高频超声检查在诊断糖尿病周围神经病变中的价值

摘要

Objective To?evaluate?the?value?of?sciatic?nerve?changes?in?the?diagnosis?of?diabetic?peripheral?neuropathy?by?high?frequency?ultrasound.?Methods Sciatic?nerve?changes?in?45?diabetic?patients?with?peripheral?neuropathy,39?diabetic?patients?without?peripheral?neuropathy?and?48?normal?controls?were?evaluated?by?high?frequency?ultrasound.?The?anteroposterior?diameter,left-right?diameter?and?cross-sectional?area?of?the?sciatic?nerve?were?measured.?The?differences?of?ultrasonic?parameters?among?the?3?groups?were?compared,and?the?relation?of?the?ultrasonic?parameters?to?diabetic?peripheral?neuropathy?were?analysed.?The?sensitivity,specificity?and?diagnostic?efficacy?of?ultrasonic?parameters?in?predicting?diabetic?peripheral?neuropathy?were?evaluated?and?compared. Results The?anteroposterior?diameter,left-right?diameter?and?cross-sectional?area?of?sciatic?nerve?showed?a?gradual?increasing?trend?among?the?3?groups,were?significantly?correlated?with?diabetic?peripheral?neuropathy,and?the?cross-sectional?area?of?sciatic?nerve?were?most?correlated?with?diabetic?peripheral?neuropathy.?The?sensitivity?and?specificity?of?anteroposterior?diameter?of?sciatic?nerve>10.7mm?in?predicting?diabetic?peripheral?neuropathy?were?77.78%?and?89.74%,respectively.?The?sensitivity?and?specificity?of?left-right?diameter?of?sciatic?nerve>18.4?mm?in?predicting?diabetic?peripheral?neuropathy?were?55.56%,97.44%,respectively.?The?sensitivity?and?specificity?of?across-sectional?area?of?sciatic?nerve>139.31mm2?in?predicting?diabetic?peripheral?neuropathy?were?86.67%,92.31%,respectively.?Among?ultrasound?parameters,the?area?under?the?curve?of?left-right?diameter?of?sciatic?nerve?was?the?smallest,which?was?significantly?smaller?than?anteroposterior?diameter?and?across-sectional?area.?The?area?under?the?curve?of?the?across-sectional?area?of?sciatic?nerve?was?the?biggest?and?the?area?under?the?curve?of?left-right?diameter?of?sciatic?nerve?was?between?left-right?diameter?and?across-sectional?area.?Conclusion The?appearances?of?sciatic?nerve?evaluated?by?high?frequency?ultrasound?can?effectively?diagnose?diabetic?peripheral?neuropathy?and?the?cross-sectional?area?of?sciatic?nerve?have?the?best?diagnostic?efficacy.%目的 探讨高频超声检查评估坐骨神经改变诊断糖尿病周围神经病变的价值.方法 应用高频超声技术检测45例糖尿病周围神经病变患者、39例糖尿病无周围神经病变患者和48例健康者的坐骨神经表现,测量坐骨神经前后径、左右径和横截面积,比较组间超声参数差异,分析其与糖尿病周围神经病变的相关性,并评价高频超声诊断糖尿病周围神经病变的敏感性、特异性和诊断效能.结果 坐骨神经前后径、左右径和横截面积在3组间明显递增,且均与糖尿病周围神经病变存在相关性,横截面积与糖尿病周围神经病变相关性最好.以坐骨神经前后径>10.7mm预测糖尿病伴周围神经病变的敏感性和特异性分别为77.78%,89.74%;以坐骨神经左右径>18.4mm预测糖尿病伴周围神经病变的敏感性和特异性分别为55.56%,97.44%;以坐骨神经横截面积>139.31mm2预测糖尿病伴周围神经病变的敏感性和特异性分别为86.67%, 92.31%.超声参数中,坐骨神经左右径的曲线下面积为0.750(95%?CI:0.643~0.838),明显小于前后径和横截面积(Z=3.421,P=0.0006;Z=3.653,P=0.0003),坐骨神经横截面积的曲线下面积为0.954(95%?CI:0.885~0.9882),坐骨神经前后径的曲线下面积(0.929,95%?CI:0.852~0.974)介于横截面积和左右径之间.结论 高频超声评价坐骨神经表现可有效诊断糖尿病周围神经病变,坐骨神经横截面积的诊断效能最好.