Svea Nolte, Naser B. N. Shehab, Stefan P. Berger, Celina Oldag, Ilja M. Nolte, Bianca T. A. de Greef, Fiete Lange, Marco van Londen, Catharina G. Faber, Stephan J. L. Bakker, Pieter A. van Doorn, Harmen R. Moes, Gea Drost
{"title":"肾移植受者多神经病变：一种新的临床诊断评分系统的准确性","authors":"Svea Nolte, Naser B. N. Shehab, Stefan P. Berger, Celina Oldag, Ilja M. Nolte, Bianca T. A. de Greef, Fiete Lange, Marco van Londen, Catharina G. Faber, Stephan J. L. Bakker, Pieter A. van Doorn, Harmen R. Moes, Gea Drost","doi":"10.1111/jns.70058","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background and Aims</h3>\n \n <p>Polyneuropathy is highly prevalent among kidney transplant recipients (KTR), underscoring the need for an accurate yet easy-to-perform diagnostic method to improve understanding and enable early identification of treatable cases.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This study included KTR at least 12 months post-transplant at the University Medical Centre Groningen, the Netherlands. An expert panel assessed polyneuropathy through a structured neurological examination, quantitative sensory testing, and nerve conduction studies. The modified Toronto Clinical Neuropathy Score (mTCNS) was obtained from all participants. Logistic regression analyses with Firth penalization validated the mTCNS components. A new model, the Kidney Transplant Neuropathy Score (KTNS), was developed through stepwise elimination. Diagnostic performance was evaluated with bootstrapped metrics and ROC curve analyses.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Among 160 KTR, 91 (57%) were diagnosed with polyneuropathy. All 10 mTCNS components were univariably associated with polyneuropathy; numbness (OR = 4.9 [1.8–18.0]), tingling (OR = 2.5 [1.2–5.9]), impaired nociception (OR = 1.5 [1.1–2.2]), and reduced vibration perception (OR = 1.5 [1.0–2.4]) remained independently associated in multivariable analysis. The mTCNS achieved an area under the curve (AUC) in ROC analysis of 0.83 [0.76–0.89]. Two KTNS were derived: the KTNS<sub>Basic</sub>, including history of numbness, tingling in the feet, and pinprick and vibration perception testing (AUC–ROC: 0.85 [0.79–0.90]); and the KTNS<sub>Advanced</sub>, replacing vibration perception with Achilles and patellar deep tendon reflex testing (AUC–ROC: 0.90 [0.85–0.94]).</p>\n </section>\n \n <section>\n \n <h3> Interpretation</h3>\n \n <p>The mTCNS is a valid diagnostic tool for polyneuropathy in KTR. The KTNS offers a simplified alternative based on key symptoms and sensory tests, with reflex testing included in the KTNS<sub>Advanced</sub> for settings with neurological expertise.</p>\n </section>\n \n <section>\n \n <h3> Trial Registration</h3>\n \n <p>ClinicalTrials.gov identifier: NCT04664426</p>\n </section>\n </div>","PeriodicalId":17451,"journal":{"name":"Journal of the Peripheral Nervous System","volume":"30 3","pages":""},"PeriodicalIF":3.2000,"publicationDate":"2025-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jns.70058","citationCount":"0","resultStr":"{\"title\":\"Polyneuropathy in Kidney Transplant Recipients: Accuracy of a New Clinical Diagnostic Scoring System\",\"authors\":\"Svea Nolte, Naser B. N. Shehab, Stefan P. Berger, Celina Oldag, Ilja M. Nolte, Bianca T. A. de Greef, Fiete Lange, Marco van Londen, Catharina G. Faber, Stephan J. L. Bakker, Pieter A. van Doorn, Harmen R. Moes, Gea Drost\",\"doi\":\"10.1111/jns.70058\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background and Aims</h3>\\n \\n <p>Polyneuropathy is highly prevalent among kidney transplant recipients (KTR), underscoring the need for an accurate yet easy-to-perform diagnostic method to improve understanding and enable early identification of treatable cases.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>This study included KTR at least 12 months post-transplant at the University Medical Centre Groningen, the Netherlands. An expert panel assessed polyneuropathy through a structured neurological examination, quantitative sensory testing, and nerve conduction studies. The modified Toronto Clinical Neuropathy Score (mTCNS) was obtained from all participants. Logistic regression analyses with Firth penalization validated the mTCNS components. A new model, the Kidney Transplant Neuropathy Score (KTNS), was developed through stepwise elimination. Diagnostic performance was evaluated with bootstrapped metrics and ROC curve analyses.