高频超声对糖尿病周围神经病变者正中神经的初步研究

摘要

目的：探讨高频超声评价2型糖尿病(T2DM)及合并周围神经病变(DPN)者正中神经的可行性。方法选取健康志愿者42例作为对照组,88例 T2DM 患者按照症状、体征及电生理检查结果分为非 DPN 组(42例)和 DPN 组(46例)。分别测量正中神经的6个位点(腕横纹处、豌豆骨、钩骨、腕横纹上方6 cm、肱骨内上髁上4 cm、肱骨中点)的宽(W)、厚(T)及横截面积(CSA)。绘制 ROC 曲线,评价不同位点各径线对 DPN 的诊断价值。结果①与对照组相比,DPN 组 W 在腕横纹处、豌豆骨、钩骨、腕横纹上方6 cm 增宽,T 则在除肱骨内上髁上4cm 外5个位点均增大(P 均<0.05),CSA 在全部位点均增粗(P 均<0.01)；非 DPN 组 W 在腕横纹处、钩骨及肱骨中点增宽(P均<0.05),T 在腕横纹处、豌豆骨处增大,CSA 在除腕横纹处以外其余位点均增大(P 均<0.01)。与非 DPN 组相比,DPN 组 W 于腕横纹处,T 于肱骨中点,CSA 在腕横纹处、豌豆骨、钩骨、腕横纹上方6 cm 增大(P 均<0.001)。②不同位点的 W、T 及 CSA 对 DPN 诊断价值最高时对应的敏感性分别为80.4%,84.8%,84.8%,特异性均为54.8%,CSA 和 T 对 DPN 的诊断价值高于 W,诊断价值最高时CSA 及 T 对应的位点均位于钩骨,对应的临界值分别为0.097 cm2,0.233 cm。结论高频超声可以评价 DPN 者正中神经主干及各径线的异常改变情况,DPN 者正中神经各个位点 W 及 T 有不同程度的增加,而 CSA 在所有位点均增大,不同位点的 W、T 及 CSA 诊断价值最高时分别对应的敏感性均高于特异性,且以钩骨水平处的 T 及 CSA 对 DPN 的临床诊断价值最高。%Objective To explore the feasibility of high-frequency ultrasound detecting median nerve (MN) in type 2 diabetes mellitus(T2DM)with diabetic peripheral neuropathy(DPN).Methods Forty-two healthy volunteers were included as control group(Group A).Eighty-eight T2DM patients were divided into two groups according to symptoms,signs and electrophysiological results:with DPN (group C,46 patients) and without DPN (Group B,42 patients).The width(W),thickness(T) and cross-sectional area(CSA) of MN at 6 points [the wrist crease,pisiform bone,hamate bone,the 6 cm proximal to the wrist crease,the 4 cm proximal to tip of the medial epicondyle(ME) and the midpoint of the humerus] were evaluated.ROC curve was plotted to determine clinical diagnostic value of three lines on six points in diagnosis of DPN. Results ①Comparing with Group A,the width(P <0.05) except for the 4 cm proximal to tip of ME and the midpoint of the humerus,the thickness (P <0.05) except for the 4 cm distal to ME and CSAs of all points were enlarged in DPN patients(P <0.001).The width(P <0.05)at the wrist crease,hamate bone and the midpoint of the humerus,the thickness (P <0.01) at the wrist crease and pisiform bone,CSAs (P <0.01) of all sites except for the wrist crease were increased in Group B.Comparing Group B with C, the width at the wrist crease,the thickness in the midpoint of the humerus,CSAs except for the 4 cm proximal to ME and the midpoint of the humerus were dramaticlly increased in Group C(P <0.001).②A diagnostic value comparison:when diagnostic value of W,T and CSA at six points is the most predictive, the sensitivity is 80.4%,84.8%,84.8% respectively and specificities are all 54.8%.Diagnostic value of CSA and T is superior to the width.The CSA and T of the hamate bone level were the most predictive of DPN.The corresponding optimal cut-off value was 0.097 cm 2 ,0.233 cm respectively.Conclusions The backbone and the abnormal changes of different lines of the MN in DPN can be observed by high-frequency ultrasound.The width and thickness of the MN at six points are increased in different degree,but CSAs of all levels can enlarge.When diagnostic value of W,T and CSA at six points is the most predictive for DPN, the sensitivity is superior to specificity respectively.The CSA and T of the hamate bone levelare the most predictive for the evaluation of DPN.