剪切波弹性成像诊断2型糖尿病正中神经病变的价值  

Shear Wave Elastography in Diagnosis of Type 2 Diabetes Mellitus with Median Neuropathy

作　　者：穆晶晶[1] 杨华睿 王媛[1] 王引弟[1] 童明辉[1] 陈斌娟[1] MU Jingjing;YANG Huarui;WANG Yuan;WANG Yindi;TONG Minghui;CHEN Binjuan(Department of Ultrasound,the Second Hospital of Lanzhou University,Lanzhou 730000,China)

机构地区：[1]兰州大学第二医院超声科,甘肃兰州730000

出　　处：《中国医学影像学杂志》2018年第11期831-834,841,共5页Chinese Journal of Medical Imaging

基　　金：甘肃省自然科学基金(17JR5RA245)

摘　　要：目的探讨剪切波弹性成像(SWE)技术对诊断2型糖尿病(T2DM)患者糖尿病性正中神经病变的价值,并探讨T2DM周围神经病变(DPN)患者糖化血红蛋白(HbA1c)与正中神经弹性模量值及剪切波速度(SWV)的关系。资料与方法选取正常志愿者、T2DM非DPN患者及T2DM合并DPN患者各60例。超声检查腕横纹上5 cm处正中神经,测量其厚径、宽径、周长、截面积(CSA),并利用SWE测量该处正中神经的弹性模量值及SWV,绘制受检者工作特性曲线。记录DPN患者入院HbA1c。结果 3组正中神经厚径、非DPN组较对照组宽径、CSA、周长差异均无统计学意义(P>0.05);但非DPN组弹性模量值[(57.20±11.20)k Pa]及SWV[(4.29±0.43)m/s]分别与对照组[(38.79±8.73)k Pa、[(3.53±0.42)m/s]比较,差异均有统计学意义(P<0.05)。DPN组与对照组、非DPN组相比,其宽径、CSA、周长均增大,差异均有统计学意义(P<0.05),且DPN组的弹性模量值及SWV值分别高于对照组与非DPN组,差异均有统计学意义(P<0.001)。当选取弹性模量值为61.25 kPa作为诊断DPN的最佳截点值时,其敏感度为78.3%、特异度为70.0%;选取SWV为4.45 m/s作为诊断DPN的最佳截点值时,其敏感度为80.0%、特异度为71.7%。T2DM合并DPN组患者HbA1c与正中神经的弹性模量值及SWV呈显著正相关。随着HbA1c增加,弹性值及SWV逐渐增大(r=0.677,P<0.001;r=0.713,P<0.001)。结论 SWE技术评估糖尿病正中神经病变具有较高的临床应用价值,有助于T2DM患者DPN早期诊断与治疗监测。Purpose To explore the value of shear wave elastography （SWE） in diagnosis of diabetic median nerve （MN） lesions in patients with type 2 diabetes mellitus （T2DM） and probe into how glycosylated hemoglobin value （HbA1c） in patients with diabetic peripheral neuropathy （DPN） correlates with MN elastic modulus value and shear wave velocity （SWV）. Materials and Methods Normal volunteers and patients with T2DM non-peripheral neuropathy （non-DPN） and T2DM-combined DPN were selected, with 60 cases in each category. Ultrasonic examination of MN was performed at 5 cm above rasceta, and its thickness, width, perimeter, and cross-sectional area （CSA） were measured. SWE was adopted to measure the elastic modulus value of MN and SWV, with ROC curve being plotted. HbA1c of DPN patients at the time of hospital admission was recorded. Results There was no statistical significance concerning the difference in thickness between the three groups, so were the difference in width, CSA, and perimeter between the non-DPN group and the control group （P〉0.05）. However, there was statistical significance concerning the difference in elastic modulus value [（57.20±11.20） kPa] and SWV [（4.29±0.43） m/s] between the non-DPN group and the control group [（38.79±8.73） kPa, [（3.53± 0.42） m/s]） （P〈0.05） by respective comparison. Width, CSA and perimeter were all seen increase in the DPN group compared with the control group and the non-DPN group, the difference of which was statistically significant （P〈0.05）. The elastic modulus value and SWV value of the DPN group were also higher than that of the control group and the non-DPN group, the difference of which was statistically significant （P〈0.001）. When choosing elastic modulus value at 61.25 kPa as the optimal cut-off value for the diagnosis of DPN, the sensitivity was 78.3%, and specificity 70.0%. When choosing SWV at 4.45 m/s as the optimal cut-off value for the diagnosis of DPN, the sensitivity was 80.0%, and spec

关 键 词：糖尿病 2型 糖尿病神经病变 正中神经病 超声检查 多普勒 彩色 弹性成像技术 

分 类 号：R587.1[医药卫生—内分泌] R445.1[医药卫生—内科学]