高频超声在诊断糖尿病周围神经病变中的应用

High-frequency ultrasound in the diagnosis of diabetic peripheral nervec

目的探讨糖尿病患者周围神经超声下的形态学改变及其与电生理的关系。方法随机选取糖尿病患者200例,分为有周围神经病变症状或体征组(Ⅰ组)与无周围神经病变症状或体征组(Ⅱ组);同时选取健康人120例为对照组。应用高频超声对受试者的正中神经、尺神经、桡神经于固定位置进行横截面积(CSA)测量,并观察神经的形态学改变。同时对其中的157例患者行电生理检查。结果与对照组相比,糖尿病患者周围神经多表现为CSA增粗,内部回声减低,边界模糊,神经内部点状回声不清晰或消失。与Ⅱ组比较,Ⅰ组正中神经CSA于腕横纹、豌豆骨、钩骨三处增粗(P<0.05);尺神经于肱骨内髁上6cm、肱骨中点、肱骨内髁下8cm三处增粗(P<0.05);桡神经于桡神经沟处增粗(P<0.05)。糖尿病患者正中神经CSA与感觉神经传导速度、波幅呈负相关,与潜伏期呈正相关。尺神经CSA与感觉神经传导速度、波幅呈负相关,与潜伏期呈正相关。结论高频超声对糖尿病患者周围神经的评估有一定临床价值。

Objective To investigate the size and diversification of peripheral nerve measured by ultrasonography in diabetic patients.Methods 200 diabetic patients were surveyed and were divided into two groups：patients with and without diabetic peripheral neuropathy（DPN）.Another 120 healthy volunteers were enrolled in this study.The cross-sectional areas（CSAs） of fixed position were measured on the median nerve,ulnar nerve,and radial nerve.The morphological changes of the nerve were also observed.At the same time,157 cases underwent electrophysiological examination.Results The CSAs of peripheral nerves in diabetic patients were significantly increased（P0.001）,and most nerves accompany reduced internal echo and fuzzy boundaries,compared with the control participants.Compared with that of the patients without DPN,CSAs of the median nerve at the wrist crease,pisiform bone,and hamate bone significantly increased（P0.05） in patients with DPN.The mean CSAs of the ulnar nerve are significantly thickened in the 6cm proximal to tip of the medial epicondyle,the midpoint of the humerus and 8cm distal to tip of the medial epicondyle（P0.0001）,and the mean CSAs of the radial nerve also increased in radial groove（P0.000 1）.The Cross-sectional areas of median nerve were negatively correlated with sensory nerve conduction velocity（r=-0.233） and amplitude（r=-0.34）,and was positively correlated with latency（r=0.367）.The CSAs of ulnar nerve showed negative correlation with sensory nerve conduction velocity（r=-0.21） and amplitude（r=-0.275）,and positive correlation with latency（r=0.20）.Conclusion There is close correlation between CSAs and electrophysiology.High-frequency ultrasound may play a role in the diagnosis of diabetic peripheral nerve.