Huang Yu-Chuan, Chuang Yao-Chung, Chiu Wen-Chan, Huang Chih-Cheng, Cheng Ben-Chung, Kuo Chun-En Aurea, Lin Ting-Yin, Chiang Hui-Ching, Lai Yun-Ru
Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Department of Neurology, Pao Chien Hospital, Pingtung, Taiwan.
Front Neurosci. 2023 Mar 27;17:1115242. doi: 10.3389/fnins.2023.1115242. eCollection 2023.
The diagnosis and assessment of neuropathy severity of diabetic sensorimotor polyneuropathy (DSPN) are mainly based on clinical neuropathy scores and electrophysiologic studies. This study aimed to determine whether quantitative thermal testing (QTT) can be used as a screening and follow-up tool for DSPN of prediabetes and type 2 diabetes at baseline and at 1-year follow-up.
All patients were assessed using the Toronto Clinical Neuropathy Score (TCNS) and underwent electrophysiological testing, including a nerve conduction study (NCS) and QTT, at baseline and at a 1-year follow-up. The TCNS and the composite scores of nerve conduction were used to assess the severity of DSPN. The DSPN status at the 1-year follow-up was classified as remaining no DSPN, remaining DSPN, regression to no DSPN, or progression to DSPN.
Diabetic sensorimotor polyneuropathy was initially diagnosed in 89 patients with prediabetes and type 2 diabetes (22%). The regressed to no DSPN in 29 patients and progressed to DSPN in 20 patients at the 1-year follow-up. TCNS was significantly correlated with composite scores of nerve conduction, hand cold detection threshold (CDT), hand warm detection threshold (WDT), foot CDT, and foot WDT. Stepwise logistic regression demonstrated that the foot CDT ( < 0.0001) was independently associated with the presence of DSPN. The TCNS, composite scores of the nerve conduction, hand WDT, hand CDT, foot WDT, and foot CDT were all statistically significant among the four different DSPN status groups at two different time periods (baseline and the 1-year follow-up).
The foot CDT can be used as an initial screening tool for DSPN alternatively. The characteristics of nerve damage after 1 year of DSPN can be progressive or reversible, and the neurological functions of large and small fibers have a parallel trend, which can be objectively measured by NCS and QTT.
糖尿病性感觉运动性多发性神经病变（DSPN）的诊断和神经病变严重程度评估主要基于临床神经病变评分和电生理研究。本研究旨在确定定量热测试（QTT）是否可作为糖尿病前期和2型糖尿病患者DSPN在基线和1年随访时的筛查及随访工具。
所有患者均使用多伦多临床神经病变评分（TCNS）进行评估，并在基线和1年随访时接受电生理测试，包括神经传导研究（NCS）和QTT。TCNS和神经传导综合评分用于评估DSPN的严重程度。1年随访时的DSPN状态分为仍无DSPN、仍有DSPN、恢复至无DSPN或进展为DSPN。
89例糖尿病前期和2型糖尿病患者（22%）最初被诊断为糖尿病性感觉运动性多发性神经病变。1年随访时，29例患者恢复至无DSPN，20例患者进展为DSPN。TCNS与神经传导综合评分、手部冷觉检测阈值（CDT）、手部温觉检测阈值（WDT）、足部CDT和足部WDT显著相关。逐步逻辑回归显示足部CDT（<0.0001）与DSPN的存在独立相关。在两个不同时间段（基线和1年随访）的四个不同DSPN状态组中，TCNS、神经传导综合评分、手部WDT、手部CDT、足部WDT和足部CDT均具有统计学意义。
足部CDT可作为DSPN的替代初始筛查工具。DSPN 1年后神经损伤的特征可能是进行性的或可逆的，大小纤维的神经功能具有平行趋势，可通过NCS和QTT客观测量。
