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拉丁美洲2型糖尿病患者远端对称性多发性神经病变的筛查试验

Screening tests for distal symmetrical polyneuropathy in Latin American patients with type 2 diabetes mellitus.

作者信息

Gómez-Banoy Nicolás, Cuevas Virginia, Soler Fernando, Pineda Maria Fernanda, Mockus Ismena

机构信息

Laboratorio de Lípidos y Diabetes, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia.

出版信息

Arch Endocrinol Metab. 2017 Sept-Oct;61(5):470-475. doi: 10.1590/2359-3997000000283. Epub 2017 Jul 13.

Abstract

OBJECTIVE

This cross sectional study intended to evaluate two bedside tests (Neuropad and VibraTip) as screening tools for distal symmetrical polyneuropathy (DSPN) in Latin American patients with type 2 diabetes mellitus (T2D).

SUBJECTS AND METHODS

Ninety-three Colombian patients diagnosed with T2D were recruited. Anthropometric variables, glycemic control parameters, lipid profile and renal function were assessed for each patient. DSPN was defined by a Michigan Neuropathy Screening Instrument (MNSI) clinical score greater than 2. Both Neuropad and Vibratip tests were applied to each patient. Contingency analyses were performed to evaluate the diagnostic power of both tools.

RESULTS

The prevalence of DSPN determined clinically by MNSI was 25.8%. DSPN in these patients was associated with age, worsening renal function, and insulin treatment. The sensitivity and specificity of the Neuropad test for DSPN was 66.6% and 63% respectively. Its negative predictive value (NPV) was 84.6%. The VibraTip test exhibited a sensitivity of 54.1% and specificity of 91.3%, with a NPV of 85.1%.

CONCLUSION

Neuropad and VibraTip are reliable screening tools for DSPN in Latin American population. VibraTip presents a considerable diagnostic power for DSPN in this population. Further studies regarding the cost-effectiveness of these tools in clinical practice are needed.

摘要

目的

本横断面研究旨在评估两种床旁检测方法(神经垫和振动尖端)作为拉丁美洲2型糖尿病(T2D)患者远端对称性多发性神经病变(DSPN)筛查工具的效果。

对象与方法

招募了93名诊断为T2D的哥伦比亚患者。对每位患者评估人体测量变量、血糖控制参数、血脂谱和肾功能。DSPN由密歇根神经病变筛查工具(MNSI)临床评分大于2来定义。对每位患者均应用神经垫和振动尖端检测。进行列联分析以评估这两种工具的诊断能力。

结果

通过MNSI临床诊断的DSPN患病率为25.8%。这些患者的DSPN与年龄、肾功能恶化和胰岛素治疗有关。神经垫检测DSPN的敏感性和特异性分别为66.6%和63%。其阴性预测值(NPV)为84.6%。振动尖端检测的敏感性为54.1%,特异性为91.3%,NPV为85.1%。

结论

神经垫和振动尖端是拉丁美洲人群DSPN可靠的筛查工具。振动尖端在该人群中对DSPN具有相当的诊断能力。需要进一步研究这些工具在临床实践中的成本效益。

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