The Application Value Of Toronto Clinical Scoring System For Diabetic Peripheral Neuropathy

Objective:To evaluate the application value of Toronto clinical scoring system and its grading of neuropathy for diabetic peripheral neuropathy.Methods:To collect 209 patients with T2DM,each patient was performed TCSS,15 patients were randomly selected to repeat TCSS the next day and 134 patients were performed MNSI at the same time. Compared the diagnostic value of single test in TCSS,evaluated the accuracy and reliability of TCSS while taken neural electromyogram as gold standard for DPN.Explored the relationship between TCSS grading of neuropathy and the clinical features of diabetes.Results:There were 123 patients diagnosed as having DPN by neural electromyogram.The youden index of 128 HZ vibration test,ankle reflex and numbness were relatively higher as a single test in TCSS,the area under ROC curve of TCSS was 0.870(95%CI0.809-0.923)(P＜0.05), no significant difference of the area under ROC curve was observed between TCSS and MNSI(P=0.10).When choosing 5 or 6 as the cut-off point of TCSS,the corresponding youden index were 0.538,0.528,kappa were 0.542,0.522,simple correlation coefficient were 0.543,0.523 respectively.The test-retest reliability of TCSS showed standard deviation was 0.55,coefficient of variation was 12.5%and simple correlation coefficient was 0.98.There was a linear correlation between TCSS grading of neuropathy and the severity of diabetic diabetic kidney disease and diabetic retinopathy(P＜0.05).Conclusion:The diagnostic value of TCSS was relatively accurate and reliable,so it could be used for diagnosing diabetic peripheral neuropathy.A good correlation was observed between TCSS grading of neuropathy and the clinical features of diabetes which showed TCSS grading of neuropathy was valuable for clinical application.