The Value Of Simple Neural Screening Tests, Michigan Neuropathy Screening Instrument For The Diagnosis Of Diabetic Neuropathy, And The Impact Of Inflammatory Factors For The Diabetic Neuropathy

Objective:(1) Assess the accuracy of five simple sensory neural screening tests for the diagnosis of diabetic distal symmetric polyneuropathy.(2) To investigate the value of the Michigan Neuropathy Screening Instrument in the diagnosis of diabetic distal symmetric polyneuropathy and the possible cut-off point.(3) To investigate the risk ratio of high sensitivity C reactive protein, interleukin-1, interleukin-6in diabetic distal symmetric polyneuropathy.Methods:(1) Data collection:Total of327patients with type2diabetes mellitus (T2DM) hospitalized in our department, and88patients with normal blood glucose were chosen randomly as research subjects. General clinic data, biochemistry parameters and fasting peripheral blood were collected.(2) Symptom and simple neural screening tests (ankle reflex, superficial pinprick sensation, temperature sensation, vibration sensation, pressure sensation test), Michigan Neuropathy Screening Instrument(MNSI) and neural electrophysiological examinations were performed, and all of the participants were divided into three groups based on the distal symmetric polyneuropathy(DSPN) standard:T2DM with DSPN (DSPN group)197, T2DM without DSPN (DM group)130, and normal control group (NC group)88.(3) Regression analysis was used to evaluate the diagnostic performance of each test and search for the possible cutoff point for the MNSI.(4) Compare the inflammation factors in the three groups, and divide them into four groups according to the inflammation distribution and multivariable adjusted Logistic regression analysis were conducted to examine the odds ratio (OR) for DSPN.(5)Statistical SPSS17.0was applied to conduct statistical analysis, the comparison among normal distribution data was computed using t test or ANOVA analysis, and rank sum test was used for the skewness distribution data analysis, x2test used for the categorical variables. The weights of the five screening methods and MNSI equaled1first, Logistic regression was used to calculate the coefficients and intercept, which were used as the weights to make receiver operating characteristic curve (ROC). MedcalC software and Delong et al method were used to compare the AUC of different combinations of methods. The Logistic regression analysis were conducted to examine the risk factor of DSPN and OR for DSPN.Results:(1) The BMI, coronary heart disease history, TG, HbAlc and hsCRP of the DM group were higher than the NC group. The ages, BMI, SBP, coronary heart disease history, TG, HbAlc, hsCRP of the DSPN group were higher than the NC group, while the DBP was lower. The DSPN group had higher ages, BMI, DM course, the rate of insulin combined with oral medicine, coronary heart disease history, hsCRP and MNSI questionnaire and physical exam score than the DM group, while DBP, rate of diabetes with no treatment or diet+exercise were lower.(2) Ages, DM course, diabetic nephropathy history, MNSI score, HbAlc and hsCRP were the independent risk factors of DSPN.(3) The ankle reflex had the highest sensitivity, and the vibration sensation was the second.(4) The combination "ankle reflex+vibration sense+pressure sensation" offered best consistence with the confirmed DSPN, and the operation was quite easy.(5) For the MNSI, the question1,3,9,11and ankle reflex, vibration sensation achieved similar accuracy to the whole index, and confirmed the possibility of making4and2as cutoff point respectively.(6) HsCRP may be a risk predictor for T2DM patients with DSPN, and this effect was independent of ages, DM course, blood pressure, blood fat and BMI.(7) IL-6was an independent risk factor of DSPN, while the value of IL-1was not clear.Conclusion:(1) Ages, DM course, diabetic nephropathy history, MNSI questionnaire and physical exam score, HbAlc and hsCRP were the risk factor of DSPN.(2) The combination "ankle reflex+vibration sense+pressure sensation" offered best consistence with the confirmed DSPN, and the operation was quite easy.(3) For the MNSI, the question1,3,9,11as well as ankle reflex, vibration sensation achieved similar accuracy to the whole index, and confirmed the possibility of making4and2as cutoff point for the questionnaire and physical exam.(4) HsCRP may be a risk predictor for T2DM patients with DSPN, and this effect was independent of ages, DM course, blood pressure, blood fat and BMI.