高频超声检查在诊断糖尿病周围神经病变中的价值

目的 探讨高频超声检查评估坐骨神经改变诊断糖尿病周围神经病变的价值.方法 应用高频超声技术检测45例糖尿病周围神经病变患者、39例糖尿病无周围神经病变患者和48例健康者的坐骨神经表现,测量坐骨神经前后径、左右径和横截面积,比较组间超声参数差异,分析其与糖尿病周围神经病变的相关性,并评价高频超声诊断糖尿病周围神经病变的敏感性、特异性和诊断效能.结果 坐骨神经前后径、左右径和横截面积在3组间明显递增,且均与糖尿病周围神经病变存在相关性,横截面积与糖尿病周围神经病变相关性最好.以坐骨神经前后径>10.7mm预测糖尿病伴周围神经病变的敏感性和特异性分别为77.78%,89.74%;以坐骨神经左右径>18.4mm预测糖尿病伴周围神经病变的敏感性和特异性分别为55.56%,97.44%;以坐骨神经横截面积>139.31mm2预测糖尿病伴周围神经病变的敏感性和特异性分别为86.67%, 92.31%.超声参数中,坐骨神经左右径的曲线下面积为0.750(95%?CI:0.643~0.838),明显小于前后径和横截面积(Z=3.421,P=0.0006;Z=3.653,P=0.0003),坐骨神经横截面积的曲线下面积为0.954(95%?CI:0.885~0.9882),坐骨神经前后径的曲线下面积(0.929,95%?CI:0.852~0.974)介于横截面积和左右径之间.结论 高频超声评价坐骨神经表现可有效诊断糖尿病周围神经病变,坐骨神经横截面积的诊断效能最好.

Objective To evaluate the value of sciatic nerve changes in the diagnosis of diabetic peripheral neuropathy by high frequency ultrasound. Methods Sciatic nerve changes in 45 diabetic patients with peripheral neuropathy,39 diabetic patients without peripheral neuropathy and 48 normal controls were evaluated by high frequency ultrasound. The anteroposterior diameter,left-right diameter and cross-sectional area of the sciatic nerve were measured. The differences of ultrasonic parameters among the 3 groups were compared,and the relation of the ultrasonic parameters to diabetic peripheral neuropathy were analysed. The sensitivity,specificity and diagnostic efficacy of ultrasonic parameters in predicting diabetic peripheral neuropathy were evaluated and compared. Results The anteroposterior diameter,left-right diameter and cross-sectional area of sciatic nerve showed a gradual increasing trend among the 3 groups,were significantly correlated with diabetic peripheral neuropathy,and the cross-sectional area of sciatic nerve were most correlated with diabetic peripheral neuropathy. The sensitivity and specificity of anteroposterior diameter of sciatic nerve>10.7mm in predicting diabetic peripheral neuropathy were 77.78% and 89.74%,respectively. The sensitivity and specificity of left-right diameter of sciatic nerve>18.4 mm in predicting diabetic peripheral neuropathy were 55.56%,97.44%,respectively. The sensitivity and specificity of across-sectional area of sciatic nerve>139.31mm2 in predicting diabetic peripheral neuropathy were 86.67%,92.31%,respectively. Among ultrasound parameters,the area under the curve of left-right diameter of sciatic nerve was the smallest,which was significantly smaller than anteroposterior diameter and across-sectional area. The area under the curve of the across-sectional area of sciatic nerve was the biggest and the area under the curve of left-right diameter of sciatic nerve was between left-right diameter and across-sectional area. Conclusion The appearances of sciatic nerve evaluated by high frequency ultrasound can effectively diagnose diabetic peripheral neuropathy and the cross-sectional area of sciatic nerve have the best diagnostic efficacy.