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目的通过对比糖尿病周围神经病变(DPN)患者与正常人群周围神经声像图,总结DPN的一般声像图特征及特异性超声表现;高频超声(HFUS)与肌电图(EMG)进行相关性分析,印证HFUS对DPN的诊断价值;同时观察糖尿病(DM)患者DPN与足背动脉受累是否具有相关性。方法选择内蒙古医科大学附属医院DPN患者30例[A组,男性22例,女性8例;年龄(56.40±8.77)岁]和同期体检或诊治其他疾病不伴发DM及DPN患者30例[B组,正常对照组,男性20例,女性10例;年龄(55.33±10.10)岁],以及有DM无DPN患者30例[C组,男性22例,女性8例;年龄(54.90±10.48)岁)]。3组行超声检查,A组和B组观察和记录双上肢正中神经、尺神经、双下肢坐骨神经、胫神经、腓总神经、腓肠神经前后径(D1)、左右径(D2)、横截面积(CSA)、神经被膜、神经束膜、内部回声及彩色多普勒(CDFI)情况;同时A组患者进行EMG检查,记录上述神经的潜伏期、波幅及神经传导速度;A组和C组进行双下肢足背动脉的超声检查,观察其管径、斑块、内中膜情况,记录其收缩期峰值流速(PSV)、搏动指数(PI)及阻力指数(RI)。结果 B组各神经显示清晰,横断面表现为边界清晰的筛网状结构,神经被膜及神经束膜表现为线状高回声,纵断面表现为由平行线状高回声(神经束膜)分割成的断续管状低回声(神经束);A组各神经肿大增粗、内部回声减低、神经被膜及神经束膜线状高回声模糊不清,D1、D2、CSA均较B组增大,血流信号增多(P<0.05)。A组神经(正中神经、尺神经、腓总神经、胫神经、腓肠神经)CSA与EMG潜伏期呈正相关(r=0.527、0.910、0.702、0.581、0.793),与电位波幅呈负相关(r=-0.676、-0.298、-0.666、-0.439、-0.586),与神经传导速度呈负相关(r=-0.766、-0.853、-0.716、-0.877、-0.774);A组及C组足背动脉均有患者出现动脉粥样硬化表现,表现为内中膜不平整,局段或弥漫性增厚、单发或多发斑块,PSV、PI、RI随病变程度不同,变化不同,两组间差异无统计学意义(P>0.05)。结论 HFUS诊断DPN有特征性声像图表现,HFUS对DPN有一定的诊断价值;神经CSA增大与EMG潜伏期延长、电位波幅减低、神经传导速度减慢具有相关性,HFUS与EMG检查结果相一致,再次肯定了HFUS对DPN的诊断价值;DPN患者与DM不伴发DPN患者足背动脉受累情况未见明显差异。
OBJECTIVE: To compare the characteristics of common ultrasonographic features and specific ultrasonographic features of DPN by comparing peripheral neurosurgery in patients with diabetic peripheral neuropathy (DPN) and normal subjects. The correlation between high frequency ultrasound (HFUS) and electromyography (EMG) Analyze and confirm the diagnosis value of HFUS to DPN; at the same time, it is observed whether DPN is involved in the dorsalis pedis artery in diabetic patients. Methods Thirty patients with DPN in the Affiliated Hospital of Inner Mongolia Medical University [Group A, 22 males and 8 females; age (56.40 ± 8.77) years old] and 30 patients with concomitant physical examination or other diseases without DM and DPN [Group B , Normal control group, 20 males and 10 females; age (55.33 ± 10.10) years old) and 30 patients with DM without DPN [group C, 22 males and 8 females; age 54.90 ± 10.48 years) ]. Group A and group B were observed and recorded the anteroposterior nerve, ulnar nerve, bilateral lower extremity sciatic nerve, tibial nerve, common peroneal nerve, sural nerve anteroposterior diameter (D1), left and right diameter (D2), cross section (CSA), nerve capsule, perineurium, internal echo and color Doppler (CDFI). At the same time, the patients in group A underwent EMG examinations to record the latency, amplitude and nerve conduction velocity of the above nerve. A group and C group The left lower extremity dorsalis artery ultrasound examination, observation of its diameter, plaque, intima media situation, record the peak systolic velocity (PSV), pulsatility index (PI) and resistance index (RI). Results The nerves in group B showed a clear appearance. The cross-section showed a clear-cut mesh structure. The nerve capsule and perineurium showed linear hyperechogenicity. The longitudinal section showed the linear hyperechoic (perineurium) (Group B), the intermittent tubular hypoechoic (nerve bundles) in group A were higher than those in group B. In group A, the enlargement of each nerve, the decrease of internal echo, the obstruction of hyperechoic of nerve capsule and perineurium, the increase of D1, D2 and CSA, Blood flow signal increased (P <0.05). There was a positive correlation between CSA and latency of EMG in group A (median nerve, ulnar nerve, common peroneal nerve, tibial nerve and sural nerve) (r = 0.527,0.910,0.702,0.581,0.793), negatively correlated with amplitude of potential (r = -0.676, -0.298, -0.666, -0.439, -0.586) and negatively correlated with nerve conduction velocity (r = -0.766, -0.853, -0.716, -0.877, -0.774) Patients showed atherosclerosis, showed intima-mediastinal, regional or diffuse thickening, single or multiple plaques, PSV, PI, RI with varying degrees of change, the difference between the two groups No statistical significance (P> 0.05). Conclusion The diagnosis of DPN by HFUS is characterized by sonographic features. HFUS has some diagnostic value for DPN. The increase of nerve CSA is related to prolongation of EMG latency, decrease of potential amplitude and slowing of nerve conduction velocity. The results of HFUS and EMG are consistent , Once again confirmed the value of HFUS diagnosis of DPN; DPN patients with DM without DPN patients with dorsal artery involvement had no significant difference.