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密歇根筛查量表对糖尿病神经病变的诊断价值

张春风1,谢云2   

  1. 1. 天津医科大学代谢病医院神经内科
    2. 天津医科大学代谢病医院5楼病房
  • 收稿日期:2012-05-09 修回日期:2012-09-17 出版日期:2013-03-15 发布日期:2013-03-15
  • 通讯作者: 张春风

The Evaluation of the Michigan Neuropathy Screening Instrument in the Diagnosis of Diabetic Peripheral Neuropathy

ZHANG Chun feng1,XIE Yun 2   

  1. 1. Department of Neurology, Metabolic Disease Hospital of Tianjin Medical University, The Key Laboratory of Hormone and Development of the Ministry of Health , Tianjin 300070, China
    2. Department of Neurology, Metabolic Disease Hospital of Tianjin Medical University, The Key Laboratory of Hormone andDevelopment of the Ministry of Health , Tianjin 300070, China
  • Received:2012-05-09 Revised:2012-09-17 Published:2013-03-15 Online:2013-03-15
  • Contact: ZHANG Chun feng

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摘要：

【摘要】目的 探讨密歇根神经病变筛查量表（MNSI）在诊断糖尿病周围神经病变（DPN）中的价值。方法 糖尿病患者267例分别进行MNSI筛查和神经电生理检查，依MNSI体检评分将患者分为A组（0~2.4分）112例、B组（2.5~ 4.4分）88例及C组（≥4.5分）67例，比较各组间的性别、年龄及病程等一般资料情况和神经电生理检查结果的差异。对MNSI问卷中可能影响DPN的问题进行逐步Logistic回归分析，将MNSI问卷评分和体检评分与上述相关指标进行相关性分析。结果（1）A组患者年龄、糖尿病病程低于B、C组，C组患者无波形比例（16.42%）高于其余2组（P < 0.05）。（2）A组患者的胫后神经运动神经波幅以及双下肢感觉、运动神经传导速度均高于B、C组，其DPN确诊率（50.89%）低于B、C组（P < 0.05）。（3）MNSI问卷中问题1、2、11及14是DPN的影响因素。（4）MNSI问卷评分与患者年龄、糖尿病病程呈正相关，与胫后神经运动神经波幅、双下肢感觉神经传导速度呈负相关；MNSI体检评分与患者年龄、糖尿病病程、人体质量指数呈正相关，与胫后神经运动神经波幅、双下肢感觉神经、运动神经传导速度呈负相关（P < 0.05）。结论 以MNSI问卷评分4分，体检评分2分为截点，能较好诊断出神经电生理异常，且DPN的检出率明显提高。

关键词: 糖尿病, 密歇根神经筛查量表（MNSI）, 神经电生理检查（NET）, 体质指数（BMI）, 糖尿病周围神经病变(DPN)

Abstract:

[Abstract] Objective  To investigate the value of the Michigan Neuropathy Screening Instrument (MNSI) in the diagnosis of diabetic peripheral neuropathy (DPN). Methods  A total of 267 patients with diabetes mellitus underwent the measurements of MNSI and neural electrophysiological test. All of the participants were divided into three groups based on MNSI score: 112 patients in group A (score 0-2.4), 88 in group B (score 2.5-4.4) and 67 in group C (score≥4.5). The differences of gender, age, history of diabetes and neural electrophysiological test results were compared between three groups. The stepwise logistic regression was used to analyze the effect of MNSI questionnaire for the DPN. The relationship between the MNSI questionnaire, exam score and the index mentioned above was analyzed. Results  (1) The patients in group A were much younger and had a shorter history of diabetes than those in group B and group C. Compared with the other two groups, patients in group C got significantly higher perception of non-waveform in the neuroelectricity test (P ＜0.05). (2) There were significantly higher values, including the amplitude of the motor nerve of the posterior tibial nerve, the nerve conduction velocity of the sensory nerve and motor nerve, in group A than those of group B and group C. The diagnosis rate of DPN was significantly lower in group A than that of group B and group C (P ＜0.05). (3) The questions of 1, 2, 11 and 14 in MNSI were the risk factors for DPN. (4) The MNSI questionnaire was positively correlated with age and history of diabetes, and negatively correlated with the amplitude of motor nerve of posterior tibial nerve and sensory nerve conduction velocity of both legs.The MNSI score was positively correlated with age, history of diabetes and body mass index, and negatively correlated with the amplitude of motor nerve of posterior tibial nerve and sensory nerve, motor nerve conduction velocity of both lower limbs (P ＜0.05). Conclusion  Regard the MNSI questionnaire 4 and exam score 2 as a cut-off point, higher score will get a high risk of DPN, and the nerve conduction will be worse.

Key words: Diabetes, Michigan Neuropathy Screening Instrument(MNSI), Neural Electrophysiological Test（NET）, Body Mass Index(BMI), Diabetic Peripheral Neuropathy（DPN）