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Among 160 KTR, 91 (57%) were diagnosed with polyneuropathy. All 10 mTCNS components were univariably associated with polyneuropathy; numbness (OR = 4.9 [1.8–18.0]), tingling (OR = 2.5 [1.2–5.9]), impaired nociception (OR = 1.5 [1.1–2.2]), and reduced vibration perception (OR = 1.5 [1.0–2.4]) remained independently associated in multivariable analysis. The mTCNS achieved an area under the curve (AUC) in ROC analysis of 0.83 [0.76–0.89]. Two KTNS were derived: the KTNS<sub>Basic</sub>, including history of numbness, tingling in the feet, and pinprick and vibration perception testing (AUC–ROC: 0.85 [0.79–0.90]); and the KTNS<sub>Advanced</sub>, replacing vibration perception with Achilles and patellar deep tendon reflex testing (AUC–ROC: 0.90 [0.85–0.94]).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Interpretation</h3>\\n \\n <p>The mTCNS is a valid diagnostic tool for polyneuropathy in KTR. The KTNS offers a simplified alternative based on key symptoms and sensory tests, with reflex testing included in the KTNS<sub>Advanced</sub> for settings with neurological expertise.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Trial Registration</h3>\\n \\n <p>ClinicalTrials.gov identifier: NCT04664426</p>\\n </section>\\n </div>\",\"PeriodicalId\":17451,\"journal\":{\"name\":\"Journal of the Peripheral Nervous System\",\"volume\":\"30 3\",\"pages\":\"\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2025-09-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jns.70058\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the Peripheral Nervous System\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/jns.70058\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the Peripheral Nervous System","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/jns.70058","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Polyneuropathy in Kidney Transplant Recipients: Accuracy of a New Clinical Diagnostic Scoring System
Background and Aims
Polyneuropathy is highly prevalent among kidney transplant recipients (KTR), underscoring the need for an accurate yet easy-to-perform diagnostic method to improve understanding and enable early identification of treatable cases.
Methods
This study included KTR at least 12 months post-transplant at the University Medical Centre Groningen, the Netherlands. An expert panel assessed polyneuropathy through a structured neurological examination, quantitative sensory testing, and nerve conduction studies. The modified Toronto Clinical Neuropathy Score (mTCNS) was obtained from all participants. Logistic regression analyses with Firth penalization validated the mTCNS components. A new model, the Kidney Transplant Neuropathy Score (KTNS), was developed through stepwise elimination. Diagnostic performance was evaluated with bootstrapped metrics and ROC curve analyses.
Results
Among 160 KTR, 91 (57%) were diagnosed with polyneuropathy. All 10 mTCNS components were univariably associated with polyneuropathy; numbness (OR = 4.9 [1.8–18.0]), tingling (OR = 2.5 [1.2–5.9]), impaired nociception (OR = 1.5 [1.1–2.2]), and reduced vibration perception (OR = 1.5 [1.0–2.4]) remained independently associated in multivariable analysis. The mTCNS achieved an area under the curve (AUC) in ROC analysis of 0.83 [0.76–0.89]. Two KTNS were derived: the KTNSBasic, including history of numbness, tingling in the feet, and pinprick and vibration perception testing (AUC–ROC: 0.85 [0.79–0.90]); and the KTNSAdvanced, replacing vibration perception with Achilles and patellar deep tendon reflex testing (AUC–ROC: 0.90 [0.85–0.94]).
Interpretation
The mTCNS is a valid diagnostic tool for polyneuropathy in KTR. The KTNS offers a simplified alternative based on key symptoms and sensory tests, with reflex testing included in the KTNSAdvanced for settings with neurological expertise.
期刊介绍：
The Journal of the Peripheral Nervous System is the official journal of the Peripheral Nerve Society. Founded in 1996, it is the scientific journal of choice for clinicians, clinical scientists and basic neuroscientists interested in all aspects of biology and clinical research of peripheral nervous system disorders.
The Journal of the Peripheral Nervous System is a peer-reviewed journal that publishes high quality articles on cell and molecular biology, genomics, neuropathic pain, clinical research, trials, and unique case reports on inherited and acquired peripheral neuropathies.
Original articles are organized according to the topic in one of four specific areas: Mechanisms of Disease, Genetics, Clinical Research, and Clinical Trials.
The journal also publishes regular review papers on hot topics and Special Issues on basic, clinical, or assembled research in the field of peripheral nervous system disorders. Authors interested in contributing a review-type article or a Special Issue should contact the Editorial Office to discuss the scope of the proposed article with the Editor-in-Chief.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
