| Objective:By completing a series of studies on the ultrasound parameters of lower limb nerve,dorsal artery,Achilles tendon and foot muscle in the patients of type 2 diabetes with or without diabetic peripheral neuropathy(DPN).We explored the diagnostic value of Ultrasonography in the diagnosis of DPN,in order to assist the clinical and evaluate the condition of DPN.Methods:From December 2017 to November 2018,43 T2DM patients with DPN admitted to the Department of Diabetes,Lianyungang Hospital of Traditional Chinese Medicine were enrolled in the DPN group.43 patients without DPN were included in the control group.In the same period,43 non-diabetic healthy volunteers were taken for reference comparison.Ultrasonic exploration method:We used Ultrasonography to observe the internal structure of the non-dominant side and the surrounding tissue.We measured the cross-sectional area of the nerve by tracing the outer edge.The arterial wall and lumen structure echoes were observed,the inner diameter was measured,and the maximum blood flow velocity was measured by Pulse Doppler.When exploring the short extensor muscles of the toes,We observed the internal muscle bundle morphology and echo,and measured the Cross-sectional area by drawing the outer edge of the trace.When we explored the Achilles tendon,At first,We observed the longitudinal and lateral scans to see if there was any change in the internal structure of the Achilles tendon,and then measured the thickness of the Achilles tendon near the end.We used Ultrasonography to detect the cross-sectional area of common peroneal nerve,the cross-sectional area of the sural nerve,the cross-sectional area of the superficial peroneal nerve,the cross-sectional area of the short toe muscle of the dorsal,the thickness of the Achilles tendon,the dorsal artery diameter and Maximum blood flow velocity and the first toe artery diameter and Maximum blood flow velocity.We tested the values of the obtained parameters,and analyzed the comparison of neurological abnormalities,the correlation with neuropathy,the lesion trend with increasing disease duration,and used the area under the ROC curve to evaluate the efficacy of ultrasound diagnostic accuracy for lower limb parameters.Results:Sonogram results:abnormal neurological changes in the lower extremities included uneven thickening of the epicardial layer and enhanced echo,reduced echo of internal nerve bundles,ambiguous structure of the cross-section of the nerve cross-section,and no boundary with adjacent tissues,a few abnormal blood flow signals in the nerve bundle.The changes in the abnormal sonogram of the distal extremity artery included thickening of the wall and uneven roughness of the intima.In some patients,the arterial lumen was narrowed to varying degrees,and the blood flow spectrum lost its normal phase waveform,showed a continuous low amplitude Phase wave.Abnormal changes in the sonogram of the short toe muscles included different degrees of disordered irregularities in the internal fiber structure of the muscles,some fibrous interstitial spaces,and the overall muscle tissue echoes are significantly increased.The anomalous sonogram of the Achilles tendon showed a slight thickening of the tendon,and the longitudinal section showed a slightly reduced echo of the band,but the internal collagen fibers were distorted and arranged disorderly,and the cross section showed an elliptical slightly higher echo.There were strong echoes in the tendon tissue of some patients.Calcium salt spot.PD sometimes showed a little abnormal blood flow signals in the tendon.In this study,the cross-sectional area of common peroneal nerve,the cross-sectional area of the sural nerve,the cross-sectional area of the superficial peroneal nerve,and the thickness of the Achilles tendon were increased in the DPN group compared with the NDPN group and the non-diabetic group,While,the dorsal artery diameter and Maximum blood flow velocity,the first toe artery diameter and Maximum blood flow velocity,and the cross-sectional area of the short toe muscle of the dorsal were decreased compared with the NDPN group and the non-diabetic group,and the difference was statistically significant(P<0.05).About sonogram changes in the sural nerve of the two groups of diabetic patients,the number of abnormal sonogram changes in the DPN group was significantly higher than that in the NDPN group.In the DPN group,the ultrasound parameters of the lower limbs were compared according to disease course.The measured value-mean about the cross-sectional area of common peroneal nerve,the cross-sectional area of the sural nerve and the thickness of the Achilles tendon increased with the disease course.The cross-sectional area of the short toe muscle of the dorsal decreased with the disease course.In the study,the cross-sectional area of the common peroneal nerve and the dorsal artery diameter and Maximum blood flow velocity,the thickness of the Achilles tendon,and the cross-sectional area of the short toe muscle of the dorsal were briefly correlated.In comparison,there was a negative correlation with the dorsal artery diameter and Maximum blood flow velocity,the first toe artery diameter and Maximum blood flow velocity,the cross-sectional area of the short toe muscle of the dorsal.and there was a positive correlation with the thickness of the Achilles tendon.The comparison of the effectiveness of the ultrasonic diagnostic accuracy of the lower limb parameters was analyzed by ROC curve.The results showed that all the parameter curves of the two ROC curves were progressive to the upper left corner,and the nerve,muscle and Achilles tendon indicators were progressively progressive to the upper left corner.The progressiveness of the arteries was slightly lower,the progressive P values of all parameters were<0.05,and all had certain diagnostic potency.Conclusion:High-frequency ultrasound can be used for multi-parameter acquisition of lower extremities and analysis of the condition of T2DM patients with DPN. |
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