Application Value Of Real-time Shear Wave Elastography In Early Diagnosis Of Type 2 Diabetic Peripheral Neuropathy

Objective:In order to explore the value of real-time shear wave elastography(SWE)in the assessment of nerve and muscle injury in diabetes mellitus type 2(T2DM)patients,SWE was used to measure the median nerve(MN),tibial nerve(TN),adductor pollicis brevis(APB)and gastrocnemius(GA)muscle in T2DM patients,and to analyze the correlation between clinical data and nerve and muscle ultrasound parameters in T2DM patients.Methods:1.Ninety T2DM patients who were hospitalized at the Affiliated Hospital of Yunnan University from January 2021 to October 2022 were selected as the case group.The Michigan Nerve Screening Inventory(MNSI)was used to assess the degree of nerve injury in the case group.Thirty-one patients with MNSI ≤2 were classified as diabetic without peripheral neuropathy(NDPN)group,while 59 patients with MNSI>2 were classified as diabetic peripheral neuropathy(DPN)group.An additional 70 healthy volunteers served as the control group.2.The age,gender and body mass index(BMI)of the above three groups were collected,as well as the case group patients’ fasting C-peptide,fasting plasma glucose(FPG),and glycated hemoglobin(HbAlc).3.In the three groups,the cross-sectional areas(CSA)of bilateral MNs and TNs were measured using high-frequency ultrasound,and the shear wave velocities(SWV)of bilateral MNs,TNs,APBs,and GAs at rest were measured using SWE,and SWV described tissue stiffness.Statistical analysis was performed on these collected parameters.Results:1.Comparison of clinical data of case groupsThe FPG,fasting C-peptide and HbAlc in the NDPN and DPN groups were not statistically different(all P>0.05);the MNSI score was higher in the DPN group than in the NDPN group(P<0.05);the mean duration of T2DM was significantly longer in the DPN group than in the NDPN group(P<0.05).2.Comparison of CSA of MN and TNThere was no statistically significant difference in the CSA of the MN and TN on the left and right sides between the three groups(all P>0.05);the CSA of MN was significantly larger in the DPN group than in the NDPN and control groups(all P<0.05),and the CSA of TN was significantly larger in the DPN and NDPN groups than in the control group(all P<0.05).3.Comparison of nerve and muscle stiffnessThere was no statistically significant difference in SWV of MN and TN on the left and right sides between the three groups(all P>0.05);the SWV of MN in the DPN and NDPN groups was larger than that in the control group,and the SWV of TN in the DPN group was larger than that in the NDPN and control groups,and the difference was statistically significant(all P<0.05).There was no statistically significant difference between the three groups in SWV of APB and GA on both left and right sides(all P>0.05);the SWV of APB in the DPN group was significantly less than that in the NDPN and control groups,and the SWV of GA in the DPN and NDPN groups was significantly less than that in the control group,and the difference was statistically significant(all P<0.05).4.Correlation analysisThe CSA of both MN and TN was positively correlated with SWV(P<0.05);there was no correlation with disease duration of T2DM and MNSI score(P>0.05 for both).SWV of both MN and TN was positively correlated with the duration of T2DM(P<0.05 for both).The SWV of TN was positively correlated with the MNSI score(P<0.05);the SWV of MN was not correlated with the MNSI score(P>0.05).SWV of MN did not correlate with SWV of its innervated APB(P>0.05);SWV of TN did not correlate with SWV of its innervated GA(P>0.05).Conclusions:1.In the early stage of type 2 diabetic peripheral neuropathy,the cross-sectional area of the tibial nerve,median nerve and gastrocnemius muscle stiffness have a change firstly.In evaluating the severity of neuropathy,median nerve cross-sectional area,tibial nerve,and abductor pollicis brevis stiffness showed superiority.2.The median nerve and tibial nerve stiffness showed more closely correlation with the clinical evaluation data of the severity of peripheral neuropathy in type 2 diabetes.3.SWE is a simple,non-invasive,and economical method for assessing the degree of nerve and muscle damage in T2DM patients in real time,quantitatively and dynamically.It can provide a reference basis for early clinical screening of diabetic peripheral neuropathy(DPN)and tracking of DPN development.