Dyck P J, Melton L J, O'Brien P C, Service F J
Peripheral Neuropathy Research Center, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Diabetes. 1997 Sep;46 Suppl 2:S5-8. doi: 10.2337/diab.46.2.s5.
The quality of the epidemiological data on diabetic neuropathies remains poor for a variety of reasons. They include variability in 1) ascertainment of diabetes, 2) the clinical varieties of diabetic patients studied, 3) characterization of neurological dysfunction, 4) abnormal limits for neurological examinations and tests, 5) minimal criteria for neuropathy, 6) correct attribution of nondiabetic neurological disease, 7) correct attribution of type of neuropathy, 8) estimating neuropathy from use of multiple tests, and 9) estimating severity of polyneuropathy. We have tried to remedy these short-comings in the Rochester Diabetic Neuropathy Study (RDNS). It was not possible to adequately characterize and quantitate diabetic polyneuropathies using only one or two clinical or test abnormalities. To estimate severity of diabetic polyneuropathy, the results of the neurological examination and abnormalities of nerve conduction, quantitative sensory tests, and quantitative autonomic tests were combined into a composite score. One begins by scoring a standard test of neurological deficits (impairments) of the lower limbs (NIS[LL]) and adds to this transformed numbers for percentile abnormality of seven good functional tests. This NIS(LL)+7 tests score appears to provide a much more comprehensive and stable numeric score by which to diagnose and grade severity of diabetic polyneuropathy than does the use of individual clinical or test results. This test score should be useful as a measure of change in diabetic polyneuropathy for purposes of medical practice, epidemiology studies, and controlled clinical trials. The staging approach that we introduced previously continues to provide an important measure of overall severity of diabetic polyneuropathy, taking into account both symptoms and impairments.
由于多种原因，糖尿病神经病变的流行病学数据质量仍然很差。这些原因包括：1）糖尿病确诊的变异性；2）所研究的糖尿病患者临床类型的变异性；3）神经功能障碍的特征描述；4）神经检查和测试的异常界限；5）神经病变的最低标准；6）非糖尿病性神经疾病的正确归因；7）神经病变类型的正确归因；8）通过多项测试评估神经病变；9）评估多发性神经病变的严重程度。我们试图在罗切斯特糖尿病神经病变研究（RDNS）中弥补这些不足。仅使用一两种临床或测试异常情况，无法充分描述和量化糖尿病多发性神经病变。为了评估糖尿病多发性神经病变的严重程度，将神经检查结果、神经传导异常、定量感觉测试和定量自主神经测试的结果合并为一个综合评分。首先对下肢神经功能缺损（损伤）的标准测试（NIS[LL]）进行评分，并在此基础上加上七个良好功能测试百分位数异常的转换数值。与使用单个临床或测试结果相比，这种NIS(LL)+7测试评分似乎能提供一个更全面、更稳定的数值评分，用于诊断和分级糖尿病多发性神经病变的严重程度。这个测试评分在医疗实践、流行病学研究和对照临床试验中，作为衡量糖尿病多发性神经病变变化的指标应该是有用的。我们之前引入的分期方法，在考虑症状和损伤的情况下，仍然是评估糖尿病多发性神经病变总体严重程度的重要指标。
