Diagnostic value of shear wave elastography combined with vascular endothelial growth factor B and hemoglobin A1c in early diabetic peripheral neuropathy_West China Medical Journal

Authors：

LI Juan ¹ , ZHENG Jiali ¹ , LI Yue ¹ ,  HUANG Jing ²

1. Department of Ultrasound Medicine, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan 621000, P. R. China;
2. Endocrine Department, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan 621000, P. R. China;

Corresponding author：

HUANG Jing, Email: 32872173@qq.com

Keywords：

Shear wave elastography; vascular endothelial growth factor B; hemoglobin A1c; diabetic peripheral neuropathy

DOI：

10.7507/1002-0179.202410084

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Objective To analyze the diagnostic value of shear wave elastography (SWE) combined with vascular endothelial growth factor B (VEGF-B) and hemoglobin A1c (HbA1c) in early diabetic peripheral neuropathy (DPN). Methods A total of 100 patients with type 2 diabetes mellitus (T2DM) admitted to Mianyang Central Hospital between October 2020 and October 2023 were selected and divided into a T2DM with DPN group (n=31) and a T2DM without DPN group (n=69) based on the presence or absence of DPN. Additionally, 50 healthy individuals from the same hospital’s health examination center were included as a healthy control group. The basic clinical characteristics, mean elasticity (E_mean) values of the left and right median and tibial nerves, serum VEGF-B, and HbA1c levels were compared among the three groups. The diagnostic efficacy of SWE, VEGF-B, and HbA1c for DPN was evaluated using receiver operating characteristic (ROC) curves, and Pearson correlation analysis was performed to assess the relationships between median/tibial nerve E_mean and VEGF-B/HbA1c. Results The E_mean values of the left and right median nerves, E_mean values of the left and right tibial nerves, serum VEGF-B, and HbA1c levels in the T2DM with DPN group were significantly higher than those in the T2DM without DPN group and the healthy control group (P<0.05). The E_mean values of the left and right median and tibial nerves, E_mean values of the left and right tibial nerves, and HbA1c level in the T2DM without DPN group were significantly higher than those in the healthy control group (P<0.05), while no significant difference was observed in serum VEGF-B level between the T2DM without DPN group and the healthy control group (P>0.05). The area under the ROC curve for the combined diagnosis of DPN using SWE, VEGF-B, and HbA1c was 0.859 [95% confidence interval (0.828, 0.955)]. The sensitivity of the combined diagnosis (93.72%) was significantly higher than that of individual diagnoses (78.82%, 75.39%, and 71.05%, respectively; P<0.05), while the specificity (88.64%) showed no significant difference compared to individual diagnoses (80.18%, 78.96%, and 82.88%, respectively; P>0.05). Positive correlations were observed between median/tibial nerve E_mean and VEGF-B/HbA1c levels (r=0.428, 0.395, 0.416, and 0.416, respectively; P<0.05). Conclusions Elevated median/tibial nerve E_mean, serum VEGF-B, and HbA1c levels are closely associated with DPN. The combination of SWE, VEGF-B, and HbA1c improves diagnostic sensitivity for DPN, demonstrating significant clinical value.

