Louraki M, Tsentidis C, Kallinikou D, Katsalouli M, Kanaka-Gantenbein C, Kafassi N, Papathanasiou A, Karavanaki K
Diabetic Clinic, Second Pediatric Department University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece.
Diabetic Clinic, Second Pediatric Department University of Athens, "P&A Kyriakou" Children's Hospital, Athens, Greece.
Prim Care Diabetes. 2014 Jul;8(2):147-57. doi: 10.1016/j.pcd.2013.11.002. Epub 2013 Dec 4.
To define the reproducibility of vibration perception thresholds (VPTs) and the possible associated factors, as an early index of peripheral diabetic neuropathy (PDN) in type 1 diabetes mellitus (T1DM) children and adolescents.
A single examiner studied 118 T1DM subjects (aged 13.5±3.4 years) and 79 controls (aged 12.0±3.07 years). Glycaemic control was assessed with HbA1c levels. VPT was measured twice on upper and lower limbs, using a Biothesiometer. Concordance between the two VPT measurements was evaluated using the Cohen's Weighted Kappa statistic (Kappa=0.41-0.60→moderate concordance, Kappa=0.61-0.80→substantial concordance).
T1DM children had significantly higher VPTs than controls at all sites (p=0.001), but with lower Kappa values (0.64-0.70). VPT values increased in parallel with HbA1c (a.<8%, b. 8-9.5%, c.>9.5%) and T1DM duration (a.<5 years, b.5.1-10, c.>10 years). However, Kappa values were lower in the groups with the poorest control (HbA1c>9.5%) (Kappa=0.54-0.76) or the longest T1DM duration (>10 years) (Kappa=0.49-0.71). Although VPTs increased with stature and male gender, no effect on VPT reproducibility was observed. However, obesity was associated with lower VPT values and poorer concordance.
These findings suggest that the reproducibility of VPTs is lower in the high-risk patients for early subclinical PDN development, who need a regular follow-up.
确定振动觉阈值（VPT）的可重复性及可能的相关因素，作为1型糖尿病（T1DM）儿童和青少年外周糖尿病性神经病变（PDN）的早期指标。
由一名检查者对118例T1DM受试者（年龄13.5±3.4岁）和79例对照者（年龄12.0±3.07岁）进行研究。通过糖化血红蛋白（HbA1c）水平评估血糖控制情况。使用生物感觉阈值测定仪在上下肢测量VPT两次。采用Cohen加权kappa统计量评估两次VPT测量结果之间的一致性（kappa=0.41-0.60→中度一致，kappa=0.61-0.80→高度一致）。
T1DM儿童在所有部位的VPT均显著高于对照者（p=0.001），但kappa值较低（0.64-0.70）。VPT值随HbA1c水平（a.<8%，b.8-9.5%，c.>9.5%）和T1DM病程（a.<5年，b.5.1-10年，c.>10年）升高。然而，在控制最差的组（HbA1c>9.5%）（kappa=0.54-0.76）或T1DM病程最长的组（>10年）（kappa=0.49-0.71）中，kappa值较低。尽管VPT随身高和男性性别增加，但未观察到对VPT可重复性的影响。然而，肥胖与较低的VPT值和较差的一致性相关。
这些发现表明，在早期亚临床PDN发生的高危患者中，VPT的可重复性较低，这些患者需要定期随访。
