| Objective:To evaluate the value of shear wave elastography(SWE)alone and combined with Toronto clinical scoring system(TCSS)in the diagnosis of diabetic peripheral neuropathy(DPN).Methods:83 patients with type 2 diabetes mellitus(T2DM)hospitalizing in the Department of Endocrinology,Second Affiliated Hospital of Soochow University from July 2018 to December 2019 were selected.Based on the results of nerve conduction studies(NCS),the patients were divided into two groups:diabetic neuropathy group(group DPN)and non-diabetic neuropathy group(group NDPN).There were 41 patients in group DPN(28 males and 13 females,aging from 39 to 81 years old),and 42 patients in group NDPN(27 males and 15 females,aging from 32 to 76 years old).In the meantime,21 healthy volunteers were randomly recruited in the outpatient clinic of our hospital as a control group(8 males and 13 females,aging from 41 to 79 years).Some general data like age,gender,body mass index(BMI),smoking history of the three groups and fasting C-peptide,fasting plasma glucose(FPG),glycosylated hemoglobin(HbAlc),low density lipoprotein(LDL-C),urinary albumin creatinine ratio(ACR)of the group DPN and group NDPN were recorded.The diabetic patients were scored through TCSS,and the tibial nerves of both lower limbs of the three groups were examined by high resolution ultrasound(US)and SWE,the cross-sectional area(CSA)and nerve hardness were measured.SPSS 22.0 was used in this study for statistical analysis,and the difference was statistically significant when p<0.05.Results:1.There was no significant difference in age,gender ratio,BMI and smoking rate among group DPN,group NDPN and the control group.2.The glycosylated hemoglobin of group DPN was higher than that of group NDPN(P<0.05),the TCSS score of group DPN was higher than that of group NDPN(P<0.05),and there was no significant difference in course of disease,FPG,fasting C-peptide,ACR and LDL-C between the two groups(P>0.05).3.Applying Spearman correlation analysis,we found that:(1)the average hardness of tibial nerve was positively correlated with TCSS and BMI(P<0.05),with respective correlation coefficients:0.397,0.159;(2)there was no significant correlation between the average hardness of tibial nerve and age,fasting C-peptide,FPG,HbAlc,LDL-C,ACR(P>0.05).4.Through the use of Mantel-Haenszel chi-square test,we found the correlation existing between TCSS and NCS(?2=23.58,P<0.001),and the correlation coefficient was 0.536(P<0.001)according to Pearson correlation analysis.5.There was no significant difference in CSA of tibial nerve among the three groups.6.The average hardness of tibial nerve of group DPN was higher than that of group NDPN and control group.In addition,the average hardness of tibial nerve of group NDPN was significantly higher than that of the healthy control group(P<0.05).The contrastive analysis showed that there was no significant difference in the average hardness of the left and right tibial nerve among the three groups.7.The analysis of ROC curve showed:in the diagnosis of DPN through TCSS,AUC was 0.811(95%CI 0.715-0.906),with 6 as the best cutoff value,sensitivity was 95.12%,specificity was 64.29%,Jordan index was 0.594,negative likelihood ratio was 0.08,and positive likelihood ratio was 2.66.8.ROC curve analysis showed that:in the diagnosis of DPN through SWE of tibial nerve,AUC was 0.800(95%CI 0.715-0.885),with 61.8kPa as the best cutoff value,the sensitivity was 80.00%,the specificity was 68.70%,the Youden index was 0.487,the negative likelihood ratio was 0.29,and the positive likelihood ratio was 2.56.9.Under the condition of meeting diagnostic criteria of both SWE and TCSS at the same time(Series connection):in the diagnosis of DPN through SWE and TCSS,the sensitivity was 90.24%,the specificity was76.19%,the Youden index was 0.686,the negative likelihood ratio was 0.128,and the positive likelihood ratio was 3.79.The Cohen'skappa coefficient was used to analyze the consistency of the combined diagnostic test and NCS examination in the diagnosis of DPN,and the result showed that the coefficient was 0.735(P<0.001).10.Under the condition of meeting diagnostic criteria of SWE or TCSS(Parallel connection):in the diagnosis of DPN through SWE and TCSS,the sensitivity was 97.56%,the specificity was 19.05%,the Youden index was 0.166,the negative likelihood ratio was 0.128,and the positive likelihood ratio was 1.205.The Cohen'skappa coefficient was used to analyze the consistency of the combined diagnostic test and NCS examination in the diagnosis of DPN.The result showed that the coefficient was 0.188(P<0.05).Conclusion:The hardness of tibial nerve is significantly increased in diabetic patients,and it is further increased after they have DPN,which suggests that SWE has a certain value in the early diagnosis of DPN.And when SWE and TCSS are combined in series to diagnose DPN,the sensitivity and specificity are further improved,suggesting that SWE combined with TCSS could be used as a convenient,effective and noninvasive assistant means to diagnose DPN. |
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