剪切波弹性成像在2型糖尿病腓肠神经病变中的应用

doi:10.3969/j.issn.1006-9771.2019.02.016

《中国康复理论与实践》 ›› 2019, Vol. 25 ›› Issue (2): 213-216.doi: 10.3969/j.issn.1006-9771.2019.02.016

剪切波弹性成像在2型糖尿病腓肠神经病变中的应用

穆晶晶, 陈斌娟, 逯雪峰, 张曈, 王媛, 王引弟, 童明辉

兰州大学第二医院超声科，甘肃兰州市 730030

收稿日期:2018-09-14 修回日期:2018-10-22 出版日期:2019-02-25 发布日期:2019-04-01
通讯作者: 童明辉。E-mail： tongmh1962@126.com
作者简介:穆晶晶(1994-)，女，汉族，甘肃平凉市人，硕士研究生，主要研究方向：肌骨超声。
基金资助:
1.甘肃省自然科学基金项目(No. 17JR5RA245)

Application of Shear Wave Elastography in Type 2 Diabetic Sural Neuropathy

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

Received:2018-09-14 Revised:2018-10-22 Published:2019-02-25 Online:2019-04-01
Contact: TONG　Ming-huicorresponding author:. E-mail： tongmh1962@126.com
Supported by:
Natural Science Foundation of Gansu (No. 17JR5RA245)

摘要/Abstract

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。

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

Abstract: 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.

Key words: type 2 diabetes, peripheral neuropathy, sural nerve, shear wave elastography

中图分类号:

R587.2

穆晶晶, 陈斌娟, 逯雪峰, 张曈, 王媛, 王引弟, 童明辉. 剪切波弹性成像在2型糖尿病腓肠神经病变中的应用[J]. 《中国康复理论与实践》, 2019, 25(2): 213-216.

MU Jing-jing, CHEN Bin-juan, LU Xue-feng, ZHANG Tong, WANG Yuan, WANG Yin-di, TONG Ming-hui. Application of Shear Wave Elastography in Type 2 Diabetic Sural Neuropathy[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2019, 25(2): 213-216.

参考文献

[1] 乔春梅,王晓磊,哈斯,等. 超声在周围神经病变诊断中的应用进展[J]. 生物医学工程与临床, 2015, 19(1): 90-94.
[2] Handelsman Y, Bloomgarden Z T, Grunberger G, et al. American Association of Clinical Endocrinologists and American College of Endocrinology－Clinical Practice Guidelines for Developing A Diabetes Mellitus Comprehensive Care Plan-2015 [J]. Endocr Pract, 2015, 21(1): 1-87.
[3] Vinik A I, Casellini C M. Guidelines in the management of diabetic nerve pain: clinical utility of pregabalin [J]. Diabetes Metab Syndr Obes, 2013, 6: 57-78.
[4] 张红,哈斯,王晓磊. 超声检查糖尿病周围神经和足背动脉及肌电图的比较研究[J]. 生物医学工程与临床, 2017, 21(1): 30-37.
[5] 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2013年版)[J]. 中国糖尿病杂志, 2014, 30(8): 893-942.
[6] 边红霞. 糖尿病周围神经病的神经电生理特点分析[J]. 中国药物与临床, 2018, 18(3): 448-449.
[7] 沈开霞. 糖尿病周围神经病变患者的腓肠神经超声影像学特点分析[D]. 苏州:苏州大学, 2016.
[8] 杨丽清,杜红枝,陈武,等. 高频超声对糖尿病周围神经病变者正中神经的初步研究[J]. 中华超声影像学杂志, 2016, 25(3): 238-242.
[9] Hassan A, Leep Hunderfund A N, Watson J, et al. Median nerve ultrasound in diabetic peripheral neuropathy with and without carpal tunnel syndrome [J]. Muscle Nerve, 2013, 47(3): 437-439.
[10] Watanabe T, Ito H, Sekine A, et al. Sonographic evaluation of the peripheral nerve in diabetic patients: the relationship between nerve conduction studies, echo intensity, and cross-sectional area [J]. J Ultrasound Med, 2010, 29(5): 697-708.
[11] 程娟,陈亚青. 超声诊断糖尿病周围神经病变[J]. 中国医学影像技术, 2011, 27(5): 1035-1038.
[12] Sigrist R M S, Liau J, Kaffas A E, et al. Ultrasound elastography: review of techniques and clinical aplications [J]. Theranostics, 2017, 7(5): 1303-1329.
[13] Dikici A S, Ustabasioglu F E, Delil S, et al. Evaluation of the tibial nerve with shear-wave elastography: a potential sonographic method for the diagnosis of diabetic peripheral neuropathy [J]. Radiology, 2017, 282(2): 494-501.
[14] 董荣芳,张铭,郑丹枫,等. 糖尿病周围神经病的病理学研究[J]. 诊断病理学杂志, 2015, 22(3): 133-138.
[15] 郭军红,蒲传强. 糖尿病周围神经病的病理与电生理研究进展[J]. 中国康复理论与实践, 2009, 15(1): 8-10.
[16] 吕秀花. 剪切波弹性成像检测正中神经病变初步应用及其对腕管综合征诊断价值的研究[D]. 西安:第四军医大学, 2015.
[17] 周晓华,王闯,毛林,等. 实时剪切波弹性成像评估兔急性肌肉损伤的实验研究[J]. 临床超声医学杂志, 2018, 20(3): 181-184.
[18] Bercoff J, Tanter M, Fink M. Supersonic shear imaging: a new technique for soft tissue elasticity mapping [J]. IEEE Trans Ultrason Ferroelectr Freq Control, 2004, 51(4): 396-409.
[19] Kantarci F, Ustabasioglu F E, Delil S, et al. Median nerve stiffness measurement by shear wave elastography: a potential sonographic method in the diagnosis of carpal tunnel syndrome [J]. Eur Radiol, 2014, 24(2): 434-440.
[20] Fukashi I, Miki T, Rie K, et al. Elasticity of the tibial nerve assessed by sonoelastography was reduced before the development of neuropathy and further deterioration associated with the severity of neuropathy in patients with type 2 diabetes [J]. J Diabetes Investig, 2016, 7(3): 404-412.
[21] Suda T, Okawa O, Masaoka R, et al. Shear wave elastography in hepatitis C patients before and after antiviral therapy [J]. World J Hepatol, 2017, 9(1): 64-68.
[22] Dietrich C F, Bamber J, Berzigotti A, et al. EFSUMB Guidelines and Recommendations on the Clinical Use of Liver Ultrasound Elastography, Update 2017 (Short Version) [J]. Ultraschall Med, 2017, 38(4): 377-394.
[23] Orman G, Ozben S, Huseyinoglu N, et al. Ultrasound elastographic evaluation in the diagnosis of carpal tunnel syndrome: initial findings [J]. Ultrasound Med Biol, 2013, 39(7): 1184-1189.
[24] Klauser A S, Miyamoto H, Martinoli C, et al. Sonoelastographic findings of carpal tunnel injection [J]. Ultraschall Med, 2015, 36(6): 618-622.
[25] 蔡莹莹,余小琴,刘滨月. 剪切波弹性成像检测技术对肾弥漫性病变诊断价值研究[J]. 中国实用医药, 2018, 13(13): 54-55.
[26] Bhatia K S, Tong C S, Cho C C, et al. Shear wave elastography of thyroid nodules in routine clinical practice: preliminary observations and utility for detecting malignancy [J]. Eur Radiol, 2012, 22(11): 2397-2406.

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

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