Analysis Of Clinical Symptom Integral Table In Screening Diabetic Peripheral Neuropathy

Objective Research and compare the value of Clinical Symptom Integral Table (CSIT) and Toronto Clinical Scoring System (TCSS) in screening diabetic peripheral neuropathy (DPN), and provide a simple and effective screening method for diabetes specialist nurse.Methods170type2diabetic patients receive electromyogram (EMG) examination, CSIT and TCSS assessment. And the20cases of the patients randomly selected receive CSIT assessment repeatedly at different time points. The general information, including the age, gender, height, body weight, body mass index (BMI), blood pressure, course of diabetes, and the glycemic indicators, including random blood glucose (RBG), hemoglobin Alc (HbAlc), fasting plasma glucose (FPG),2h plasma glucose (2hPG) were collected. Taking EMG examination as a gold standard for diagnosing DPN, divide them into DPN group and non-DPN group. Using the method of independent samples t-test, the general information and glycemic indicators of the two groups were compared. Compare the diagnostic value of every item in CSIT, evaluate and compare the screening value, accuracy and reliability of CSIT and TCSS, and identify the optimal cut-off points, using the method of diagnostic test and the ROC curve analysis.Results①Among the170type2diabetic patients,113cases (66.5%) are in the DPN group and57cases (33.5%) are in the non-DPN group.②The age, course of diabetes, Systolic blood pressure, HbAlc, RBG, FPG and2hPG are significantly higher in DPN group than in non-DPN group (P<0.05), but height, body weight, BMI, diastolic blood pressure of the two groups have no significant difference (P>0.05).③There are different peripheral nerve symptoms in the141patients (82.9%) of170diabetic patients, limb numbness60.6%, limb weakness48.2%, limb pain32.9%, feeling diminished31.2%, limb coldness27.1%, muscle atrophy22.4%; The sensitivity and specificity of six symptoms in CSIT are different, and among them, the Youden index of feeling diminished, limb numbness and limb weakness are highest and are0.389、0.358、0.330respectively.④The area under the ROC curve of CSIT and TCSS are0.838(95%CI:0.778-0.898),0.865(95%CI:0.807-0.924) respectively, and there are no significant difference of their diagnostic value.⑤The optimal cut-off point of CSIT and TCSS are6and5respectively; The corresponding sensitivity, specificity, false positive and negative rate, positive and negative likelihood ratios, positive and negative predictive values, Youden index of CSIT are72.57%,85.96%,14.04%,27.43%,5.17,0.32,91.12%,61.22%,0.59respectively; The corresponding indicators of TCSS are77.88%,91.23%,8.77%,22.12%,8.88,0.24,94.63%,67.51%,0.69respectively; And they all have a moderate consistency with EMG examination (the Kappa is0.532,0.636respectively, P<0.01).⑥The number of positive cases of CSIT and TCSS screening DPN are90(52.9%),93(54.7%) respectively, and there are no significant difference (P>0.05).⑦The retest reliability coefficient of CSIT is0.986, which is statistically significant (P<0.01).⑧In terms of the time they took, averagely CSIT takes about3.10minutes, TCSS takes approximately10.05minutes, and their differences are statistically significant (P<0.01).Conclusion CSIT has high diagnostic value in screening DPN, and its accuracy and reliability are good, and it has a moderate consistency with EMG examination. Compared with TCSS, their value is close. Although the accuracy and reliability of the CSIT are not better than TCSS, but its operation is more convenient, easier and time-saving. This suggests that specialist nurse can use different screening methods according to patients’ condition: patients with neurological symptoms can be directly used CSIT score; the patients who have low CSIT scores (<6) or no neurological symptoms can be used TCSS score for screening.