断点分别为27.5℃、34.7℃、20.5℃、43.5℃及0.416。