Abstract: Objective　By analyzing the correlation between the changes in the shear wave hardness of the calf motor nerve and its innervating muscles in patients with type 2 diabetes, to explore the clinical value of high-frequency gray-scale ultrasound and shear wave elastography in the evaluation of the calf motor nerve and muscle lesions in patients with diabetic peripheral neuropathy (DPN). Methods　A case-control study was conducted on 80 inpatients in Department of Diabetes, Lianyungang Traditional Chinese Medicine Hospital Affiliated to Kangda College of Nanjing Medical University from August 2020 to November 2021. There were 40 DPN patients, including 18 males and 22 females, with an age of (58.95±7.08); and there were 40 diabetic patients with no neuropathy, including 18 males and 22 females, with an age of (59.03±8.03). There were 30 normal controls in the same period, with an age of (58.40±6.26). High frequency ultrasound conventional gray-scale mode and shear wave imaging mode were used to collect the cross-sectional areas of the peroneal nerve and tibial nerve and the Young's modulus of gastrocnemius, tibial anterior muscle, and peroneal muscle. We used one way ANOVA to compare the measured values of the 3 groups and analyzed the correlation between the cross-sectional area of the motor nerve of the calf and the Young's modulus of the corresponding innervated muscle. The independent-sample t test and χ² test were used. Kendall W test was used to test the consistency. Pearson correlation analysis was applied. Results　There were statistical differences in the measured values of ultrasonic parameters between the three groups (all P<0.05). The cross-sectional areas of the tibial and peroneal nerves in the DPN patients were the largest, which were (16.29±2.01) mm² and (19.88±2.71) mm², respectively; the shear wave hardness Young's modulus was the lowest in the DPN patients; and the Young's modulus values of the gastrocnemius muscle (maximum plantar flexion), gastrocnemius (maximum dorsiflexion), tibial anterior muscle, and peroneal muscle in the DPN patients were (56.29±10.12) kPa, (79.25±12.86) kPa, (76.84±12.88) kPa, and (67.09±12.55) kPa. The cross-sectional areas of the tibial and peroneal nerves in the DPN patients were negatively correlated with the Young's modulus of the corresponding innervated muscles (all P<0.01). The cross-sectional area of the tibial nerve was correlated with the Young's modulus (maximum dorsiflexion) and (maximum plantar flexion) of the gastrocnemius muscle (r= -0.617 and -0.632). The correlation r value between the cross-sectional area of the peroneal nerve and the Young's modulus of the tibialis anterior muscle (maximum plantar flexion) was -0.622. The correlation r value between cross-sectional area of the peroneal nerve and the Young's modulus of the peroneal muscle (foot inversion) was -0.629. Conclusions　Patients with DPN have reduced leg muscle stiffness. Conventional gray-scale ultrasound can be combined with shear wave elastography to assess the motor nerve and its innervation muscle lesions of the leg, providing more imaging diagnostic evidences for clinical evaluation of DPN patients.

Key words: Diabetic peripheral neuropathy, Ultrasound, Shear wave elastography, Calf muscle

摘要： 目的　通过分析2型糖尿病患者小腿运动神经及其支配肌肉剪切波硬度测值变化及相关性，探讨高频灰阶超声与剪切波弹性成像联合评估糖尿病周围神经病变（DPN）患者小腿运动神经及肌肉病变的临床价值。方法　选取2020年8月至2021年11月南京医科大学康达学院附属连云港中医院糖尿病科住院病例80例对照研究。DPN患者40例中男18例，女22例，年龄（58.95±7.08）岁；不伴周围神经病变的糖尿病患者40例中男18例，女22例，年龄（59.03±8.03）岁。同期正常对照组30例，年龄（58.40±6.26）岁。运用超高频超声常规灰阶模式和剪切波成像模式采集受检者小腿腓神经、胫神经截面积，腓肠肌、胫骨前肌、腓骨肌杨氏模量测值。单因素方差分析比较3组受检超声参数测值，并对小腿运动神经截面积与对应支配肌肉的杨氏模量相关性分析。统计学方法采用独立样本t检验、χ²检验，运用Kendall W检验进行一致性检验，并采用Pearson相关性分析。结果　3组间各超声参数测值比较差异均有统计学意义（均P <0.05）。其中DPN患者的胫神经截面积、腓总神经截面积值最大，分别为（16.29±2.01）mm²、（19.88±2.71）mm²，其剪切波硬度杨氏模量值最低，腓肠肌（最大跖屈位）、腓肠肌（最大背屈位）、胫骨前肌、腓骨肌杨氏模量值分别为（56.29±10.12）kPa、（79.25±12.86）kPa、（76.84±12.88）kPa、（67.09±12.55）kPa。相关性分析结果显示DPN患者小腿胫神经、腓总神经截面积与对应支配肌肉杨氏模量测值均呈负相关（均P <0.01），其中胫神经截面积与腓肠肌杨氏模量（最大背屈位）及（最大跖屈位）相关性r值分别为-0.617和-0.632，腓总神经截面积与胫骨前肌杨氏模量（最大跖屈位）相关性r值为-0.622，腓总神经截面积与腓骨肌杨氏模量值（足内翻位）相关性r值为-0.629。结论　糖尿病周围神经病变患者存在小腿肌肉硬度减低，常规灰阶超声可联合剪切波弹性成像评估小腿运动神经及其支配肌肉病变，为临床评估DPN患者提供更多的影像学诊断依据。

关键词: 糖尿病周围神经病变, 超声, 剪切波弹性成像, 小腿肌肉