Clinical Study On Diagnostic Method Of Diabetic Peripheral Neuropathy And Its Distribution Characteristics Of TCM Syndromes

Purpose:To evaluate the diagnostic value of the 10 g nylon silk,vibration threshold value,sense of temperature,pain sense and ankle reflex in the diagnosis of diabetic peripheral neuropathy(DPN)and to search an exact diagnostic method of DPN not only economical but also easy to handle.And the distribution characteristics of traditional Chinese medicine(TCM)syndrome for the DPN.Material and method:To carry out the measurements of the nerve conduction velocity(NCV), 10 g nylon silk,vibration threshold value,sense of temperature,pain sense and ankle reflex on the 151 patients who have been diagnosed of diabetes between April 2014 to June 2014 in the endocrinology department of affiliated hospital of the Liaoning University of Traditional Chinese Medicine.The diagnostic criteria of DPN refers to the ascertained diagnostic criteria of the type 2 diabetes prevention and control in the guide to China in 2013.The sensitivity,specificity,positive forecast value,negative forecast value,Youden index,Kappa value and receiver operating characteristic curves serve as assessments of the diagnostic efficiency of the five methods.According to the 2011 edition of“Traditional Chinese Medicine Diabetic peripheral neuropathy Prevention Guide”for DPN syndrome differentiation standard.The patients with the ascertained diagnostic criteria can be divided into Qi deficiency,blood stasis,Yin deficiency and blood stasis,phlegm stagnation obstructing meridian and deficiency of liver and kidney. Comparing the characteristic among the four syndromes.Recording each patient’s sex,age,course of diabetes,Hb A1 c,BMI and blood lipid.Using SPSS17.0 software for statistical analysis,K value serves as the evaluation index of the consistency about the different screening methods.To draw ROC curve and through calculating the area under the ROC curve(AUC)to compare different combinations of DPN diagnosis effect.Comparison between group by t test and One-way ANOVA.Results:1.Study participants included 151 cases,through statistical analysis:The sensitivity,specificity and K value of the ankle reflex are 66.04%、95.56%、 0.51,in mediate accordance with the diagnostic criteria and it is the best one among the five methods. While the sensitivity and accordance of the pressure sense are of the least accordance with the diagnostic criteria.When taking three kinds among five kinds of examination of temperature sensation plus ankle reflex plus vibration threshold sense show highest AUC value,it is 0.89 and it is the best combination of the diagnostic performance.2.There are 82 cases which not only conform to the ascertained diagnostic criteria,but also the DPN syndrome differentiation standard.With Qi deficiency and blood stasis 35 cases(42.68%),Yin deficiency and blood stasis 21cases(25.61%),phlegm stagnation obstructing meridian 16cases(19.51%),deficiency of liver and kidney 10cases(12.20%).Syndrome distribution of 82 diagnosed DPN patients are as follows:Qi deficiency and blood stasis>Yin deficiency and blood stasis> phlegm stagnation obstructing meridian>deficiency of liver and kidney.Qi deficiency and blood stasis and Yin deficiency and blood stasis are a total of 56 cases,accounted for 68.29%,explain that they are the common types of the distribution about the TCM syndrome type.3.In terms of age,the average age of the deficiency of liver and kidney is the oldest,(78.10±1.97)years old,and has statistical significance compared with other groups(P<0.05).In terms of duration,the average duration of the deficiency of liver and kidney is the longest,(17.10±11.86)years, and has statistical significance compared with Qi deficiency and blood stasis and Yin deficiency and blood stasis(P<0.05). In terms of BMI,the average BMI of phlegm stagnation obstructing meridian is the biggest,(31.34±2.90)kg/m2,and has statistical significance compared with other groups(P<0.05).In terms of TC、TG、LDL-C and HDL-C,there has no statistical significance compared with other groups(P<0.05).Conclusion:1.When taking three kinds among five kinds of examination of temperature sensation plus ankle reflex plus vibration threshold sense show the best combination of the diagnostic performance,it is an exact diagnostic method of DPN not only economical but also easy to handle for screening DPN.2.Qi deficiency and blood stasis and Yin deficiency and blood stasis are the common types of the distribution about the TCM syndrome type.3.The duration of the deficiency of liver and kidney is longer than other groups clearly.The deficiency of liver and kidney is the most syndrome in older DPN patients. The BMI of phlegm stagnation obstructing meridian is bigger than other groups clearly.