A comparison of clinical effectiveness of different neuropathy scoring systems in screening asymptomatic diabetic peripheral neuropathy / 中华内科杂志

ABSTRACT

Objective To evaluate the clinical effectiveness in screening asymptomatic diabetic peripheral neuropathy(ADPN) by the Michigan neuropathy screening instrument (MNSI) and the Toronto clinical scoring system(TCSS).Methods MNSI,TCSS and neural electrophysiological test (NET) were conducted in 232 neurologically asymptomatic type 2 diabetes patients.By using the results of NET as the golden criteria for diagnosis of ADPN,we evaluated the effectiveness of the two different scoring system by the receiver operator characteristic curve.The sensitivity,specificity,positive and negative predictive values,accuracy,Youden indexes and kappa values on different diagnostic cut-off points of MNSI and TCSS were analyzed.The correlation between the two different scoring system and the risk factors of diabetic peripheral neuropathy (DPN) were also analyzed.Results The area under the ROC curve of MNSI and TCSS were 0.792,0.704,respectively.The sensitivity,specificity,accuracy,Youden indexes and kappa values of MNSI over 2 and TCSS over 2 were 66.2％ vs 73.3％,90.4％ vs 63.7％,78.3％ vs 68.5％,0.566 vs 0.370,and 0.588 vs 0.345,respectively.MNSI was better than TCSS in the effectiveness of diagnosing ADPN and consistence with the result of NET.Moreover,MNSI was associated with the most related risk factors of DPN including age,glycosylated hemoglobin (HbA1c),HbA1c × disease duration,islet function and HDL-C.Conclusions MNSI could be used as a relatively simple and reliable method for clinical and epidemiological screening and assessment of ADPN.