文章摘要
超微血管成像参数与T2DM神经电生理参数的相关性及对DPN的 诊断价值分析
Correlation between ultramicrovascular imaging parameters and neuroelectrophysiological parameters of T2DM and its diagnostic value in DPN
投稿时间:2024-03-20  修订日期:2024-03-20
DOI:
中文关键词: 2型糖尿病  超微血管成像  神经电生理检查  周围神经病变  诊断
英文关键词: Type 2 diabetes mellitus  Ultramicrovascular imaging  Neuroelectrophysiological examination  Peripheral neuropathy  diagnosis.
基金项目:
作者单位邮编
李维芝 咸阳市中心医院 712000
朱文峰 咸阳市中心医院 712099
崔蕾 咸阳市中心医院 
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中文摘要:
      【摘要】 目的 探究超微血管成像(SMI)参数与2型糖尿病(T2DM)神经电生理参数的相关性,并分析超微血管成像参数对周围神经病变(DPN)的诊断价值。方法 选取2021年1月至2023年6月期间医院收治的143例T2DM患者,纳入T2DM组,同期选取体检健康者40例纳入对照组,患者均进行SMI及神经电生理检查,采用Spearman及Pearson法分析T2DM患者SMI参数[血流分级及血管指数(VI)]与神经电生理参数[运动传导速度(MCV)、感觉传导速度(SCV)]的相关性。收集患者临床资料,采用多因素logistic回归模型分析T2DM发生DPN的影响因素,并采用受试者工作特征(ROC)曲线分析超微血管成像参数对T2DM-DPN的诊断价值。结果 DPN组与非DPN组血流分级比较,差异有统计学意义(P<0.05),T2DM组0级占比高于对照组,3级占比低于对照组(P<0.05);T2DM组第一跖背动脉(DMA)、第一趾背动脉VI值均低于对照组(P<0.05);T2DM组MCV及SCV水平均低于对照组(P<0.05);Sperman及Pearson分析结果显示,血流分级、DMA、VI值与MCV、SCV均呈正相关(P<0.05);143例T2DM患者发生DPN者98例(68.53%),未发生DPN者45例(31.47%);DPN组与非DPN组血流分级比较,差异有统计学意义(P<0.05),DPN组0级占比高于非DPN组,2级占比低于非DPN组(P<0.05),DPN组DMA、第一趾背动脉VI值均低于非DPN组(P<0.05);DPN组患者病程、HbAlc水平高于非DPN组(P<0.05);Logistic回归分析结果显示:HbAlc高水平、血流分级0~1级是T2DM发生DPN的危险因素,DMA、VI高水平是T2DM发生DPN的保护因素(P<0.05,OR>1);ROC分析结果显示:血流分级、DMA、VI单独及联合诊断T2DM的AUC值(95%CI)分别为0.718(0.637~0.791)、0.721(0.639~0.793)、0.701(0.619~0.775)、0.887(0.823~0.934),三者联合诊断效能高于各项单独检测(Z=3.445、3.363、3.222,P<0.05)。结论 T2DM患者超微血管成像参数与神经电生理参数存在明显的相关性,其中血流分级、DMA、VI均可用于T2DM-DPN的诊断,三者联合对T2DM-DPN具有较高的诊断价值。
英文摘要:
      Objective To explore the correlation between the parameters of ultramicrovascular imaging (SMI) and neuroelectrophysiological parameters of type 2 diabetes mellitus (T2DM), and to analyze the diagnostic value of ultramicrovascular imaging parameters in peripheral neuropathy (DPN). Methods A total of 143 T2DM patients admitted to the hospital from January 2021 to June 2023 were included in the T2DM group. In the same period, 40 healthy subjects were included in the control group. All patients underwent SMI and neuroelectrophysiological examinations. Spearman and Pearson methods were used to analyze the correlation between SMI parameters [blood flow grading and vascular index (VI)] and neuroelectrophysiological parameters [motor conduction velocity (MCV) and sensory conduction velocity (SCV)] in T2DM patients. The clinical data of the patients were collected, and the influencing factors of DPN in T2DM were analyzed by multivariate logistic regression model. Receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of ultramicro angiography parameters in T2DM-DPN. Results There was significant difference in blood flow classification between DPN group and non-DPN group (P<0.05). The proportion of grade 0 in T2DM group was higher than that in control group, and the proportion of grade 3 was lower than that in control group (P<0.05). The VI values of the first dorsal metatarsal artery (DMA) and the first dorsal toe artery in T2DM group were lower than those in control group (P<0.05). The levels of MCV and SCV in T2DM group were lower than those in control group (P<0.05). Sperman and Pearson analysis showed that blood flow classification, DMA and VI values were positively correlated with MCV and SCV (P<0.05). Among the 143 T2DM patients, 98 (68.53%) had DPN and 45 (31.47%) had no DPN. The difference in blood flow classification between DPN group and non-DPN group was statistically significant (P<0.05), the proportion of grade 0 in DPN group was higher than that in non-DPN group, the proportion of grade 2 was lower than that in non-DPN group (P<0.05), and the DMA and first toe dorsal artery VI values in DPN group were lower than those in non-DPN group (P<0.05). The disease course and HbAlc level in DPN group were higher than those in non-DPN group (P<0.05). Logistic regression analysis showed that high level of HbAlc, and blood flow grade 0-1 were risk factors for DPN in T2DM patients, and high level of DMA and VI were protective factors for DPN in T2DM patients (P<0.05, OR>1). ROC analysis results showed: The AUC (95%CI) values for T2DM diagnosed by blood flow grading, DMA and VI alone and combined were 0.718 (0.637~0.791), 0.721 (0.639~0.793), 0.701 (0.619~0.775) and 0.887 (0.823~0.934), respectively. The diagnostic efficiency of the three combined tests was higher than that of each single test (Z=3.445, 3.363, 3.222, P<0.05). Conclusion There is a significant correlation between ultramicrovascular imaging parameters and neuroelectrophysiological parameters in T2DM patients. Among them, blood flow grading, DMA and VI can be used for the diagnosis of T2DM-DPN, and the combination of these three parameters has high diagnostic value for T2DM-DPN.
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