2型糖尿病下肢周围神经超声表现与多伦多临床评分的关系

The relationship between ultrasonic feature of lower limb peripheral nerve and Toronto clinical scoring system in type 2 diabetes mellitus

目的：探讨2型糖尿病患者下肢周围神经超声改变与多伦多临床评分（TCSS）的关系。方法：对84例2型糖尿病患者进行 TCSS 评分，根据评分分为Ⅰ（0～5分）、Ⅱ（6～8分）、Ⅲ（9～11分）、Ⅳ（12～19分）组，对胫后神经、隐神经、腓肠神经超声检查，记录超声表现，分析3条神经超声表现与评分的关系。结果：超声下各组异常率比较：Ⅳ组神经超声异常率最高，其次为Ⅲ、Ⅱ、Ⅰ组（P ＜0．05），主要表现为神经外膜与周围组织边界不清，神经束筛网样结构消失，胫后神经、腓肠神经外膜增厚、不规则的异常率各组差异无统计学意义（P ＞0．05），隐神经神经外膜增厚、不规则在Ⅱ、Ⅲ组明显较Ⅰ、Ⅳ组多（P ＜0．05）；3条神经的超声下异常率由大到小为腓肠神经＞胫后神经＞隐神经。结论：超声下糖尿病患者周围神经的异常改变与TCSS评分相关，评分越高，超声异常改变越明显；腓肠神经超声异常率最高。

Objective To evaluate the morphological changes of the small nerves in lower extremity with high-resolution ultrasonography in type 2 diabetes mellitus （T2DM）. Methods 84 cases of T2DM patients were divided into four different groups according to TCSS score [group Ⅰ （0-5 point）, group Ⅱ （6-8 point）, groupⅢ （9-11 point）, group Ⅳ （12-19 point）]. The ultrasonic feature of posterior tibial nerve, sural nerve and saphenous nerve were observed to observe the relationship between ultrasound findings and scoring. Results Abnormality rate admitted from ultrasound findings are as follows. In group Ⅳ, nerve abnormality rate was the highest, followed by group Ⅲ, group Ⅱ and group Ⅰ （P 0.05）. The saphenous nerve epineurium abnormality increased in group Ⅱ and Ⅲ compared with group Ⅰ and Ⅳ（P 〈0.05）. Abnormality rate of 3 neural ultrasound decreased in line with sural nerve, posterior tibial nerve and saphenous nerve. Conclusions Certain correlation was observed between TCSS and never ultrasonic feature in T2DM patients. The higher TCSS scores is, the greater chance of presence of abnormal sonographic features of nerves will be. The sural nerve abnormality was higher than others.