Zhang Qi, Yi Na, Liu Siying, Zheng Hangping, Qiao Xiaona, Xiong Qian, Liu Xiaoxia, Zhang Shuo, Wen Jie, Ye Hongying, Zhou Linuo, Li Yiming, Hu Renming, Lu Bin
1 Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China.
2 Institute of Endocrinology and Diabetology, Fudan University, Shanghai, China.
J Int Med Res. 2018 Aug;46(8):3278-3284. doi: 10.1177/0300060518775244. Epub 2018 May 29.
Objective The 10 g Semmes-Weinstein monofilament evaluation (SWME) of 4 sites on each foot is recommended for distal symmetric polyneuropathy screening and diagnosis. A similar method has been proposed to diagnose 'high-risk' (for ulceration) feet, using 3 sites per foot. This study compared the effectiveness of SWME for testing 3, 4 and 10 sites per foot to identify patients with diabetic neuropathy. Methods We included 3497 subjects in a SWME of 10 sites; records from the 10-site SWME were used for a SWME of 3 and 4 sites. Neuropathy symptom scores and neuropathy deficit scores were evaluated to identify patients with diabetic peripheral neuropathy. Results The sensitivities of the 10 g SWME for 3, 4 and 10 sites were 17.8%, 19.0% and 22.4%, respectively. The Kappa coefficients for the SWME tests of 3, 4 and 10 sites were high (range: 0.78-0.93). Conclusions There were no significant differences in the effectiveness of 3-, 4- and 10-site SWME testing for diabetic peripheral neuropathy screening. SWME testing of 3 sites on each foot may be sufficient to screen for diabetic neuropathy.
目的 推荐使用10克Semmes-Weinstein单丝评估法（SWME）对每只脚的4个部位进行检测，以筛查和诊断远端对称性多发性神经病变。有人提出了一种类似的方法，即通过检测每只脚的3个部位来诊断“高危”（发生溃疡）足。本研究比较了每只脚检测3个、4个和10个部位的SWME在识别糖尿病神经病变患者方面的有效性。方法 我们纳入了3497名受试者进行10个部位的SWME检测；将10个部位SWME检测的记录用于3个部位和4个部位的SWME检测。评估神经病变症状评分和神经病变缺损评分，以识别糖尿病周围神经病变患者。结果 10克SWME检测3个部位、4个部位和10个部位的敏感性分别为17.8%、19.0%和22.4%。3个部位、4个部位和10个部位的SWME检测的Kappa系数较高（范围：0.78 - 0.93）。结论 对于糖尿病周围神经病变筛查，检测3个部位、4个部位和10个部位的SWME有效性无显著差异。每只脚检测3个部位的SWME检测可能足以筛查糖尿病神经病变。
