Screening Methods Comparison And Curative Effect Of Antioxidants On Diabetic Peripheral Neuropathy

BackgroundDiabetic peripheral neuropathy is one of the most frequent complications of the diabetes mellitus. The incidence is correlated with the course of diabetes mellitus. When the duration is more than ten years, the patients always have the clinical symptoms which may cause the high mutilation rate and lethality. So it is very important to diagnose DPN in the early stage.In order to find good screening methods of DPN, we used the NCV as golden criteria to assess the efficacy of TCSS (Toronto clinical scoring system) and DPN screening process (DPN-SP).The pathogenesis of DPN is very complicated, while increased oxidative stress probably plays an important role in the development of DPN. The pathways of advanced glycation endo-products and polyalcohol increase oxidative stress and induce the development of DPN.a-lipoic acid is one of the most effective antioxidants which has therapeutic action by cleaning the free radicals and reactive oxygen species including the lipid peroxides. ALA could protect the neurons and blood vessels which may be damaged oxidative stress caused by high glucose. For these reasons, ALA effectively improves the symptoms of DPN patients.PurposeTo evaluate the application value of TCSS and DPN-SP for DPN. To evaluate the effect of ALA on DPN patients by using TCSS.Subjects and MethodsTo collect 206 patients with T2DM, each patient was performed Nerve Conduction Velocity (NCV), TCSS and DPN screening process at the same time. To compared the diagnostic value of TCSS and DPN-SP, we evaluated the accuracy and reliability of TCSS and DPN-SP while taken NVC as gold standard for DPN. The 47 DPN patients who were diagnosed by the NCV were treated with ALA 600mg daily intravenously for 14 days. Observed and evaluated the changes of the TCSS score before and after the treatment.Results1. Comparison of screening methods1.1 NCV 112 patients were positive, while 94 patients negative.1.2 TCSS 110 patients TCSS>5 scores,96 patients TCSS≤5 scores. Sensibility, specificity, positive predictive value, negative predictive value and Youden index of TCSS were 77.68%,75.53%,79.09%,73.96% and 0.532.1.3 DPN-SP 122 patients were positive, while 84 patients negative. Sensibility, specificity, positive predictive value, negative predictive value and Youden index of DPN screening process were 81.25%,67.02%,74.59%,75.00% and 0.483.1.4 Comparison of TCSS and DPN-SP The differences between TCSS and DPN-SP were not reach statistical significance(P>0.05).2.47 cases completed the study, while the TCSS score was significantly decreased than those before therapy (P<0.01). The total effective rate of the patients was 85.11%. Among the 47 patients,29 patients who received ALA treatment felt pain when using the drugs, and 13 of them felt the pain abated when slowing the velocity of the infusion, while the rest remained unchanged. No patients in ALA injection showed local reaction. No serious adverse effects were found.Conclusions1. DPN-SP and TCSS have high sensibility and specificity which could be used to screen DPN.2. ALA effectively improves the symptoms and signs of DPN patients in a short time, and it is safe for most of the patients.