2型糖尿病下肢周围神经病变的超声特征及其与密歇根筛查量表相关性分析

发布时间：2018-03-14 21:15

  本文选题：2型糖尿病　切入点：糖尿病周围神经病变　出处：《华北理工大学》2015年硕士论文　论文类型：学位论文

【摘要】：背景近年来,糖尿病已成为威胁人类健康的主要疾病之一,而糖尿病周围神经病变(Diabetic peripheral neuropathy,DPN)是糖尿病最严重、最常见的慢性并发症之一,主要表现为患者肢体远端感觉障碍,重者可导致患肢感染、溃疡、坏疽甚至截肢等严重后果。所以及早发现DPN并及早治疗,可以减轻患者痛苦,有利于控制疾病的发展,对患者预后及提高生命质量起着非常重要的作用。目的超声观察并测量糖尿病患者腓总神经、胫神经特征,并探讨其与密歇根筛查量表评分之间的相关性。方法选取2014年1月至2014年10月,入住唐山市工人医院内分泌科的95例2型糖尿病患者作为研究对象。所有患者均符合1999年世界卫生组织糖尿病诊断标准,并除外1型糖尿病、腰椎病变、脑血管病变、外伤等引起神经病变患者。对95例2型糖尿病患者的腓总神经、胫神经进行高频超声检查,测量神经前后径、横径、并用描迹法测量截面积,同时观察下肢周围神经的超声声像图变化特征;并应用密歇根筛查量表(Michigan neuropathy screening instrument,MNSI)对其进行体格检查评分。根据周围神经病变的临床症状和体征,2型糖尿病患者不伴周围神经病变症状的53例作为NDPN组,2型糖尿病患者伴周围神经病变症状的42例作为DPN组;同期选取健康体检者30例作为正常对照组(NC组)。根据MNSI评分结果,将MNSI评分分为三个阶段,即0~2.4分32例、2.5~4.4分31例和≥4.5分32例。结果1 DPN组较NDPN组腓总神经、胫神经超声各形态参数均增大(P0.05)。2NDPN组的腓总神经及胫神经出现神经束回声阶段性减低、“筛网状”结构局部略模糊和神经外膜局部略增厚,与毗邻组织分界欠清等特点的比例小于DPN组(P0.05)。3 DPN组中,其腓总神经发生超声声像图改变的几率大于胫神经(P0.05)。4各MNSI评分等级,腓总神经、胫神经各形态参数差异均有统计学意义(P0.05)。5与MNSI评分在2.5~4.4分与≥4.5分比较,MNSI评分0~2.4分腓总神经、胫神经回声出现神经束回声减低、“筛网状”结构模糊和神经外膜不均匀增厚,与毗邻组织分界不清等改变的几率小(P0.05)。6 MNSI评分在2.5~4.4分与≥4.5分腓总神经超声声像图发生改变的神经条数多于其自身胫神经超声声像图发生改变的神经条数(P0.05)。7 95例糖尿病患者的腓总神经、胫神经的前后径、横径、截面积分别与密歇根筛查体格检查评分呈正相关,尤其是前后径及截面积有很好的相关性。结论1 2型糖尿病患者的腓总神经、胫神经各形态参数增大、超声声像图有其独特表现,且腓总神经超声声像图变化可能早于胫神经出现。2 2型糖尿病患者腓总神经、胫神经的超声形态学参数与密歇根筛查量表之间具有一定的相关性,密歇根筛查量表体格检查评分越高,神经超声特征异常的可能性越大,反之亦然。
[Abstract]:Background in recent years, diabetes has become one of the major diseases threatening human health. Diabetic peripheral neuropathy (DPN) is one of the most serious and common chronic complications of diabetes. Serious cases can lead to serious consequences such as infection, ulcers, gangrene or amputation. So early detection and early treatment of DPN can alleviate the pain of the patient and help control the development of the disease. Objective to observe and measure the characteristics of common peroneal nerve and tibial nerve in diabetic patients. Methods from January 2014 to October 2014, the correlation between MBS and Michigan screening scale was studied. Ninety-five patients with type 2 diabetes mellitus admitted to the Endocrinology Department of the Workers' Hospital of Tangshan City were included in the study. All the patients met the World Health Organization criteria for the diagnosis of diabetes in 1999, excluding type 1 diabetes, lumbar disease, cerebrovascular disease. The common peroneal nerve and tibial nerve of 95 patients with type 2 diabetes were examined by high frequency ultrasound, the anteroposterior and transverse diameters of the nerves were measured, and the cross-sectional area was measured by tracing. At the same time, the ultrasonographic changes of peripheral nerve of lower extremity were observed. Michigan neuropathy screening instrument scale (MNSI) was used to evaluate the physical examination. According to the clinical symptoms and signs of peripheral neuropathy, 53 cases of type 2 diabetes without peripheral neuropathy were treated as type 2 diabetes mellitus in NDPN group. 42 patients with peripheral neuropathy were treated as DPN group. According to the results of MNSI score, the MNSI score was divided into three stages, that is, 0.2.4 points 32 cases with 2.5 and 4.4 points 31 cases and 鈮，

本文编号：1612967