2型糖尿病病程对下肢小神经横截面积的影响

目的探讨超声观察2型糖尿病患者下肢周围神经横截面积(CSA)改变,及其与多伦多临床评分系统(TCSS)评分、糖尿病病程的关系。方法选取2型糖尿病患者84例(患者组)。依据TCSS评分评价糖尿病感觉运动性多发神经病(DSP),并分为无DSP(0~5分)、轻度(6~8分)、中度(9~11分)及重度DSP(12~19分)亚组;依据糖尿病病程分为0~5年、6~10年、11~15年及15年亚组。同期选取30名健康志愿者作为正常对照组。对各组均行下肢神经超声检查,检测隐神经、腓肠神经和胫后神经的CSA值。进行统计学分析。结果患者组各亚组及正常对照组间隐神经、腓肠神经和胫后神经CSA差异均有统计学意义(P均0.05)。隐神经、腓肠神经和胫后神经CSA均与TCSS评分呈线性正相关(r=0.615、0.632、0.641,P均0.05),且均与糖尿病病程存在线性正相关关系(r=0.613、0.643、0.682,P均0.05)。结论 2型糖尿病患者高频超声所示下肢周围神经CSA改变与神经损害严重程度及糖尿病病程有关。高频超声可为糖尿病感觉运动多发神经病的分期诊断提供依据。

Influence of duration to cross-sectional area of lower limb small nerves in type 2 diabetes mellitus patients

Objective To investigate the changes of nerves cross-sectional areas (CSA) in lower extremely, and the correlation between CSA changes and Toronto clinical scoring system (TCSS) score and disease duration in patients with type 2 diabetes. Methods A total of 84 patients with type 2 diabetes (study group) and 30 age-matched healthy controls (control group) were enrolled in this study. The severity of diabetic sensorimotor polyneuropathy (DSP) was evaluated according to TCSS. The degrees included DSP absent (score of 0-5), mild (score of 6-8), moderate (score of 9-11), severe (12-19). Then patients with different severity of DSP were divided into various subgroups. According to disease duration, patients were divided into four different subgroups:0-5 years, 6-10 years, 11-15 years and >15 years subgroup. Ultrasonography was performed on study group and control group, respectively. CSAs of saphenous, sural and posterior tibial nerves were recorded. And statistical analysis was done. Results There were statistical differences among different subgroups of study group and control group (all P<0.05). Positive correlations were found between TCSS scores and nerve CSAs, including saphenous, sural and posterior tibial nerves (r=0.615, 0.632, 0.641, all P<0.05); as well was those between disease duration of diabetes and nerve CSAs (r=0.613, 0.643, 0.682, all P<0.05). Conclusion Nerve CSAs changes by ultrasound relate to disease severity and duration in patients with type 2 diabetes. High-frequency ultrasound is a useful diagnostic tool for staging DSP especially.