Davis E A, Jones T W, Walsh P, Byrne G C
Department of Diabetes and Endocrinology, Princess Margaret Hospital for Children, Perth, Western Australia.
Diabetes Care. 1997 Sep;20(9):1448-53. doi: 10.2337/diacare.20.9.1448.
To develop clinically useful reference ranges for vibration perception thresholds (VPTs), using biothesiometry in children and adolescents and to assess the reliability of the technique to identify subclinical neuropathy in subjects with IDDM at this age and to examine a large population-based sample of pediatric patients.
VPTs were measured using a handheld biothesiometer at the medial malleolus and hallux in 232 nondiabetic children and adolescents aged 7-18 years (12.9 +/- 4.2 years) and a population-based sample of 307 young IDDM patients (13.3 +/- 4.6 years of age). The mean of three readings at each site was correlated with height, pubertal status, and age for all subjects and, in addition for the IDDM sample, with the duration of IDDM, ambient blood glucose, and mean HbA1c from diagnosis. Those IDDM subjects found to have elevated VPTs (> 97th percentile), and a control group of patients with IDDM underwent nerve conduction studies to determine the sensitivity and specificity of biothesiometry to detect abnormal neural function in children. Interoperator reliability was assessed in a separate trial in which two operators measured VPTs independently in the same 11 children.
In the nondiabetic control subjects, height demonstrated the best correlation with VPT measures, and a reference range was thus established with percentile charts, using mean VPT and height. VPTs were higher in the diabetic sample, compared with the nondiabetic sample (P < 0.05). Of the children, 28 (9.1%) had VPT values > 97th percentile developed from studies of the nondiabetic subjects; of these, 11 were younger than 11 years and 8 were prepubertal. Nerve conduction studies confirmed reduced conduction velocity and prolonged distal latencies in those with abnormal VPTs, compared with normal control subjects and IDDM patients with normal VPTs. Sensitivity of biothesiometry to reflect abnormal nerve function was estimated as 82% and specificity as 75% at this age. Interoperator variation was small (7.25% of total variance).
Biothesiometry is a useful noninvasive tool for the detection of subclinical neuropathy in children and adolescents. The use of height-related reference ranges may make screening for neuropathy more feasible in younger patients and allow large-scale longitudiral analysis of its development.
利用生物感觉测量法为儿童和青少年制定临床上有用的振动觉阈值（VPT）参考范围，评估该技术在识别这个年龄段的1型糖尿病（IDDM）患者亚临床神经病变方面的可靠性，并对大量基于人群的儿科患者样本进行研究。
使用手持式生物感觉测量仪在232名7 - 18岁（平均12.9±4.2岁）的非糖尿病儿童和青少年以及307名基于人群样本的年轻IDDM患者（平均13.3±4.6岁）的内踝和拇趾处测量VPT。对所有受试者，每个部位三次读数的平均值与身高、青春期状态和年龄进行相关性分析，对于IDDM样本，还与IDDM病程、即时血糖以及自诊断以来的平均糖化血红蛋白（HbA1c）进行相关性分析。那些VPT升高（>第97百分位数）的IDDM受试者以及一组IDDM对照组患者接受神经传导研究，以确定生物感觉测量法在检测儿童异常神经功能方面的敏感性和特异性。在一项单独试验中评估了不同操作者之间的可靠性，两名操作者在相同的11名儿童中独立测量VPT。
在非糖尿病对照受试者中，身高与VPT测量值的相关性最佳，因此使用平均VPT和身高通过百分位数图表建立了参考范围。与非糖尿病样本相比，糖尿病样本中的VPT更高（P < 0.05）。在儿童中，28名（9.1%）的VPT值高于根据非糖尿病受试者研究得出的第97百分位数；其中，1名年龄小于岁，8名处于青春期前。神经传导研究证实，与正常对照受试者和VPT正常的IDDM患者相比，VPT异常者的传导速度降低，远端潜伏期延长。在这个年龄段，生物感觉测量法反映异常神经功能的敏感性估计为82%，特异性为75%。不同操作者之间的差异较小（占总方差的7.25%）。
生物感觉测量法是检测儿童和青少年亚临床神经病变的一种有用的非侵入性工具。使用与身高相关的参考范围可能使对较年轻患者的神经病变筛查更可行，并允许对其发展进行大规模纵向分析。
