剪切波弹性成像对2型糖尿病正中神经病变的初步研究  

Shear wave elastography preliminary study of the median nerve lesion in type 2 diabetes

作　　者：王媛[1] 穆晶晶[1] 王引弟[1] 王挺[1] 陈斌娟[1] WANG Yuan;MU Jingjing;WANG Yindi;WANG Ting;CHEN Binjuan(Department of Ultrasound,Lanzhou University Second Hospital,Lanzhou730030,P.R.China)

机构地区：[1]兰州大学第二医院超声科

出　　处：《医学影像学杂志》2019年第6期1016-1019,共4页Journal of Medical Imaging

基　　金：甘肃省自然科学基金项目(编号:17JR5RA245)

摘　　要：目的探讨剪切波弹性成像技术(SWE)对2型糖尿病(T2DM)患者正中神经病变的应用价值。方法选取正常志愿者、T2DM无周围神经病变患者和T2DM并周围神经病变患者各60例,超声检查腕横纹上5cm处正中神经,测量其厚径(D1)、宽径(D2)、周长(C)、截面积(CSA)并应用SWE测量该点正中神经的平均杨氏模量值(EI)及剪切波传播速度(SWV)。比较3组间参数的差异并绘制ROC曲线,分析C、CSA、EI及SWV鉴别诊断糖尿病周围神经病变(DPN)与非DPN的敏感度及特异度。并比较EI和SWV两种剪切波测量值的曲线下面积。结果1)三组间正中神经D1无统计学差异,非DPN组较正常组其D2、CSA、C均无统计学差异(P>0.05),EI、SWV均有统计学差异(P<0.05);DPN组较正常组、非DPN组其D2、CSA、C均有统计学差异(P<0.05),EI及SWV值有显著统计学差异(P<0.001);2)弹性图像DPN组表现以不均匀的黄绿色为主,非DPN组表现为不均匀的蓝绿色为主,对照组表现为均匀蓝色;3)C、CSA、EI和SWV的阈值分别为1.01cm、0.07cm2、61.25kPa、4.45m/s时,ROC曲线下面积分别为0.734、0.625、0.822、0.835(P均<0.01),鉴别诊断DPN与非DPN的敏感度、特异度分别为81.7%、65.00%;81.70%、35.00%;78.30%、70.00%;80.00%、71.70%。比较EI和SWV曲线下面积,EI值和SWV值对DPN的诊断效能相当。(Z=1.328,P=0.184)。结论弹性剪切波成像可以对2型糖尿病患者的正中神经进行评估,为临床DPN的早期诊断提供一定的参考价值。Objective To investigate the sheaRwave elastographic (SWE) application value of the median nerve in patients with type 2 diabetic peripheral neuropathy (T2DM). Methods We collected normal volunteers, T2DM patients without peripheral neuropathy and T2DM with peripheral neuropathy with each of 60 cases. The median nerve of 5 cm above the wrist horizontal stripes was examined its width, thickness, circumference, cross-sectional area with ultrasound and the Young modulus value and sheaRwave velocity were measured with SWE. We observed the differences between the above parameters compared among the three groups and plotted the ROC curve. The ROC curve was used to analyze the sensitivity and specificity of circumference, cross-sectional area, the Young modulus value and sheaRwave velocity in differential diagnosis of DPN and non-DPN. We compared the area undeRthe ROC curve of Young modulus value and sheaRwave velocity. Results 1) The thickness of the median nerve was no statistical significant difference between the three groups ( P >0.05). The width, cross-sectional area, circumference, Young modulus value of the median nerve in DPN group were statistically largeR than those of non-DPN group and control group (all P <0.05). There was no significant difference in the width, cross-sectional area and circumference of the median nerve between the DPN group and non-DPN group (all P >0.05), but the Young modulus value and sheaRwave velocity of median nerve in non-DPN group were significantly largeRthan that of control group ( P <0.001);2) The DPN group mainly showed uneven greenyellow, the non-DPN group mainly showed uneven greenish blue and the control group showed even blue on the elastic images;3) When the thresholds of circumference, cross-sectional area, the Young modulus value and sheaRwave velocity respectively were 1.01 cm, 0.07 cm 2, 61.25 kPa, 4.45 m/s, the area undeRcurve were respectively 0.734, 0.625 , 0.822, 0.835 ( P <0.01), the sensitivity and specificity respectively were 81.7%, 65.00%;81.70%, 35.00%;78.30%

关 键 词：2型糖尿病 周围神经系统疾病 正中神经 弹性成像技术 超声检查 

分 类 号：R745[医药卫生—神经病学与精神病学] R445.1[医药卫生—临床医学]