基于超声的2型糖尿病患者迷走神经病变分析

目的 了解2型糖尿病患者迷走神经病变，从而为糖尿病神经病变临床诊疗提供参考依据。方法 收集2020年1月—2021年6月在南京医科大学附属无锡人民医院内分泌科接受诊治的51例2型糖尿病患者和42例健康志愿者临床资料进行分析。采用自主神经症状（SAS）量表对2型糖尿病患者自主神经系统症状进行评价；采用超声测定迷走神经横断面面积，比较2型糖尿病患者和健康对照迷走神经横断面面积差异，分析迷走神经横断面面积与2型糖尿病患者临床特征间的关联。结果 2型糖尿病患者和健康对照者性别构成、年龄、身高、有吸烟史比例差异均无统计学意义（P > 0.05），但2组研究对象体质量（t = 4.52，P < 0.01）、体质指数差异有统计学意义（t = 5.21，P < 0.01）。51例2型糖尿病患者中，37例出现自主神经系统症状，平均出现3.7 ±0.9种（1～9种）自主神经系统症状，总体症状影响评分平均为10.5 ±3.2分（0～25分）。2型糖尿病患者左、右侧迷走神经横断面面积平均为（1.55 ±0.44）、（1.97 ±0.66） mm²，显著大于健康对照的（1.37 ±0.37）、（1.61 ±0.540） mm²（t = 2.20，P < 0.05；t = 2.87，P < 0.01）。Pearson相关分析显示，迷走神经横断面面积与2型糖尿病患者及健康对照年龄、身高、体质量、体质指数均无统计学关联（P > 0.05），且与2型糖尿病患者糖尿病病程、自主神经系统症状数量及SAS量表总体症状影响评分均无统计学关联（P > 0.05）。结论 2型糖尿病患者存在迷走神经增粗，迷走神经超声可用于自主神经病变早期检测。

Analysis of vagal neuropathy among patients with type 2 diabetes mellitus using ultrasonography

Objective To investigate the vagal neuropathy among patients with type 2 diabetes mellitus (T2DM), so as to provide the evidence for the clinical diagnosis and therapy of diabetic neuropathy.Methods A total of 51 patients with T2DM admitted to the Department of Endocrinology. The Affiliated Wuxi People’s Hospital of Nanjing Medical University during the period from January 2020 through June 2021 and 42 healthy volunteers in the hospital during the same period were enrolled, and the clinical data were reviewed. The autonomic symptoms were evaluated among patients with T2DM using the Survey of Autonomic Symptoms Scale, and the vagus nerve cross-sectional area was measured using ultrasonography. The vagus nerve cross-sectional area was compared between T2DM patients and healthy controls, and the associations of the vagus nerve cross-sectional area with clinical features were evaluated among T2DM patients. Results There were no significant differences between T2DM patients and healthy controls in terms of gender, age, height or proportion of smokers (P > 0.05); however, significant differences were seen between T2DM patients and healthy controls in terms of body weight (t = 4.52, P < 0.01) and body mass index (t = 5.21, P < 0.01). Among the 51 T2DM patients, there were 37 cases developing autonomic symptoms, with 3.7 ±0.9 types (1 to 9 types) of autonomic symptoms seen and 10.5 ±3.2 scores (0 to 25 scores) of overall symptom impact scores evaluated. The mean left and right vagus nerve cross-sectional areas were significantly greater in patients with T2DM than in healthy controls (1.55 ±0.44 vs. 1.37 ±0.37 mm², t = 2.20, P < 0.05; 1.97 ±0.66 vs. 1.61 ±0.54 mm², t = 2.87, P < 0.01). Pearson correlation analysis revealed that the vagus nerve cross-sectional area had no statistical associations with age, height, body weight or body mass index among T2DM patients or healthy controls (P > 0.05), and did not correlate with the duration of diabetes, number of autonomic symptoms or SAS overall symptom impact scores (P > 0.05). Conclusion Thickening of vagus nerve is detected in patients with T2DM, and ultrasonography of vagus nerve is effective for early diagnosis of autonomic neuropathy.