Greco C, Di Gennaro F, D'Amato C, Morganti R, Corradini D, Sun A, Longo S, Lauro D, Pierangeli G, Cortelli P, Spallone V
Endocrinology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy.
Diabet Med. 2017 Jun;34(6):834-838. doi: 10.1111/dme.13310. Epub 2017 Jan 19.
To validate the Composite Autonomic Symptom Score (COMPASS) 31, in its Italian version, for the diagnosis of diabetic cardiovascular autonomic neuropathy in a clinic-based, single-centre study.
A total of 73 participants with diabetes (age 55 ± 14 years) completed the COMPASS 31 questionnaire before undergoing cardiovascular autonomic neuropathy and diabetic polyneuropathy assessment according to cardiovascular reflex tests, neuropathic symptoms and signs, and vibration and thermal thresholds.
The COMPASS 31 total weighted score differed between participants with and without cardiovascular autonomic neuropathy (29.9 ± 19.5 vs 16.1 ± 14.7; P = 0.003) and with and without diabetic polyneuropathy (28.9 ± 19.1 vs 12.7 ± 11.3; P < 0.0001). It was related to cardiovascular reflex tests score (rho = 0.38, P = 0.0013) as well as diabetic polyneuropathy symptoms (rho=0.61, P < 0.0001) and signs scores (rho = 0.49, P < 0.0001). Receiver-operating curve analysis showed a fair diagnostic accuracy of total score for cardiovascular autonomic neuropathy (area under the curve 0.748 ± 0.068, 95% CI 0.599-0.861) and diabetic polyneuropathy (area under the curve 0.742 ± 0.061, 95% CI 0.611-0.845). The best score thresholds were 16 for early cardiovascular autonomic neuropathy (sensitivity 75.0%, specificity 64.9%, positive predictive value 37.5% and negative predictive value 90.2%), and 17 for both confirmed cardiovascular autonomic neuropathy and diabetic polyneuropathy (sensitivity 70.0% and 65.5%, respectively; specificity 66.7% and 79.5%, respectively; positive predictive value 25.0% and 67.9%, respectively; and negative predictive value 93.0% and 77.8%, respectively). COMPASS 31 had a good internal consistency according to Cronbach's α coefficient of 0.73.
COMPASS 31 can represent a valid, easy-to-use, quantitative assessment tool for autonomic symptoms in diabetic neuropathy, with a fair diagnostic accuracy for both cardiovascular autonomic neuropathy and diabetic polyneuropathy.
在一项基于临床的单中心研究中，验证意大利语版的综合自主神经症状评分（COMPASS）31用于诊断糖尿病心血管自主神经病变。
共有73名糖尿病患者（年龄55±14岁）在根据心血管反射试验、神经病变症状和体征以及振动和热阈值进行心血管自主神经病变和糖尿病多发性神经病变评估之前，完成了COMPASS 31问卷。
有和没有心血管自主神经病变的参与者之间COMPASS 31总加权评分存在差异（29.9±19.5对16.1±14.7；P = 0.003），有和没有糖尿病多发性神经病变的参与者之间也存在差异（28.9±19.1对12.7±11.3；P < 0.0001）。它与心血管反射试验评分（rho = 0.38，P = 0.0013）以及糖尿病多发性神经病变症状（rho = 0.61，P < 0.0001）和体征评分（rho = 0.49，P < 0.0001）相关。受试者工作特征曲线分析显示，总评分对心血管自主神经病变（曲线下面积0.748±0.068，95%CI 0.599 - 0.861）和糖尿病多发性神经病变（曲线下面积0.742±0.061，95%CI 0.611 - 0.845）具有较好的诊断准确性。早期心血管自主神经病变的最佳评分阈值为16（敏感性75.0%，特异性64.9%，阳性预测值37.5%，阴性预测值90.2%），确诊的心血管自主神经病变和糖尿病多发性神经病变的最佳评分阈值均为17（敏感性分别为70.0%和65.5%；特异性分别为66.7%和79.5%；阳性预测值分别为25.0%和67.9%；阴性预测值分别为93.0%和77.8%）。根据Cronbach's α系数为0.73，COMPASS 31具有良好的内部一致性。
COMPASS 31可作为一种有效、易用的糖尿病神经病变自主神经症状定量评估工具，对心血管自主神经病变和糖尿病多发性神经病变均具有较好的诊断准确性。
