全足底神经传导研究：早期诊断周围性糖尿病神经病变的新工具。

Whole plantar nerve conduction study: A new tool for early diagnosis of peripheral diabetic neuropathy.

机构信息

Division of Internal Medicine, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, I-80138 Naples, Italy.

Division of Neurology and Neurophysiopathology, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Piazza Luigi Miraglia 2, I-80138 Naples, Italy.

出版信息

Diabetes Res Clin Pract. 2021 Jun;176:108856. doi: 10.1016/j.diabres.2021.108856. Epub 2021 May 7.

DOI:10.1016/j.diabres.2021.108856

PMID:33965449

Abstract

AIMS

Peripheral neuropathy (PN) affects two-thirds of type 2 diabetes patients (T2DM). According to diabetic PN length-dependent pattern, neurophysiological evaluation of foot-sole nerves might increase NCS diagnostic sensitivity, hence allowing early diagnosis of PN. Thus, we aim to assess the ability of whole plantar nerve (WPN) conduction in diabetic PN early diagnosis.

METHODS

This is a single center prospective observational cohort study on 70 T2DM patients referred to Internal Medicine Unit of A.O.U. "Luigi Vanvitelli" between October 2019/October 2020. Primary endpoint was WPN efficacy assessment in PN early detection. As secondary, we evaluated (i) a potential cut-off of SNAPs amplitude by WPN and (ii) WPN diagnostic accuracy vs. gold-standard distal sural nerve conduction.

RESULTS

ROC curve analysis allowed to establish two potential cut-offs for people aged ≤60 years (AUROC: 0.83, 95%CI: 0.69-0.96, p < 0.001) and ≤60 years (AUROC: 0.76, 95%CI: 0.59-0.93, p = 0.017). In depth, we fixed a cut-off of WPN-SNAP amplitude of 4.55 μV and 2.65 μV, respectively, with subsequent 48 patients classified as PN-T2DM.

CONCLUSIONS

Our data support WPN conduction study reliability in characterizing the most distal sensory nerve fibers at lower limbs. Thus, WPN may represent an extremely useful diagnostic tool for diabetic PN early detection.

摘要

目的

周围神经病变（PN）影响三分之二的 2 型糖尿病患者（T2DM）。根据糖尿病性 PN 长度依赖性模式，对足底神经的神经生理学评估可能会提高 NCS 诊断的敏感性，从而可以早期诊断 PN。因此，我们旨在评估整个足底神经（WPN）传导在糖尿病性 PN 早期诊断中的能力。

方法

这是一项于 2019 年 10 月至 2020 年 10 月在 Luigi Vanvitelli 综合医院内科就诊的 70 例 T2DM 患者的单中心前瞻性观察队列研究。主要终点是评估 WPN 在 PN 早期检测中的效能。其次，我们评估了（i）通过 WPN 评估 SNAPs 幅度的潜在截止值，以及（ii）WPN 诊断准确性与金标准远端腓肠神经传导的比较。

结果

ROC 曲线分析允许为年龄≤60 岁的人建立两个潜在截止值（AUROC：0.83，95％CI：0.69-0.96，p<0.001）和≤60 岁的人（AUROC：0.76，95％CI：0.59-0.93，p=0.017）。深入分析，我们分别固定了 WPN-SNAP 幅度的截止值为 4.55μV 和 2.65μV，随后将 48 例患者分类为 PN-T2DM。