Ponirakis G, Petropoulos I N, Fadavi H, Alam U, Asghar O, Marshall A, Tavakoli M, Malik R A
Institute of Human Development, Centre for Endocrinology and Diabetes, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK.
Diabet Med. 2014 Dec;31(12):1673-80. doi: 10.1111/dme.12536. Epub 2014 Jul 14.
Neuropad is a simple visual indicator test, with moderate diagnostic performance for diabetic peripheral neuropathy. As it assesses sweating, which is a measure of cholinergic small nerve fibre function, we compared its diagnostic performance against established measures of both large and, more specifically, small fibre damage in patients with diabetes.
One hundred and twenty-seven participants (89 without diabetic peripheral neuropathy and 38 with) aged 57 ± 9.7 years underwent assessment with Neuropad, large nerve fibre assessments: Neuropathy Disability Score, vibration perception threshold, peroneal motor nerve conduction velocity; small nerve fibre assessments: neuropathy symptoms (Diabetic Neuropathy Symptoms score) corneal nerve fibre length and warm perception threshold.
Neuropad has a high sensitivity but moderate specificity against large fibre neuropathy assessments: Neuropathy Disability Score (> 2) 70% and 50%, vibration perception threshold (> 14 V) 83% and 53%, and peroneal motor nerve conduction velocity (< 42 m/s) 81% and 54%, respectively. However, the diagnostic accuracy of Neuropad was significantly improved against corneal nerve fibre length (< 14 mm/mm2) with a sensitivity and specificity of 83% and 80%, respectively. Furthermore, the area under the curve for corneal nerve fibre length (85%) was significantly greater than with the Neuropathy Disability Score (66%, P = 0.01) and peroneal motor nerve conduction velocity (70%, P = 0.03). For neuropathic symptoms, sensitivity was 78% and specificity was 60%.
The data show the improved diagnostic performance of Neuropad against corneal nerve fibre length. This study underlines the importance of Neuropad as a practical diagnostic test for small fibre neuropathy in patients with diabetes.
Neuropad是一种简单的视觉指标测试，对糖尿病周围神经病变具有中等诊断性能。由于它评估出汗情况，而出汗是胆碱能小神经纤维功能的一种测量方法，我们将其诊断性能与糖尿病患者大神经纤维以及更具体的小神经纤维损伤的既定测量方法进行了比较。
127名年龄在57±9.7岁的参与者（89名无糖尿病周围神经病变，38名有糖尿病周围神经病变）接受了Neuropad评估、大神经纤维评估：神经病变残疾评分、振动觉阈值、腓总运动神经传导速度；小神经纤维评估：神经病变症状（糖尿病神经病变症状评分）、角膜神经纤维长度和温觉阈值。
Neuropad对大纤维神经病变评估具有高敏感性但中等特异性：神经病变残疾评分（>2）分别为70%和50%，振动觉阈值（>14V）分别为83%和53%，腓总运动神经传导速度（<42m/s）分别为81%和54%。然而，Neuropad对角膜神经纤维长度（<14mm/mm2）的诊断准确性显著提高，敏感性和特异性分别为83%和80%。此外，角膜神经纤维长度的曲线下面积（85%）显著大于神经病变残疾评分（66%，P=0.01）和腓总运动神经传导速度（70%，P=0.03）。对于神经病变症状，敏感性为78%，特异性为60%。
数据显示Neuropad对角膜神经纤维长度的诊断性能有所提高。本研究强调了Neuropad作为糖尿病患者小纤维神经病变实用诊断测试的重要性。
