2型糖尿病下肢神经损伤的剪切波弹性成像评估

Shear wave elastography evaluation of lower limb nerve injury in type 2 diabetes

目的评估2型糖尿病患者(diabetes mellitus,DM)下肢神经损伤,为DM患者的病情进展判断及治疗干预提供影像学依据。方法连续收集2020年1-6月于空军军医大学第一附属医院确诊收治的44例2型糖尿病周围神经病变患者(diabetic peripheral neuropathy,DPN),同期纳入门诊体检中心健康体检者32例为对照组。联合应用高频超声及剪切波弹性成像技术(shear wave elastic maging technology,SWE)对所有研究对象双侧下肢神经(胫、腓总及腓肠神经)进行成像及参数分析。结果高频超声参数中胫神经直径及横截面积(cross-sectional area,CAS)、腓总神经CAS具有较好的诊断效能;剪切波弹性参数中,腓总神经杨氏模量平均值Mean(kPa)、最大值Max(kPa)、腓总神经平均速度Mean(m/s)及最大速度Max(m/s)具有较好诊断效能(0.70<AUC<0.90,P均<0.001)。下肢感觉及运动神经中腓总神经最为敏感,可作为DPN的重点观察指标。结论超声剪切波弹性成像可检出2型糖尿病周围神经损害,为临床干预提供早期诊断依据。

Objective To evaluate the nerve damage of the lower limbs of patients with type 2 diabetes(Diabetes Mellitus,DM),and to provide imaging evidence for the judgment of the progress of the disease and treatment intervention in patients with DM.Methods A total of 44 patients with type II diabetic peripheral neuropathy admitted to the First Affiliated Hospital of Air Force Military Medical University from January to June in 2020 were collected,and 32 healthy subjects were included in the outpatient physical examination center as the control group.High frequency ultrasound and shear wave elastic imaging(SWE)technology were used to image and analyze the parameters of bilateral lower limb nerves(tibial nerve,common peroneal nerve,and sural nerve).Results Among the high-frequency ultrasound parameters:Diameter and Cross-sectional area of the tibial nerve,and the common peroneal nerve CAS have better diagnostic performance;Among the shear wave elastic parameters,mean(kPa),max(kPa),mean(m/s)and max(m/s)of the common peroneal nerve had better diagnostic efficiency(0.70<AUC<0.90,all P<0.001).Conclusion Ultrasound shear wave elastography can detect peripheral nerve damage in type 2 diabetes,and provide early diagnosis basis for clinical intervention.