剪切波弹性成像评估糖尿病周围神经病变患者针灸治疗效果的价值  

Shear Wave Elastography in Evaluating the Therapeutic Effect of Acupuncture in Diabetic Peripheral Neuropathy

作　　者：宋乐云 聂文素 张卫平[1] SONG Leyun;NIE Wensu;ZHANG Weiping(Department of Ultrasound,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China;不详)

机构地区：[1]南昌大学第一附属医院超声科,江西南昌330006 [2]江西省妇幼保健院超声科,江西南昌330006

出　　处：《中国医学影像学杂志》2025年第2期197-202,共6页Chinese Journal of Medical Imaging

基　　金：江西省卫生健康委员会科技计划项目(202210452);江西省中医药管理局科技计划项目(2021A060)。

摘　　要：目的探讨剪切波弹性成像评估糖尿病周围神经病变(DPN)患者针灸治疗效果的价值。资料与方法前瞻性收集2022年2月13日—2023年6月3日南昌大学第一附属医院内分泌科与治未病中心收治的60例2型DPN,采用随机数字表法选取30例DPN为A组,行降血糖+营养神经类药物甲钴胺片治疗;30例DPN为B组,在A组治疗基础上给予针灸治疗。所有患者治疗前后1周内均行正中神经及胫神经常规超声和剪切波弹性成像检查,获得治疗前后正中神经及胫神经直径、横截面积和杨氏模量;同时进行治疗前后正中神经、胫神经的神经电生理检查,获得运动及感觉传导速度;收集同期健康成人30名作为对照组,获得上述超声参数。比较治疗前后各组上述参数变化,同时以肌电图结果判断针灸治疗是否有效,并绘制正中神经及胫神经治疗前后杨氏模量差值诊断针灸治疗有效的受试者工作特征曲线。结果治疗前A、B组正中神经及胫神经直径、横截面积、杨氏模量值差异均无统计学意义(P>0.05),但均高于对照组(P<0.05、P<0.001);治疗后B组正中神经及胫神经杨氏模量值均低于A组(P=0.036、0.025),且A、B组正中神经及胫神经杨氏模量值均高于对照组(P均<0.001)。治疗后A组、B组、对照组正中神经及胫神经直径、横截面积差异均无统计学意义(F=0.824、0.176、0.106、0.982,P>0.05);A、B组治疗后正中神经及胫神经杨氏模量值明显低于治疗前(A组:t=5.422、4.429,P均<0.001;B组:t=6.110、7.081,P均<0.001)。正中神经及胫神经杨氏模量差值的曲线下面积、敏感度、特异度及最佳截断值分别为0.920、95%、90%、4.600 kPa和0.820、85%、70%、6.250 kPa,两者诊断效能无明显差异(Z=1.489,P=0.136)。结论剪切波弹性成像能提供周围神经弹性模量信息,评估神经硬度,为评估DPN治疗效果提供一种无创、有效的评估方法。Purpose To explore the value of shear wave elastography(SWE)in evaluating the therapeutic effect of acupuncture in patients with diabetic peripheral neuropathy(DPN).Materials and Methods Sixty patients with type 2 DPN treated at the Department of Endocrinology and Preventive Treatment Center in the First Affiliated Hospital of Nanchang University from February 13,2022 to June 32023 were selected prospectively,and were divided by random number table into group A(30 cases)who received hypoglycemic plus mecobalamin tablets,and group B(30 cases)who received acupuncture in addition to the treatment given to group A.Routine ultrasound and SWE were conducted to measure the diameter,cross-sectional area and Young's modulus(E)of the median nerve and tibial nerve before and after treatment.Electrophysiological examination was also performed to obtain motor nerve conduction velocity and sensory nerve conduction velocity of the median nerve and tibial nerve before and after treatment.Additionally,a control group comprising 30 healthy adults was included as the control group,and the above ultrasonic parameters were obtained.The changes in the above parameters before and after treatment were compared among the groups,and the effectiveness of acupuncture was assessed based on electromyography results.Furthermore,a receiver operating characteristic curve was constructed for the difference in E(ΔE)of the median nerve and tibial nerve.Results There were no significant differences in diameter,cross-sectional area and E of the median nerve and tibial nerve between group A and group B before treatment(P>0.05),but they were higher than those in control group(P<0.05,P<0.001).After treatment,the E values of the median nerve and tibial nerve in group B were lower than those in group A(P=0.036,0.025),and the E value in both group A and B remained significantly higher than those in control group(all P<0.001).There were no significant differences in diameter and cross-sectional area of the median nerve and tibial nerve among group A,B and

关 键 词：糖尿病 糖尿病神经病变 超声检查 剪切波弹性成像 针灸疗法 治疗效果 

分 类 号：R445.1[医药卫生—影像医学与核医学] R587.2[医药卫生—诊断学]