| 摘要: |
| 目的：利用高频超声联合定量温度觉检查（quantitative thermal perception testing, QTT）分析糖尿病周围神经病变（diabetic peripheral neuropathy ，DPN）神经损害的特点，为临床预防、诊断、治疗DPN提供依据。方法：取2014年12月-2017年5月医院收治的DPN患者110例，应用超声及QTT分析DPN神经损害特点。结果：QTT检测结果中，DPN患者下肢冷觉阈值（CDT）、温觉阈值（WDT）、冷痛觉阈值（CPT）和热痛觉阈值（HPT）异常比例均高于上肢（P＜0.05）；上肢患者的WDT及HPT在年龄及病程分组中的比较差异有统计学意义（P＜0.05），60岁及以上或病程10年以上的患者WDT和HPT异常比例均达到45%以上，高于其他组。平均血糖波动幅度（Mean amplitude of glycemic excursions，MAGE）较大的患者无论上肢、下肢或上下肢合计观察到的WDT和HPT异常比例均明显高于平均血糖波动幅度较小的患者（P＜0.05）；超声测量神经横截面积结果显示：高年龄组（≥45岁）和长病程组（＞10年）的患者发生尺神经和正中神经异常增粗的比例明显高于低年龄组（＜45岁）和短病程组（＜10年）（P＜0.05），MAGE较大的患者发生正中神经异常增粗的比例明显高于MAGE小的患者（P＜0.05）。MAGE＞4mmol/L的患者，其尺神经、正中神经及腓总神经增粗较明显（P＜0.05）。结论：1、DPN患者神经损害以热感觉受损为主，下肢神经比上肢神经更易受到损害。2、45岁及以上或病程10年以上的患者发生尺神经和正中神经损害的比例较高。3、MAGE较大（＞4mmo/L）的患者发生正中神经损害比例较高。上述神经损伤的特点可为临床预防、诊断、治疗DPN提供依据。 |
| 关键词: 定量温度觉 超声 糖尿病周围神经病变 横截面积 平均血糖波动幅度 |
| DOI： |
| 投稿时间：2018-08-12修订日期：2018-08-12 |
| 基金项目:1.国家自然科学基金(81701891) 2.十堰市科技局引导性科研项目（18Y63） |
|
| Analysis of the characteristics of diabetic peripheral nerve injury by high frequency ultrasound combined with QTT |
| Hu Pei,Zheng Guangmei |
| (Department of Ultrasound,Renmin Hospital,Hubei University of Medicine,Shiyan) |
| Abstract: |
| Objective: High frequency ultrasound combined with policy thermal perception testing(QTT)was used to analyze the characteristics of nerve damage in diabetic peripheral neuropathy (DPN), provide the basis for the clinical prevention, diagnosis and treatment of DPN.Methods: 110 DPN patients admitted to the hospital from December 2014 to May 2017 were selected, and the characteristics of nerve damage in diabetic peripheral neuropathy were analyzed by ultrasound and QTT. Results: In the results of QTT, the CDT,WDT,CPT and HPT of the lower limbs in DPN"s are all higher than the upper limbs (P < 0.05);The difference of WDT and HPT in the age and course groups of patients in the upper limbs was statistically significant (P < 0.05),the abnormal rates of WDT and HPT in patients aged 60 years or above and 10 years or more were all above 45%, higher than those in other groups.The patients with larger mean amplitude of glycemic excursions(MAGE)were significantly higher than those with smaller MAGE, regardless of the abnormal proportion of WDT and HPT observed in upper limbs, lower limbs or upper and lower limbs;The results of ultrasonic measurement of nerve cross sectional area showed:the proportion of patients with ulnar nerve and median nerve abnormally thickened in the high age group( ≥45 years) and the long duration group (10 years >) was significantly higher than that in the low age group (< 45 years) and the short duration group (P < 0.05),the proportion of patients with larger MAGE with abnormal enlargement of median nerve was significantly higher than those with smaller MAGE (P < 0.05).The thickening of ulnar nerve, median nerve and peroneal nerve was obvious in the patients of MAGE > 4mmol/L (P < 0.05).Conclusion: 1.The main nerve damage in DPN patients is thermal sensation damage, and the lower limb nerve is more vulnerable than the upper limb nerve.2.The incidence of ulnar and median nerve damage was higher in patients aged 45 years and older or over 10 years of course.3.Patients with large MAGE (> 4mmo/L) had higher incidence of median nerve damage. The above characteristics of nerve injury can provide basis for clinical prevention, diagnosis and treatment of DPN. |
| Key words: Quantitative thermal perception testing Ultrasound Diabetic peripheral neuropathy Cross sectional area Mean amplitude of glycemic excursions |
