Park Jung Hwan, Kim Dong Sun
Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.
Diabetes Metab J. 2018 Oct;42(5):442-446. doi: 10.4093/dmj.2017.0090.
Early recognition and appropriate management of diabetic peripheral polyneuropathy (DPNP) is important. We evaluated the necessity of simple, non-invasive tests for DPNP detection in clinical practice. We enrolled 136 randomly-chosen patients with type 2 diabetes mellitus and examined them with the 10-g Semmes-Weinstein monofilament examination, the 128-Hz tuning-fork, ankle-reflex, and pinprick tests; the Total Symptom Score and the 15-item self-administered questionnaire of the Michigan Neuropathy Screening Instrument. Among 136 patients, 48 had subjective neuropathic symptoms and 88 did not. The abnormal-response rates varied depending on the methods used according to the presence of subjective neuropathic symptoms (18.8% vs. 5.7%, <0.05; 58.3% vs. 28.4%, <0.005; 81.3% vs. 54.5%, <0.005; 12.5% vs. 5.7%, =0.195; 41.7% vs. 2.3%, <0.001; and 77.1% vs. 9.1%, <0.001; respectively). The largest abnormal response was derived by combining all methods. Moreover, these tests should be implemented more extensively in diabetic patients without neuropathic symptoms to detect DPNP early.
早期识别和妥善管理糖尿病周围神经病变（DPNP）至关重要。我们评估了在临床实践中使用简单、非侵入性检查来检测DPNP的必要性。我们随机选取了136例2型糖尿病患者，对其进行10克Semmes-Weinstein单丝检查、128赫兹音叉检查、踝反射检查和针刺检查；并采用总症状评分以及密歇根神经病变筛查工具的15项自填问卷进行评估。在136例患者中，48例有主观神经病变症状，88例没有。根据主观神经病变症状的有无，不同检查方法的异常反应率有所不同（分别为18.8%对5.7%，<0.05；58.3%对28.4%，<0.005；81.3%对54.5%，<0.005；12.5%对5.7%，=0.195；41.7%对2.3%，<0.001；77.1%对9.1%，<0.001）。综合所有检查方法得出的异常反应率最高。此外，对于没有神经病变症状的糖尿病患者，应更广泛地开展这些检查以早期发现DPNP。
