2型糖尿病周围神经病变患者正中神经剪切波弹性成像特征

Shear wave elastographic features of median nerve in patients with type 2 diabetic peripheral neuropathy

目的探讨2型糖尿病周围神经病变(DPN)患者正中神经(MN)的剪切波弹性成像(SWE)特征。方法收集2型糖尿病患者120例,根据电生理检查结果和临床症状,分为DPN组(n=60)及非DPN组(n=60);选取同期60名健康志愿者为对照组。采用高频超声和SWE检查MN,测量其宽径、厚径、周长、横截面积及杨氏模量值,比较3组上述参数的差异,观察3组弹性图像颜色变化。绘制ROC曲线,分析杨氏模量值鉴别诊断DPN与非DPN的敏感度及特异度。结果 3组MN厚径的差异无统计学意义(P>0.05);DPN组MN的宽径、横截面积、周长、杨氏模量值均大于非DPN组及对照组(P均<0.05);非DPN组MN的杨氏模量值大于对照组(P<0.001),但2组MN的宽径、横截面积、周长的差异均无统计学意义(P均>0.05)。弹性图像上,DPN组表现为黄绿色,非DPN组表现为绿蓝色,对照组表现为蓝色。杨氏模量值阈值为61.25kPa时,ROC曲线下面积为0.822(P<0.001),鉴别诊断DPN与非DPN的敏感度、特异度分别为78.30%、70.00%。结论 2型糖尿病合并DPN患者的杨氏模量值大于非DPN患者,以杨氏模量值鉴别诊断DPN与非DPN有助于早期诊断2型糖尿病合并DPN。

Objective To investigate the shear wave elastographic（SWE）features of the median nerve（MN）in patients with type 2 diabetic peripheral neuropathy（DPN）.Methods Totally 120 patients with type 2 diabetes were collected and classified into two groups（DPN group and non-DPN group,each n=60）according to the electrophysiological examination results and clinical symptoms.Sixty healthy volunteers were selected as the controls（control group）.MN was examined with high-frequency ultrasound and SWE,and the width,thickness,circumference,cross-sectional area and the Young modulus value of MN were measured.The differences of the above parameters were compared among the three groups,and the color changes of elastic images were observed.ROC curve was plotted to analyze the sensitivity and specificity of Young modulus value in differential diagnosis of DPN and non-DPN.Results There was no statistically significant difference of MN thickness among the three groups（P〉0.05）.The width,cross-sectional area,circumference,Young modulus value of MN in DPN group were statistically larger than those in non-DPN group and control group（all P〈0.05）.The Young modulus value of MN in non-DPN group was significantly larger than in control group（P〈0.001）,but there was no significant difference of the width,cross-sectional area nor circumference between the two groups（all P〉0.05）.On the elastic images,DPN group mainly showed yellow-green,the non-DPN group mainly showed greenish blue,and the control group mainly showed blue.Taking Young modulus value 61.25 kPa as a threshold,the area under curve was 0.822（P〈0.001）,the sensitivity and specificity in differential diagnosis of DPN and non-DPN was 78.30% and 70.00%,respectively.Conclusion The Young modulus value of type 2 diabetic patients with DPN is larger than that of non-DPN,which is helpful to the early differential diagnosis of DPN and non-DPN.