The Ultrasonic Feature Of Median Nerve Of Diabetic Peripheral Neuropathy And The Relationship With The Types Of TCM Syndrome

Part Ⅰ Ultras onographic characteristics of the median nerve in carpal tunnel of the patients with diabetic peripheral neuropathyObjective:To discuss ultrasonic feature of median nerve(MN) in carpal tunnel of the patients with diabetic peripheral neuropathy(DPN). Evaluation the value of ultrasonography in the diagnosis of DPNN.Materials and Methods:According to the diagnostic criteria of diabetes and diabetic peripheral neuropathy,and inclusion criteria for this study,40diabetic peripheral neuropathy patients (22males,18females, mean age:54.95±11.85years) and another40healthy volunteers (21males,19females, mean age:54.85±11.16years) were enrolled in. Cross-sectional images during motion from full extension to flexion of the fingers were recorded. Coordinate data were recorded and median nerve cross-sectional area were calculated. SPSS13.0software were used for statistical analysis of the data,and the normal distribution and homogeneity of variance test on the data, to comparing the difference of the sonographic features and measure between the DPN group and the control group.Results:The CSAs of peripheral nerves in diabetic peripheral neuropathy patients were significantly increased and most nerves accompany reduced internal echo and fuzzy boundaries, compared with the control participants.DPN group detected abnormal nerve root numberof the median nerve in the carpal tunnel segment significantly higher than that in the control group, the difference between the two groups was statistically significant (P<0.05).The cross-sectional area and thickness of the median nerve in carpal tunnel section of the DPN group (Respectively:13.38±4.45mm2,2.00±0.31mm) were greater than the control group (respectively:8.42±1.56mm2,1.9±0.15mm) in extensor bit. And in the flexor bit,the DPN group’s cross-sectional area and thickness (respectively:11.95±4.31mm2,2.21±0.27mm) were also greater than the control group (respectively:7.19± 1.29mm2,2.14±0.16mm).The difference between the two groups was statistically significant (P<0.05)Conclusion:High-frequency ultrasound can display morphology change of median nerve in diabetes peripheral neuropathy patients and may play a role in the diagnosis of diabetic peripheral nerve.High-frequency ultrasound can clearly show the structural features of the median nerve in the carpal tunnel of the DPN’s. and also can provide objective morphological basis for reference for the diagnosis of clinical DPN. Ultrasound measurements of the median nerve cross-sectional area and thickness provide quantitative indicators for DPN diagnosis and severity assessment DPN median nerve cross-sectional area and the thickness change rate is smaller than the normal in flexion fingers of dynamic ultrasound examination.It can be used for the evaluation of the carpal tunnel segment nerve entrapment.It can provide an objective basis to make preoperative evaluation and treatment plan for implementating the peripheral nerve decompression.Part Ⅱ The relationship between types of TCM syndrome of Diabetic peripheral neuropathy and ultrasonic feature of median nerveObjective:To study the clinical and the media nerve ultrasound features of diabetic peripheral neuropathy and to explore the relationship between the types of TCM (Traditional Chinese Medicine) syndromes and the clinical and ultrasound features of diabetic patients.Materials and Methods:70cases of patients of diabetic peripheral neuropathy were observed(average age63.20±12.53years,The mean fasting glucose17.38±2.39mmol/L,Average BMI24.16±2.08kg/m2, Aver age history of diabetes7.87±5.52years). According to syndrome differentiation, they were classified as syndrome of blood stasis due to qi deficiency, syndrome of yin deficiency and blood stasis, syndrome of phlegm and blood stasis obstructing channel, and syndrome of deficiency of liver and kidney. Ultrasonography was performed in the patients with diabetic peripheral neuropathy. We studied the ultrasound features of median nerve.the cross-sectional areas (CSAs) of fixed position were measured on the median nerve.Statistical were analysised by SPSS13.0. DPN diagnosis were divided into:blood stasis, deficiency and blood stasis, phlegm and blood stasis, liver and kidney deficiency four syndromes according the criteria. The median nerve cross-sectional area compared with various syndromes and the relationship with the TCM syndromes were calculated by Spearman rank. The Cochran-Armitag trend test were done to analysis ultrasonographic of the media nerve and the severity of the syndrome type in TCM.Results:Types of TCM syndrome of Diabetic:syndrome of blood stasis due to qi deficiency28cases, syndrome of yin deficiency and blood stasis18cases,syndrome of phlegm and blood stasis obstructing channe116cases、syndrome of deficiency of liver and kidney8cases.Median nerve cross-sectional area of a mean of the70patients with DPN was13.95±3.75mm2. The median nerve cross-sectional area of DPN were related to the admission blood glucose and the Course of disease. There are some differences on sonographic appearance and Cross-sectional area of the median nerve between different DPN TCM syndrome.The cross-sectional area in descending order as syndrome of deficiency of liver and kidney (average18.84±2.18mm2)> syndrome of phlegm and blood stasis obstructing channel (average16.29±2.64mm2)> syndrome of yin deficiency and blood stasis (average13.54±4.05mm2)> syndrome of blood stasis due to qi deficiency (average11.48±2.05mm2). The ultrasonography of media nerve changes as the syndrome types of TCM pathological changes from light to heavy increasing gradually. There was a significant difference of Morphological parameters and CSA between the four syndromes.The TCM syndrome types and the median nerve cross-sectional area have strong correlation, the correlation coefficient was0.675.Conclusion:According to this study, we can consider DPN between different TCM syndrome types section of wrist median nerve cross-sectional area average differences, section of wrist median nerve cross-sectional area measurement can provide quantitative indexes for TCM syndrome differentiation type;There is a relationship between the types of TCM syndromes of diabetic peripheral neuropathy and media nerve ultrasound changes.So the ultrasound study can help the clinician to distinguish the types of TCM syndromes of diabetic peripheral neuropathy.