摘要
目的分析剪切波弹性成像技术(shear wave elastography,SWE)联合血管内皮生长因子B(vascular endothelial growth factor B,VEGF-B)、糖化血红蛋白(hemoglobin A1c,HbA1c)对早期糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)的诊断价值。方法选定绵阳市中心医院2020年10月—2023年10月就诊的100例2型糖尿病(type 2 diabetes mellitus,T2DM)患者,根据有无DPN将其分为T2DM合并DPN组(n=31)和T2DM无DPN组(n=69),另选取同期该院体检中心50例健康体检者设为健康对照组,比较3组基本临床特征、左右侧正中神经及胫神经弹性平均值(mean elasticity,E_(mean))、血清VEGF-B、HbA1c,通过受试者操作特征曲线,分析SWE、VEGF-B、HbA1c联合对DPN的诊断效能,Pearson相关分析正中神经E_(mean)、胫神经E_(mean)与VEGF-B、HbA1c的相关性。结果T2DM合并DPN组左右侧正中神经E_(mean)、左右侧胫神经E_(mean)、血清VEGF-B、HbA1c均高于T2DM无DPN组、健康对照组(P<0.05),T2DM无DPN组左右侧正中神经E_(mean)、左右侧胫神经E_(mean)、HbA1c均高于健康对照组(P<0.05),T2DM无DPN组血清VEGF-B与健康对照组比较差异无统计学意义(P>0.05)。SWE、VEGF-B、HbA1c联合诊断DPN的受试者操作特征曲线下面积为0.859[95%置信区间(0.828,0.955)],联合诊断灵敏度(93.72%)均高于单一诊断(78.82%、75.39%、71.05%)(P<0.05),联合诊断特异度(88.64%)与单一诊断(80.18%、78.96%、82.88%)比较差异无统计学意义(P>0.05)。正中神经E_(mean)、胫神经E_(mean)与VEGF-B、HbA1c均呈正相关性(r=0.428、0.395、0.416、0.416,P<0.05)。结论正中神经E_(mean)、胫神经E_(mean)、血清VEGF-B、HbA1c异常增高与DPN的发生联系密切,SWE、VEGF-B、HbA1c联合检查可提高DPN诊断灵敏度,值得借鉴。
Objective To analyze the diagnostic value of shear wave elastography(SWE)combined with vascular endothelial growth factor B(VEGF-B)and hemoglobin A1c(HbA1c)in early diabetic peripheral neuropathy(DPN).Methods A total of 100 patients with type 2 diabetes mellitus(T2DM)admitted to Mianyang Central Hospital between October 2020 and October 2023 were selected and divided into a T2DM with DPN group(n=31)and a T2DM without DPN group(n=69)based on the presence or absence of DPN.Additionally,50 healthy individuals from the same hospital’s health examination center were included as a healthy control group.The basic clinical characteristics,mean elasticity(E_(mean))values of the left and right median and tibial nerves,serum VEGF-B,and HbA1c levels were compared among the three groups.The diagnostic efficacy of SWE,VEGF-B,and HbA1c for DPN was evaluated using receiver operating characteristic(ROC)curves,and Pearson correlation analysis was performed to assess the relationships between median/tibial nerve E_(mean) and VEGF-B/HbA1c.Results The E_(mean) values of the left and right median nerves,E_(mean) values of the left and right tibial nerves,serum VEGF-B,and HbA1c levels in the T2DM with DPN group were significantly higher than those in the T2DM without DPN group and the healthy control group(P<0.05).The E_(mean) values of the left and right median and tibial nerves,E_(mean) values of the left and right tibial nerves,and HbA1c level in the T2DM without DPN group were significantly higher than those in the healthy control group(P<0.05),while no significant difference was observed in serum VEGF-B level between the T2DM without DPN group and the healthy control group(P>0.05).The area under the ROC curve for the combined diagnosis of DPN using SWE,VEGF-B,and HbA1c was 0.859[95%confidence interval(0.828,0.955)].The sensitivity of the combined diagnosis(93.72%)was significantly higher than that of individual diagnoses(78.82%,75.39%,and 71.05%,respectively;P<0.05),while the specificity(88.64%)showed no significant difference compared to individual diagnoses(80.18%,78.96%,and 82.88%,respectively;P>0.05).Positive correlations were observed between median/tibial nerve E_(mean) and VEGF-B/HbA1c levels(r=0.428,0.395,0.416,and 0.416,respectively;P<0.05).Conclusions Elevated median/tibial nerve E_(mean),serum VEGF-B,and HbA1c levels are closely associated with DPN.The combination of SWE,VEGF-B,and HbA1c improves diagnostic sensitivity for DPN,demonstrating significant clinical value.
作者
李娟
郑佳利
李月
黄婧
LI Juan;ZHENG Jiali;LI Yue;HUANG Jing(Department of Ultrasound Medicine,Mianyang Central Hospital,Mianyang,Sichuan 621000,P.R.China;Endocrine Department,Mianyang Central Hospital,Mianyang,Sichuan 621000,P.R.China)
出处
《华西医学》
2025年第5期710-715,共6页
West China Medical Journal
基金
绵阳市卫生健康委员会医学科研课题(202132,202321)。
