高频超声下糖尿病周围神经病变声像图表现与神经电生理特征的相关性研究

Study on the correlation between the appearance of diabetic peripheral neuropathy and the electrophysiological characteristics of nerves by high-frequency ultrasound

目的应用高频超声探讨2型糖尿病周围神经病变(Diabetic peripheral neuropathy,DPN)的声像图表现,分析其与神经电生理特征的关系,从而评估高频超声在早期DPN诊断中的价值。方法选取2018年1月至2019年8月间来我院就诊的72例2型糖尿病(Patients with type 2 diabetes,T2DM)患者,根据糖尿病病程、有无周围神经病变症状及糖化血红蛋白水平分为以下四组:糖尿病无症状组(A组),糖尿病有症状血糖控制良好组(B1组),糖尿病有症状血糖控制不佳组(B2组),同期选取26例来我院健康体检者作为对照组(C组),对所有研究对象双上肢腕横纹处正中神经及双下肢内踝处胫神经进行高频超声检查,测量各神经的横截面积(cross sectional area,CSA),将所得数据进行统计学分析。结果各组间研究对象年龄、性别差异均无统计学意义(P>0.05);B1组正中神经和胫神经CSA较A组及C组显著增大(P<0.05);A组正中神经和胫神经CSA较C组显著增大P<0.05);B2组正中神经和胫神经CSA较B1组显著增大(P<0.05);糖尿病有症状组胫神经CSA与神经电生理运动传导速度和波幅呈负相关,与潜伏期呈正相关(P<0.05)。结论高频超声对早期2型糖尿病周围神经病变的临床诊断具有一定价值及具有较好的临床指导意义和应用前景。

Objective By using high-frequency ultrasound to explore sonographic performance of the type 2 diabetic peripheral neuropathy(Diabetic peripheral neuropathy,DPN),and to analyze its relationship with neuroelectrophysiological characteristics,so as to evaluate the value of high-frequency ultrasound in early diagnosis of DPN.Methods 72 patients with Type 2 diabetes(T2DM)who came to our hospital from January 2018 to August 2019 were selected.According to the course of diabetes,the presence or absence of symptoms of peripheral neuropathy,and the level of glycated hemoglobin,all the patients were divided into the following four groups:Diabetic asymptomatic group(group A),diabetic symptomatic with good blood sugar control group(group B1),diabetic symptomatic with poor blood sugar control group(group B2).During the same period,26 patients who came to our hospital for health examination were selected as the control group(Group C).The high-frequency ultrasound examination was performed on the median nerve located in wrist striated of both upper limbs and the tibial nerve located in the medial malleolus of both lower limbs of all the subjects,and the cross sectional area(CSA)of each nerve was measured,and the data obtained were statistically analysis.Results There was no statistically significant difference in age and gender between the groups(P>0.05).The median nerve and tibial nerve CSA in group B1 was significantly larger than that in groups A and C(P<0.05).The median nerve and tibial nerve CSA in group A was significantly increased compared with group C(P<0.05).The median nerve and tibial nerve CSA in B2 group was significantly increased than group B1(P<0.05).In diabetic symptomatic group,tibia nerve CSA were negative correlation with nerve electrophysiological motor conduction velocity and amplitude,and positive correlation with incubation period(P<0.05).Conclusion High-frequency ultrasound has certain value in the clinical diagnosis of early type 2 diabetic peripheral neuropathy and has good clinical guidance significance and application prospects.