剪切波弹性成像在2型糖尿病腓肠神经病变中的应用  

Application of Shear Wave Elastography in Type 2 Diabetic Sural Neuropathy

作　　者：穆晶晶[1] 陈斌娟[1] 逯雪峰 张曈[1] 王媛[1] 王引弟[1] 童明辉[1] MU Jing-jing;CHEN Bin-juan;LU Xue-feng;ZHANG Tong;WANG Yuan;WANG Yin-di;TONG Ming-hui(Department of Ultrasound,Second Hospital of Lanzhou University,Lanzhou,Gansu 730030,China)

机构地区：[1]兰州大学第二医院超声科,甘肃兰州市730030

出　　处：《中国康复理论与实践》2019年第2期213-216,共4页Chinese Journal of Rehabilitation Theory and Practice

基　　金：甘肃省自然科学基金项目(No.17JR5RA245)~~

摘　　要：目的探讨剪切波弹性成像(SWE)对2型糖尿病(T2DM)患者腓肠神经病变的诊断价值。方法 2017年9月至12月,T2DM患者119例根据是否存在糖尿病周围神经病变(DPN)分为DPN组(n=61)和非DPN组(n=58);另选同期健康志愿者60例为对照组。超声测量腓肠神经厚径、宽径、周长和截面积,SWE测量腓肠神经杨氏模量和剪切波速度(SWV),以神经电生理检查结果为金标准绘制接受者操作特征(ROC)曲线,确定杨氏模量值和SWV诊断DPN的截点,比较两种方法的曲线下面积。结果 DPN组腓肠神经厚径较对照组增加(P <0.05);三组间腓肠神经宽径、截面积、周长、杨氏模量值和SWV均有显著性差异(P <0.05)。腓肠神经SWE图像显示,DPN组为黄蓝绿色夹杂,非DPN组为深蓝色,对照组为均匀浅蓝色。杨氏模量值诊断截点为51.65 kPa,曲线下面积0.925,敏感性86.9%,特异性89.7%;SWV诊断截点为4.15 m/s,曲线下面积0.923,特异性89.7%,敏感性85.2%;两者诊断效能相当(Z=0.556,P=0.579)。结论 SWE可以为临床诊断T2DM后腓肠神经病变提供参考。Objective To explore the value of shear wave elastography (SWE) for diagnosis of sural neuropathy in patients with type 2 diabetes mellitus (T2DM). Methods From September to December, 2017, 119 patients with T2DM were divided into diabetic peripheral neuropathy (DPN) group (n = 61) and non-DPN group (n = 58) according to the diagnosic criteria. In the same period, other 60 healthy volunteers were also recruited as normal group. They were measured the thickness, width, circumference and cross-sectional area of sural nerve, as well as the Young's modulus and shear wave velocity (SWV) with SWE. Based on the results of electrophysiology, the receiver operating characteristic (ROC) curve was drawn to determine the cut-off of the Young's modulus and SWV to differentiate DPN from non-DPN, and their area under the curve was compared. Results The thickness of sural nerve was more in DPN group than in the normal group (P < 0.05). There were significant differences among all the groups in width, cross-sectional area, circumference, Young's modulus and SWV of sural nerves (P < 0.05). For SWE image, it was yellow-green for DPN group, dark blue for non-DPN group, and uniform light blue for the normal group. The cut-off was 51.65 kPa for Young's modulus, with the area under the curve of 0.925, sensitivity of 86.9% and specificity of 89.7%;while it was 4.15 m/s for SWV, with the area under curve of 0.923, specificity of 89.7% and sensitivity of 85.2%. The diagnostic efficiency for DPN was similar between Young's modulus and SWV (Z = 0.556, P = 0.579). Conclusion SWE can provide useful information for clinical diagnosis of sural neuropathy after T2DM.

关 键 词：2型糖尿病 周围神经病变 腓肠神经 剪切波弹性成像 

分 类 号：R587.2[医药卫生—内分泌]