摘要
目的:探究2型糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)高频超声声像图特征与神经电生理参数的相关性。方法:选取2019年1月至2020年12月在我院收治的2型糖尿病(type 2 diabetes mellitus,T2DM)患者为研究对象,根据患者是否发生周围神经病变分为A组(n=43)和B组(n=57),另以同期健康受试者作为C组(n=40)。所有入试者均进行高频超声检查右侧上肢正中神经的5个位点,计算横截面积(cross-sectional area,CSA);仅T2DM患者进行神经电生理检查(neural-electrophysiological test,NET),分析CSA与神经电生理参数[腕-拇短展肌处远端潜伏期(distalmotorlatenc y,DML)、肘-腕处传导速度(motor conduction velocity,MCV)、指1-腕处传导速度(sensory conduction velocity,SCV)、指1-腕处波幅(sensorynerveactionpotential,SNAP)、F波平均潜伏期(Fwaveaveragelatency,F-AL)]间的相关性,并采用受试者工作特征(receiveroperatingcharacteristic,ROC)曲线分析不同水平下高频超声参数CSA对DPN的诊断价值。结果:A组、B组、C组在肘关节处(N1)、腕横纹上4~5 cm处(N2)、豌豆骨(N3)、钩骨(N4)、旋前圆肌入口(N5)水平的CSA均依次降低(P<0.05);且A组在豌豆骨、钩骨水平的CSA均较B组更高(P<0.05)。A组、B组、C组间在有血流、筛网状结构消失、内部回声减低上占比均逐渐降低(P<0.05)。与B组相比,A组的DML、F-AL均更高,MCV、SCV、SNAP则更低(P<0.05)。CSA与SNAP、SCV、MCV呈负相关,与DML呈正相关(P<0.05),与F-AL无关(P>0.05)。ROC曲线分析显示,高频超声在钩骨水平的诊断价值最大,最佳截断值为12.19mm2,曲线下面积为0.738。结论:DPN患者的高频超声参数及声像图存在特异性表现,其CSA参数与神经电生理参数密切相关,且高频超声CSA在钩骨水平表现出较高的诊断价值,可用于DPN的早期辅助诊断。
Objective:To explore the correlation between characteristics of high-frequency ultrasound features and neuroelectrophysiological parameters of type 2 diabetic peripheral neuropathy(DPN).Methods:The patients with type 2 diabetes mellitus(T2 DM) who were treated in the hospital between January 2019 and December 2020 were selected as research subjects,and they were divided into group A(n=43) and group B(n=57) according to whether peripheral neuropathy occurred in patients,and the healthy subjects during the same period were selected as group C(n=40).All participants underwent high-frequency ultrasound examination of the 5 sites of the median nerve of the right upper limb,and the cross-sectional area(CSA) was calculated.Neuralelectrophysiological test(NET) was only performed on patients with T2 DM,and the correlation between CSA and neuroelectrophysiological parameters [distal motor latency(DML) of wrist-abductor pollicis brevis,motor conduction velocity(MCV) of elbow-wrist,sensory conduction velocity(SCV) of finger 1-wrist,sensory nerve action potential(SNAP) of finger 1-wrist,F wave average latency(F-AL)] were analyzed,and receiver operating characteristic(ROC) curve was used to analyze the diagnostic value of high-frequency ultrasound parameter CSA on DPN at different levels.Results:The CSA values of group A,group B and group C at elbow joint(N1),4–5 cm above the rasceta(N2),pisiform bone(N3),unciform bone(N4),pronator teres muscle(N5) were all decreased successively(P<0.05).The CSA values at pisiform bone and unciform bone of group A were higher than those of group B(P<0.05).The proportions of blood flow,mesh-like structure disappearance and internal echo reduction were gradually decreased among group A,group B and group C(P<0.05).Compared with group B,DML and F-AL of group A were higher while MCV,SCV and SNAP were lower(P<0.05).CSA was negatively correlated with SNAP,SCV and MCV,and was positively correlated with DML(P<0.05),but had nothing to do with F-AL(P>0.05).ROC curve analysis showed that high-frequency
作者
赵阳
文珂
沈全明
ZHAO Yang;WEN Ke;SHEN Quanming(Department of Ultrasound,Huaihe Hospital of Henan University,Kaifeng Henan 475000;Department of Plastic Surgery,Huaihe Hospital of Henan University,Kaifeng Henan 475000,China)
出处
《临床与病理杂志》
CAS
2021年第12期2923-2929,共7页
Journal of Clinical and Pathological Research
基金
河南省自然科学基金(172102310155)。
关键词
超声
神经电生理参数
2型糖尿病
周围神经病变
ultrasound
neuroelectrophysiological parameters
type 2 diabetes mellitus
peripheral neuropathy
