摘要
目的应用超声评估糖尿病患者胫神经改变情况,探讨其在预测糖尿病周围神经病变中的价值。方法对39例糖尿病周围神经病变患者(周围神经病变组)、29例糖尿病无周围神经病变患者(无周围神经病变组)和33例健康体检者(正常对照组)行胫神经的超声评估,测量和评估胫神经前后径、左右径、横截面积和血流分布情况,比较各组胫神经超声参数差异;分析胫神经各参数与糖尿病周围神经病变的相关性,以及预测糖尿病周围神经病变的诊断效能。结果胫神经前后径、左右径和横截面积在正常对照组、无周围神经病变和周围神经病变组逐渐递增,组间两两比较差异均有统计学意义(均P<0.05);胫神经前后径、左右径、横截面积和血流分布均与糖尿病周围神经病变呈正相关(r=0.785、0.649、0.785、0.268,均P<0.05);以胫神经前后径>4.01 m、左右径>5.96 mm、横截面积>21.56 mm^2、有血流分布预测糖尿病周围神经病变的敏感性和特异性分别为79.49%和96.55%,66.67%和100%,79.49%和100%,15.38%和100%。胫神经前后径和横截面积预测糖尿病周围神经病变的曲线下面积最大(均为0.958,95%可信区间:0.879～0.992);而胫神经左右径的曲线下面积为0.878(95%可信区间:0.776～0.945),小于胫神经前后径和横截面积的曲线下面积,差异均有统计学意义(Z=2.022,P=0.0432;Z=2.079,P=0.0376);胫神经血流分布情况的曲线下面积最小,仅为0.577(95%可信区间:0.451～0.696),明显小于其他超声参数,差异均有统计学意义(均P<0.0001)。结论超声可通过评估胫神经表现有效预测糖尿病周围神经病变,其中胫神经前后径和横截面积诊断效能最好。
Objective To evaluate the value of ultrasound in evaluation of the changes of phrenic nerve in predicting diabetic peripheral neuropathy.Methods Thirty-nine diabetic patients with peripheral neuropathy,29 diabetic patients without peripheral neuropathy and 33 normal controls were examined by ultrasound.The anteroposterior diameter,left-right diameter,cross-sectional area and blood flow distribution of the phrenic nerve were measured and evaluated.The differences of all ultrasographic parameters among 3 groups were compared,and the correlation between all ultrasographic parameters and the phrenic nerve to diabetic peripheral neuropathy were analyzed.The diagnostic efficacy of the all ultrasographic parameters of the phrenic nerve in predicting diabetic peripheral neuropathy were analyzed.Results The anteroposterior diameter,left-right diameter and cross-sectional area of phrenic nerve showed a gradual increasing trend in the control group,diabetes without peripheral neuropathy and diabetes with peripheral neuropathy,and the difference between any two groups was statistically significant(all P<0.05).The anteroposterior diameter,left-right diameter,cross-sectional area and blood flow distribution of phrenic nerve were significantly correlated with diabetic peripheral neuropathy(r=0.785,0.649,0.785,0.268,all P<0.05).The sensitivity and specificity of anterior diameter>4.01 mm,left-right diameter of phrenic nerve>5.96 mm,across-sectional area>21.56 mm2,the presence of flow distribution of phrenic nerve in predicting diabetic peripheral neuropathy were 79.49%and 96.55%,66.67%and 100%,79.49%and 100%,15.38%and 100%,respectively.The area under the curve of anteroposterior diameter and cross-sectional area of phrenic nerve was the largest(0.958,95%CI:0.879~0.992).The area under the curve of the left-right diameter of phrenic nerve was the smallest(0.878,95%CI:0.776~0.945),which was smaller than the anteroposterior diameter and cross-sectional area of the radial nerve.The difference was statistically significant(Z=2.022,P=0.0432,Z=2.079,P=0.0376).The area under the curve of phrenic blood flow distribution was the smallest(only 0.577,95%CI:0.451~0.696),which was significantly smaller than other ultrasound parameters(all P<0.0001).Conclusion The appearances of phrenic nerve by ultrasonography can predict diabetes peripheral neuropathy effectively,and the anteroposterior diameter of phrenic nerve and cross-sectional area of phrenic nerve have the best diagnostic efficacy.
作者
徐静
XU Jing(Department of Ultrasound,Jiangyin People’s Hospital,School of Medicine,Southeast University,Jiangsu 214400,China)
出处
《临床超声医学杂志》
2018年第12期846-848,共3页
Journal of Clinical Ultrasound in Medicine
关键词
超声检查
胫神经
糖尿病
周围神经病变
Ultrasonography
Phrenic nerve
Diabetes
Peripheral neuropathy
