【摘要】：目的:利用磁共振擴(kuò)散加權(quán)神經(jīng)成像(DW-MRN)及擴(kuò)散張量成像(DTI)技術(shù)研究2型糖尿病周圍神經(jīng)病變患者脛神經(jīng)及腓總神經(jīng)的改變,探討擴(kuò)散成像技術(shù)在糖尿病下肢神經(jīng)病變診斷中的應(yīng)用價值。材料與方法:前瞻性納入我院2型糖尿病伴周圍神經(jīng)病變患者(DPN)20名,2型糖尿病不伴周圍神經(jīng)病變患者(T2DM)20名及健康對照者(HC)20名。常規(guī)采集受試者一般情況資料,包括性別、年齡、身高、體重、糖尿病患者相關(guān)臨床指標(biāo)、肌電圖運(yùn)動神經(jīng)傳導(dǎo)速度(MCV)及密歇根神經(jīng)病變篩查(MNSI)評分。所有受試者分別進(jìn)行磁共振T1WI、T2WI/FS、MEDIC、DW-MRN、DTI序列掃描,利用磁共振后處理技術(shù)并參照解剖序列在DTI圖像上選取感興趣區(qū),自動計算脛神經(jīng)及腓總神經(jīng)FA值及ADC值,測量三次取平均值;同時觀察脛神經(jīng)及腓總神經(jīng)信號及形態(tài)的改變。采用SPSS 22.0處理數(shù)據(jù),DPN組和T2DM組兩組間計量資料比較采用兩樣本t檢驗,DPN組、T2DM組及HC組三組間計量資料比較采用單因素方差分析,并分析FA值及ADC值與神經(jīng)傳導(dǎo)速度以及臨床指標(biāo)的相關(guān)性。結(jié)果:(1)DPN組與T2DM組實驗室相關(guān)生化指標(biāo)及MNSI評分有差別,其中DPN組與T2DM組間Hb A1c、LDL-C、C肽及MNSI評分差異具有統(tǒng)計學(xué)意義(P0.05);(2)DPN組脛神經(jīng)及腓總神經(jīng)傳導(dǎo)速度(43.42±3.59m/s,44.05±3.01m/s)較T2DM組(46.43±2.86m/s,46.83±2.86m/s)及HC組(46.89±2.75m/s,47.03±2.37m/s)慢,且差異具有統(tǒng)計學(xué)意義(P0.05);(3)DPN組、T2DM組及HC組脛神經(jīng)FA值分別為0.528±0.073,0.582±0.048,0.593±0.069,腓總神經(jīng)FA值分別為0.489±0.052,0.537±0.049,0.547±0.050,DPN組脛神經(jīng)及腓總神經(jīng)FA值均較T2DM組及HC組低,且差異具有統(tǒng)計學(xué)意義(P0.05);三組脛神經(jīng)ADC值分別為1.173±0.103×10~(-3)mm~2/s,1.077±0.083×10~(-3)mm~2/s,1.070±0.077×10~(-3)mm~2/s,腓總神經(jīng)ADC值分別為1.107±0.085×10~(-3)mm~2/s,1.027±0.075×10~(-3)mm~2/s,1.020±0.065×10~(-3)mm~2/s,DPN組脛神經(jīng)及腓總神經(jīng)ADC值均較T2DM組及HC組高,且差異具有統(tǒng)計學(xué)意義(P0.05)。(4)脛神經(jīng)和腓總神經(jīng)FA值與MCV呈正相關(guān)(r=0.696,P0.001;r=0.728,P0.001),而ADC值與MCV呈負(fù)相關(guān)(r=-0.672,P0.001;r=-0.636,P0.001)。(5)FA值與Hb A1c、LDL-C及病程呈負(fù)相關(guān)(r值分別為-0.397,-0.415,-0.341;P值均0.05),而與C肽呈正相關(guān)(r=0.355,P0.05);ADC值與Hb A1c、LDL-C、及病程呈正相關(guān)(r值分別為0.598,0.552,0.361;P值均0.05),而與C肽呈負(fù)相關(guān)(r=-0.512,P0.05)。結(jié)論:磁共振擴(kuò)散加權(quán)神經(jīng)成像及擴(kuò)散張量成像技術(shù)可以顯示脛神經(jīng)及腓總神經(jīng)的走行及定量評估糖尿病患者脛神經(jīng)及腓總神經(jīng)損傷情況。
[Abstract]:Objective: to study the changes of tibial nerve and common peroneal nerve in patients with type 2 diabetic peripheral neuropathy by diffusion weighted neurography (DW-MRN) and diffusive Zhang Liang imaging (DTI). To evaluate the value of diffusion imaging in the diagnosis of diabetic lower extremity neuropathy. Materials and methods: twenty patients with type 2 diabetes mellitus with peripheral neuropathy (DPN) and 20 patients with type 2 diabetes mellitus without peripheral neuropathy (T2DM) and 20 healthy controls with (HC) were included prospectively. The general data of subjects were collected routinely, including sex, age, height, weight, clinical indexes of diabetes mellitus, electromyogram motor nerve conduction velocity (MCV) and Michigan neuropathy screening (MNSI) score. All subjects were scanned with Mr T1WII / T2WI / FSSI / DW-MRNNI sequence respectively. The region of interest was selected from DTI images by magnetic resonance postprocessing technique and anatomic sequence. The FA and ADC values of tibial nerve and common peroneal nerve were calculated automatically, and the average values of ADC were measured three times. At the same time, the signal and morphological changes of tibial nerve and common peroneal nerve were observed. SPSS 22.0 was used to process data between DPN group and T2DM group. The measurement data of DPN group and HC group were compared by single factor analysis of variance (ANOVA). The correlation of FA and ADC with nerve conduction velocity and clinical indexes was analyzed. Results: (1) there were significant differences in laboratory biochemical indexes and MNSI scores between DPN group and T2DM group. There was significant difference in Hb A 1ct LDL-C peptide and MNSI score between DPN group and T2DM group (P0.05); (2). The conduction velocity of tibial nerve and peroneal nerve in DPN group (43.42 鹵3.59 m 路s / s 44.05 鹵3.01m/s) was slower than that in T2DM group (46.43 鹵2.86 msP 路2.86m/s) and HC group (46.89 鹵2.75ms-1 路s / r = 47.03 鹵2.37m/s). The difference was statistically significant (P0.05); (3) the FA values of tibial nerve in DPN group and HC group were 0.528 鹵0.073 鹵0.048 鹵0.593 鹵0.069 and 0.489 鹵0.052 鹵0.049 鹵0.537 鹵0.049 鹵0.547 鹵0.050 respectively. The FA values of tibial nerve and common peroneal nerve in DPN group were lower than those in T2DM group and HC group. 涓斿樊寮傚叿鏈夌粺璁″鎰忎箟(P0.05);涓夌粍鑳緇廇DC鍊煎垎鍒負(fù)1.173鹵0.103脳10~(-3)mm~2/s,1.077鹵0.083脳10~(-3)mm~2/s,1.070鹵0.077脳10~(-3)mm~2/s,鑵撴，

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