The Value Of High-Frequency Ultrasound For Diagnosing And Evaluating The Severity Of Peripheral Neuropathy In The Lower Extremity Of Type 2 Diabetes

ObjectiveThis study is to observe the morphological changes of the superficial peroneal nerve and tibial nerve in patients with type 2 diabetes by high-frequency ultrasound imaging(HFUS),and to investigate the application value of HFUS in the judgement of diabetic peripheral neuropathy(DPN).The morphological changes of superficial peroneal nerve and tibial nerve in patients with different severity of DPN is analyzed to explore the application value of HFUS in predicting the severity of DPN.Materials and MethodsAccording to the inclusion and exclusion criteria established in this study,149 patients with type 2 diabetes from the Qianfoshan Hospital of Shandong University between January 2020 and December 2020 were collected.All patients with type 2 diabetes underwent clinical evaluation,HFUS,neuro-electrophy siological examination(NEE),serological laboratory examination and Vibration perception threshold(VPT)score test.According to the results of NEE and clinical evaluation,the patients with abnormal NEE results and DPN clinical symptoms or signs were classified into group A,the patients with DPN clinical symptoms or signs but normal NEE results were group B,and the patients with no DPN clinical symptoms or signs and normal NEE results are group C.The control group as group D consisted of healthy volunteers who had neither a history of diabetes nor clinical symptoms or signs of DPN.The clinical data and ultrasound measurements were statistically analysed between groups A,B,C,and D.A receiver operating characteristic curve was drawed and the area under the curve was calculated to investigate the application value of HFUS for the diagnosis of early DPN.According to the VPT score,all patients with type 2 diabetes were divided into no DPN group,mild DPN group.moderate DPN group.and severe DPN group.The clinical data and neuromorphology results were statistically anaylsed between the 4 groups to discuss the application value of HFUS in predicting the severity of DPN.ResultsAccording to the result of neuroelectrophysiology and clinical manifestation.the anteroposterior diameter,transverse diameter and cross-sectional area(CSA)of superficial peroneal nerve and tibial nerve were compared between group A.group B,group C,and group D(P<0.05).After a further pairwise comparison,comparison of the morphological parameters(anteroposterior diameter,transverse diameter.CSA)of both of the superficial peroneal nerve and tibial nerve between group A and group C,group A and group D.group B and group C,group B and group D were statistically significance(P<0.05).But only the morphological parameters(anteroposterior diameter.transverse diameter,CSA)of superficial peroneal nerve were statistically significant between group A and group B(P<0.05).There was no significant difference in the morphological parameters(anteroposterior diameter,transverse diameter,CSA)of the superficial peroneal nerve and tibial nerve between group C and D(P>0.05).According to the VPT score,the following indicators were not statistically different between different group of DPN severity,such as gender,hypertension,body mass index(BMI),fasting blood-glucose(FBG),triglyceride(Triglyceride,TG),but characteristics of age,disease course,Homocysteine(Hcy),Glycated hemoglobin(HbA1c)were statistically significant(P<0.05).In further pairwise comparison,the characteristics of age,disease course,Hcy and HbAlc were significant different between the no-DPN group and the severe DPN group(P<0.05).The characteristics of disease course,Hcy and HbAlc were significant different between the moderate DPN group and the no-DPN group(P<0.05).Only the characteristics of Hcy and HbAlc were significant different between no-DPN group and the mild DPN group(P<0.05).The morphological parameters(anteroposterior diameter,transverse diameter,CSA)of superficial peroneal nerve and tibial nerve were significant different between different severity of DPN(P<0.05).But after further pairwise comparison,only difference of the anteroposterior diameter and the CSA of the superficial peroneal nerve,the CSA of the tibial nerve were statistically significant(P<0.05).ConclusionIn patients with clinically diagnosed DPN,the measured values of the superficial peroneal nerve as well as the tibial nerve,such as anteroposterior diameter,transverse diameter,CSA were significantly increased,regardless of whether they were confirmed by neuroelectrophysiology.The anteroposterior diameter,CSA of the superficial peroneal nerve and the CSA of the tibial nerve were positively correlated with the severity of DPN.The higher the severity of the DPN,the greater the measured values of the anteroposterior diameter,CSA of the superficial peroneal nerve,and the CSA of the tibial nerve.