本文選題：2型糖尿病　切入點(diǎn)：糖尿病周圍神經(jīng)病變　出處：《華北理工大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：背景近年來,糖尿病已成為威脅人類健康的主要疾病之一,而糖尿病周圍神經(jīng)病變(Diabetic peripheral neuropathy,DPN)是糖尿病最嚴(yán)重、最常見的慢性并發(fā)癥之一,主要表現(xiàn)為患者肢體遠(yuǎn)端感覺障礙,重者可導(dǎo)致患肢感染、潰瘍、壞疽甚至截肢等嚴(yán)重后果。所以及早發(fā)現(xiàn)DPN并及早治療,可以減輕患者痛苦,有利于控制疾病的發(fā)展,對(duì)患者預(yù)后及提高生命質(zhì)量起著非常重要的作用。目的超聲觀察并測量糖尿病患者腓總神經(jīng)、脛神經(jīng)特征,并探討其與密歇根篩查量表評(píng)分之間的相關(guān)性。方法選取2014年1月至2014年10月,入住唐山市工人醫(yī)院內(nèi)分泌科的95例2型糖尿病患者作為研究對(duì)象。所有患者均符合1999年世界衛(wèi)生組織糖尿病診斷標(biāo)準(zhǔn),并除外1型糖尿病、腰椎病變、腦血管病變、外傷等引起神經(jīng)病變患者。對(duì)95例2型糖尿病患者的腓總神經(jīng)、脛神經(jīng)進(jìn)行高頻超聲檢查,測量神經(jīng)前后徑、橫徑、并用描跡法測量截面積,同時(shí)觀察下肢周圍神經(jīng)的超聲聲像圖變化特征;并應(yīng)用密歇根篩查量表(Michigan neuropathy screening instrument,MNSI)對(duì)其進(jìn)行體格檢查評(píng)分。根據(jù)周圍神經(jīng)病變的臨床癥狀和體征,2型糖尿病患者不伴周圍神經(jīng)病變癥狀的53例作為NDPN組,2型糖尿病患者伴周圍神經(jīng)病變癥狀的42例作為DPN組;同期選取健康體檢者30例作為正常對(duì)照組(NC組)。根據(jù)MNSI評(píng)分結(jié)果,將MNSI評(píng)分分為三個(gè)階段,即0~2.4分32例、2.5~4.4分31例和≥4.5分32例。結(jié)果1 DPN組較NDPN組腓總神經(jīng)、脛神經(jīng)超聲各形態(tài)參數(shù)均增大(P0.05)。2NDPN組的腓總神經(jīng)及脛神經(jīng)出現(xiàn)神經(jīng)束回聲階段性減低、“篩網(wǎng)狀”結(jié)構(gòu)局部略模糊和神經(jīng)外膜局部略增厚,與毗鄰組織分界欠清等特點(diǎn)的比例小于DPN組(P0.05)。3 DPN組中,其腓總神經(jīng)發(fā)生超聲聲像圖改變的幾率大于脛神經(jīng)(P0.05)。4各MNSI評(píng)分等級(jí),腓總神經(jīng)、脛神經(jīng)各形態(tài)參數(shù)差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。5與MNSI評(píng)分在2.5~4.4分與≥4.5分比較,MNSI評(píng)分0~2.4分腓總神經(jīng)、脛神經(jīng)回聲出現(xiàn)神經(jīng)束回聲減低、“篩網(wǎng)狀”結(jié)構(gòu)模糊和神經(jīng)外膜不均勻增厚,與毗鄰組織分界不清等改變的幾率小(P0.05)。6 MNSI評(píng)分在2.5~4.4分與≥4.5分腓總神經(jīng)超聲聲像圖發(fā)生改變的神經(jīng)條數(shù)多于其自身脛神經(jīng)超聲聲像圖發(fā)生改變的神經(jīng)條數(shù)(P0.05)。7 95例糖尿病患者的腓總神經(jīng)、脛神經(jīng)的前后徑、橫徑、截面積分別與密歇根篩查體格檢查評(píng)分呈正相關(guān),尤其是前后徑及截面積有很好的相關(guān)性。結(jié)論1 2型糖尿病患者的腓總神經(jīng)、脛神經(jīng)各形態(tài)參數(shù)增大、超聲聲像圖有其獨(dú)特表現(xiàn),且腓總神經(jīng)超聲聲像圖變化可能早于脛神經(jīng)出現(xiàn)。2 2型糖尿病患者腓總神經(jīng)、脛神經(jīng)的超聲形態(tài)學(xué)參數(shù)與密歇根篩查量表之間具有一定的相關(guān)性,密歇根篩查量表體格檢查評(píng)分越高,神經(jīng)超聲特征異常的可能性越大,反之亦然。
[Abstract]:Background in recent years, diabetes has become one of the major diseases threatening human health. Diabetic peripheral neuropathy (DPN) is one of the most serious and common chronic complications of diabetes. Serious cases can lead to serious consequences such as infection, ulcers, gangrene or amputation. So early detection and early treatment of DPN can alleviate the pain of the patient and help control the development of the disease. Objective to observe and measure the characteristics of common peroneal nerve and tibial nerve in diabetic patients. Methods from January 2014 to October 2014, the correlation between MBS and Michigan screening scale was studied. Ninety-five patients with type 2 diabetes mellitus admitted to the Endocrinology Department of the Workers' Hospital of Tangshan City were included in the study. All the patients met the World Health Organization criteria for the diagnosis of diabetes in 1999, excluding type 1 diabetes, lumbar disease, cerebrovascular disease. The common peroneal nerve and tibial nerve of 95 patients with type 2 diabetes were examined by high frequency ultrasound, the anteroposterior and transverse diameters of the nerves were measured, and the cross-sectional area was measured by tracing. At the same time, the ultrasonographic changes of peripheral nerve of lower extremity were observed. Michigan neuropathy screening instrument scale (MNSI) was used to evaluate the physical examination. According to the clinical symptoms and signs of peripheral neuropathy, 53 cases of type 2 diabetes without peripheral neuropathy were treated as type 2 diabetes mellitus in NDPN group. 42 patients with peripheral neuropathy were treated as DPN group. According to the results of MNSI score, the MNSI score was divided into three stages, that is, 0.2.4 points 32 cases with 2.5 and 4.4 points 31 cases and 鈮，

本文編號(hào)：1612967