Lagrue G, Hamon P, Maurel A, Balanger S
Service de Néphrologie, Association Claude Bernard, INSERM U. 139, Hôpital Henri-Mondor, Créteil.
J Mal Vasc. 1988;13(2):101-5.
Microangiopathy is one of the most frequent and serious complications of diabetes. Its diagnosis is based on fundus of eye and fluorescein angiography findings, but several teams have emphasized the value of conjunctival angioscopy (CA) and peri-ungual capillaroscopy (PUC), describing suggestive anomalies: microectatic venous dilatation (V/A greater than 4.5), sludge on CA, "fish shoal" capillaries on PUC. Up to the present, however, the diagnostic value of these anomalies has not been evaluated based on data that are sensitive, specific and indicate predictive positive and negative values of a sign (Se, Sp, PPV, NPV). Anomalies of CA and PUC as a function of presence or absence of "diabetes" were studied in 114 patients with moderate hypertension, including 46 "diabetics" (33 with glucose regulation disorders and 13 non-insulin dependent diabetics). "Diabetes" was observed more predominantly in males of more advanced age and with a significantly higher global CA score (4.25 +/- 1.44 as against 2.65 +/- 1.35), and this in an increased manner as the "diabetes" was severe. Some anomalies had themselves a major orientation value with an Sp greater than 80% and an Se close to 40% (global score greater than 4; V/A greater than 4.5, microectasia, rheologic changes). For the fish shoal appearance the Sp was 73.5% and the Se 43.5%. The Sp was greater than 95% when at least 4 of the following 6 signs were present: global score greater than 4, V/A greater than 4.5, microectasia, rheologic disorders, fish shoal, gerontoxons. The more signs associated the more the Sp increased; the Se decreased from 40% for one sign to less than 10% for 4 associated signs.(ABSTRACT TRUNCATED AT 250 WORDS)
微血管病变是糖尿病最常见且最严重的并发症之一。其诊断基于眼底检查和荧光素血管造影结果，但多个研究团队强调了结膜血管镜检查（CA）和甲周毛细血管镜检查（PUC）的价值，并描述了一些提示性异常：微扩张性静脉扩张（V/A大于4.5）、CA检查时出现淤滞、PUC检查时出现“鱼群样”毛细血管。然而，迄今为止，这些异常的诊断价值尚未根据敏感、特异且能表明某个体征的预测阳性和阴性值（敏感度、特异度、阳性预测值、阴性预测值）的数据进行评估。在114例中度高血压患者中，研究了CA和PUC异常与是否患有“糖尿病”的关系，其中包括46例“糖尿病患者”（33例有血糖调节障碍，13例非胰岛素依赖型糖尿病患者）。“糖尿病”在年龄较大的男性中更为常见，且CA总体评分显著更高（分别为4.25±1.44和2.65±1.35），并且随着“糖尿病”病情加重，该评分呈上升趋势。一些异常本身具有重要的导向价值，特异度大于80%，敏感度接近40%（总体评分大于4；V/A大于4.5、微扩张、血液流变学改变）。对于“鱼群样”表现，特异度为73.5%，敏感度为43.5%。当出现以下6个体征中的至少4个时，特异度大于95%：总体评分大于4、V/A大于4.5、微扩张、血液流变学紊乱、“鱼群样”表现、老年环。相关体征越多，特异度越高；敏感度则从单个体征的40%降至4个相关体征时的不到10%。（摘要截选至250词）
