高频超声对2型糖尿病伴下肢周围神经病变症状患者腓总神经的诊断价值

Diagnostic value of high frequency ultrasound on commonly peroneal nerve of patients with T2DM with peripheral neuropathy of lower limbs

目的:探讨高频超声评估2型糖尿病(T2DM)伴下肢周围神经病变的诊断价值。方法:选取在医院治疗的130例T2DM患者,根据T2DM伴下肢周围神经病变情况将其分为病变组(50例)和无病变组(80例),同时选取100名健康志愿者纳入健康对照组,3组均给予高频超声检查。比较各组腓总神经前后径、横径和横截面积及其与密歇根筛查量表(MNSI)评分的相关性分析。结果:病变组腓总神经前后径、横径和横截面积分别为(4.07±0.18)mm、(6.20±0.27)mm和(19.70±1.40)mm2,明显高于无病变组的(3.89±0.20)mm、(5.90±0.30)mm和(18.15±1.51)mm2,且高于健康对照组的(3.50±0.19)mm、(5.01±0.28)mm和(14.21±1.36)mm2,3组比较差异有统计学意义(F=9.644,F=22.103,F=40.103;P<0.05)。病变组腓总神经出现神经束回声减低、“筛网状”结构模糊、外膜不均匀增厚,与毗邻组织分界不清的比例分别为82.00%、90.00%、92.00%和44.00%,明显高于无病变组,其差异有统计学意义(x2=38.335,x2=31.855,x2=66.289,x2=18.173;P<0.05)。MNSI评分与腓总神经前后径、横径和横截面积呈正相关(r=0.564,r=0.622,r=0.603;P<0.05)。结论:高频超声可为T2DM伴下肢周围神经病变诊断提供影像依据,具有临床使用价值。

Objective: To explore the value of high frequency ultrasound in assessing type 2 diabetes mellitus (T2DM) with peripheral neuropathy of lower limbs. Methods: 130 patients with T2DM in our hospital were selected, and they were divided into lesion group (50 cases) and non-lesion group (80 cases) according to the conditions of T2DM with peripheral neuropathy. At the same time, 100 healthy volunteers were selected as control group. And all of three groups underwent high frequency ultrasound examination. And then, the anterior and posterior diameter, transverse diameter and cross sectional area (CSA) of commonly peroneal nerve among three groups were compared, and the correlation between these indicators of lesion group and Michigan neuropathy screening instrument (MNSI) score were analyzed respectively. Results: The anterior and posterior diameters, transverse diameters and CSA of commonly peroneal nerve of lesion group (4.07±0.18 mm, 6.20±0.27 mm and 19.70±1.40 mm2) were significantly higher than those of nonlesion group (3.89±0.20mm, 5.90±0.30mm and 18.15±1.51mm2) and that of healthy control group (3.50±0.19 mm, 5.01±0.28 mm and 14.21±1.36 mm2), respectively, and the differences among the three groups were significant (F=9.644, F=22.103, F=40.103, P<0.05). And the radios of the reduction of nerve tract echo, indistinction of "screen-net" structure, uneven thickening of adventitia and unclear demarcation with adjacent tissues of commonly peroneal nerve of lesion group (82.00%, 90.00%, 92.00% and 44.00%) were significantly higher than those of non-lesion group (x2=38.335, x2=31.855, x2=66.289, x2=18.173, P<0.05). The scores of MNSI were positive correlation with the anterior and posterior diameter, transverse diameter and CSA of commonly peroneal nerve (r=0.564, r=0.622, r =0.603, P<0.05) respectively. Conclusion: High-frequency ultrasound can provide imaging basis for the diagnosis of T2DM with peripheral neuropathy of lower limbs, which has value of clinical use.