声脉冲辐射力成像对2型糖尿病周围神经病变胫神经的研究

Study of Tibial Nerve in Type 2 Diabetes Mellitus Peripheral Neuropathy by Acoustic Radiation Force Impulse Imaging

摘要: 目的：探讨声脉冲辐射力成像(ARFI)在2型糖尿病伴有周围神经病变患者的胫神经损害中的应用价值。方法：选取30例健康志愿者的双侧胫神经为对照组；以临床病史、患者症状与体征、实验室相关检查、神经电生理检查结果等为依据，综合相关结果，选取60例2型糖尿病[伴周围神经病变(DPN)组(n = 30)、不伴周围神经病变(NDPN)组(n = 30)]患者的双侧胫神经作为病例组。行ARFI成像，分别检查腘窝上方3~5 cm处以及内踝上方3~5 cm处胫神经，再运用声触诊组织成像定量技术(VTIQ)测量剪切波速度(SWV)。结果：DPN组无论腘段还是踝段SWV均高于健康对照组，DPN组SWV高于NDPN组(均P < 0.05)。结论：ARFI成像中VTIQ技术能量化评估胫神经硬度改变，胫神经的硬度在评价DPN中具有较高的特异性，能量化反映出2型糖尿病周围神经病患者胫神经损害程度。

Abstract: Objective: To study the application value of acoustic radiation force impulse imaging (ARFI) on the changes of tibial nerve elasticity in patients with type 2 diabetes mellitus and peripheral neuropathy. Methods: Bilateral tibial nerves of 30 healthy volunteers were selected as the control group. According to the clinical history, symptoms and signs of patients, laboratory examination, electrophysiological examination and other comprehensive related results, 60 patients with type 2 diabetes mellitus [with peripheral neuropathy (DPN) group (n = 30) and without peripheral neuropathy (NDPN) group (n = 30)] were selected as the case group. The tibial nerve 3~5 cm above popliteal fossa and 3~5 cm above medial malleolus were examined by ARFI imaging, and then the shear wave velocity (SWV) was measured by acoustic palpation tissue imaging quantitative technique (VTIQ). Results: SWV of both popliteal and ankle segments in DPN group was higher than that in healthy control group, and SWV of DPN group was higher than that of NDPN group (all P < 0.05). Conclusion: VTIQ technique in ARFI imaging can quantitatively evaluate the hardness changes of tibial nerve, the hardness of the tibial nerve has high specificity in the evaluation of DPN and can quantify the degree of tibial nerve damage in type 2 diabetic peripheral neuropathy patients.