Diagnostic Study Of The Measurement Of Current Perception Threshold In Diabetic Peripheral Neuropathy

Objective:To analyze the general clinical characteristics and influence factors of Diabetic peripheral neuropathy(DPN)patients,with Toronto Clinical Scoring System(TCSS)as reference,To discuss the diagnostic value of Current perception threshold(CPT)in DPN.Methods:80 diabetes inpatients in the Department of Endocrinology of the Second Affiliated Hospital of Kunming Medical University from September 2020 to February 2021 were collected.General clinical data and partial biochemical indexes of all patients were collected.CPT and TCSS examinations were completed for all patients to compare the differences between the two results.According to the examination results,the 80 patients were divided into two groups,45 with abnormal CPT(CPT grade≥1.66)and 35 with normal CPT(CPT≤1.66).According to CPT grade,the abnormal CPT group was divided into CPT hypersensitivity group(CPT grade 1.67-6.62)and CPT hypoesthesia group(CPT grade 6.63-12).Demographic characteristics and biochemical indicators were compared among the groups,and diagnostic consistency was evaluated with TCSS to explore the value of CPT in DPN diagnosis.Results:(1)In all the 80 enrolled diabetic patients,the positive rate of DPN diagnosed by TCSS was 38.7%,and the positive rate of DPN diagnosed by CPT was 56.3%,the difference was statistically significant,and there was no consistent comparison value between the two.In the case of TCSS as the gold standard and CPT grade≥1.66 as the definition of DPN standard,the sensitivity and specificity of CPT in the diagnosis of DPN were 67.7%and 51.0%,respectively.The sensitivity was fair and the specificity was general.The positive detection rate of DPN in CPT was higher than that of TCSS in 43 patients with clinical symptoms.The abnormal detection rate of TCSS was 25/43=58.1%and that of CPT was 23/43=53.5%.The abnormal detection rate of TCSS was higher than that of CPT,P≥0.05 There was no statistical significance in the difference between the two,showing a consistency.Kappa value=0.341,showing a weak consistency between the two.In 37 asymptomatic patients,the abnormal detection rate of TCSS was 6/37=16.2%,and the abnormal detection rate of CPT was 22/37=59.5%.The abnormal detection rate of CPT was higher than TCSS,P<0.05.The difference between them was statistically significant.(2)The mean level of OGTT2HC peptide in the abnormal CPT group was lower than that in the normal CPT group,but there was no statistically significant difference.The prevalence of hypertension and urinary protein content in the abnormal CPT group were higher than those in the normal group,and the differences were statistically significant.(3)Among CPT normal group,CPT hypersensitivity group and CPT hypoesthesia group,smoking history and urinary creatinine protein ratio increased gradually with the severity of nerve injury,while OGTT2hCpeptide and OGTT2hINS decreased gradually with the severity of nerve injury.The proportion of hypertension and urinary protein increased gradually with the severity of nerve injury,and the difference was statistically significant.There were significant differences between normal CPT group and hypoesthesia group in the presence of hypertension and urinary protein content.(4)CPT grade was positively correlated with TCSS score and its components,and the correlation degree was moderate(0.4>r>0.2).TCSS was used as DPN diagnostic criteria,TCSS≥6.In the binary Logistic regression analysis of dependent variables,after adjusting for age,sex,HbAlc and disease course,CPT grade was associated with the presence of DPN(OR=1.167).ROC curve analysis showed that the area under the curve was 0.677(95%CI,0.553～0.802;P=0.008<0.01).The sensitivity was 61.3%,the specificity was 73.5%,the Youden index was 0.348,and the cut-off value of CPT was 5.12.Conclusion:1.CPT has certain value in the diagnosis of DPN,which is beneficial to the early diagnosis of DPN.When the critical point of CPT diagnosis was 5.12,the comprehensive sensitivity and specificity were the best.Decrease the diagnostic threshold of CPT to improve the sensitivity seems to give full play to the diagnostic advantages of CPT.2.The influencing factors of hypoesthesia of CPT include history of hypertension and urinary protein.3.The classification of CPT has certain value in guiding the prevention and treatment of DPN,and whether CPT can be used alone in the diagnosis of DPN still needs further investigation.