1.	Didangelos T, Veves A. Treatment of diabetic cardiovascular autonomic, peripheral and painful neuropathy. Focus on the treatment of cardiovascular autonomic neuropathy with ACE inhibitors. Curr Vasc Pharmacol, 2020, 18(2): 158-171.
2.	穆晶晶, 田臻, 吴成蓉, 等. 高频超声及剪切波弹性成像技术对 2 型糖尿病下肢神经病变的定量评估. 中国临床医学影像杂志, 2023, 34(7): 512-516.
3.	侯爱莲, 邹好楠, 杨德, 等. 超声剪切波弹性成像对 2 型糖尿病尺神经病变诊断价值的初步研究. 中华保健医学杂志, 2020, 22(2): 180-183.
4.	唐晓蕾, 代艳, 丁倩, 等. LncRNA H19 和 VEGF-b 在糖尿病视网膜病变患者中的表达及临床意义. 中国实验诊断学, 2022, 26(5): 642-647.
5.	石敏, 邹健, 李乔岳, 等. 2 型糖尿病患者糖化白蛋白和糖化血红蛋白比值与周围神经病变相关性研究. 陕西医学杂志, 2020, 49(12): 1557-1560.
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8.	Franceschi R, Mozzillo E, Di Candia F, et al. A systematic review of the prevalence, risk factors and screening tools for autonomic and diabetic peripheral neuropathy in children, adolescents and young adults with type 1 diabetes. Acta Diabetol, 2022, 59(3): 293-308.
9.	李雪花, 邹汶兵, 陈一平. 2 型糖尿病合并糖尿病周围神经病变患者血清神经胶质纤维酸性蛋白水平及其临床意义. 广西医学, 2020, 42(5): 562-565.
10.	孙冉, 梁丹艳, 吴国柱, 等. 高频超声与剪切波弹性成像结合临床指标评估糖尿病患者胫神经病变风险. 临床超声医学杂志, 2020, 22(3): 189-193.
11.	Vas PRJ, Papanas N. Diabetic peripheral neuropathy and depression: dancing with wolves? - Mini-review and commentary on Alghafri et al. “Screening for depressive symptoms amongst patients with diabetic peripheral neuropathy”. Rev Diabet Stud, 2021, 17(1): 17-20.
12.	唐一植, 陈伟, 靳丽嘉, 等. 高频超声结合剪切波弹性成像在诊断糖尿病周围神经病变中的应用价值. 四川医学, 2020, 41(12): 1217-1222.
13.	邓红菊, 张宇虹, 张萍, 等. 常规超声及二维超声剪切波弹性成像技术评价 2 型糖尿病周围神经病变患者股四头肌异常改变. 中国临床医学影像杂志, 2023, 34(3): 199-203.
14.	李艳飞, 王晶, 陈定章, 等. 下肢神经剪切波弹性成像对不同程度糖尿病周围神经病变的诊断效能分析. 陕西医学杂志, 2022, 51(9): 1102-1105.
15.	陆倩, 吴意赟, 王丽娟, 等. 剪切波弹性成像技术对 2 型糖尿病周围神经病变评价价值. 临床军医杂志, 2022, 50(3): 305-307.
16.	靳丽嘉, 唐一植. 多模态超声成像可诊断糖尿病患者的周围神经病变. 分子影像学杂志, 2020, 43(3): 404-409.
17.	王菲, 马麒, 郑苗. 剪切波弹性成像联合多伦多临床评分系统对糖尿病周围神经病变的诊断价值. 中国医学影像学杂志, 2022, 30(2): 159-163, 166.
18.	靳丽嘉, 唐一植, 陈鹏, 等. 基于 Logistic 回归模型筛选 CEUS 及 SWE 诊断 2 型糖尿病周围神经病变的定量参数. 河北医学, 2022, 28(9): 1550-1554.
19.	赖诚, 李明新. 血管内皮生长因子-B 对高糖环境下人视网膜色素上皮细胞凋亡的保护作用. 眼科新进展, 2020, 40(5): 430-434.
20.	童国玉, 李翠柳, 杨东辉, 等. 糖尿病前期和新诊断 2 型糖尿病患者血清血管内皮生长因子 B 水平与胰岛素抵抗的相关性. 现代生物医学进展, 2019, 19(21): 4049-4054.
21.	Hagberg CE, Falkevall A, Wang X, et al. Vascular endothelial growth factor B controls endothelial fatty acid uptake. Nature, 2010, 464(7290): 917-921.
22.	Sugimoto K, Yasujima M, Yagihashi S. Role of advanced glycation end products in diabetic neuropathy. Curr Pharm Des, 2008, 14(10): 953-961.

1. Didangelos T, Veves A. Treatment of diabetic cardiovascular autonomic, peripheral and painful neuropathy. Focus on the treatment of cardiovascular autonomic neuropathy with ACE inhibitors. Curr Vasc Pharmacol, 2020, 18(2): 158-171.
2. 穆晶晶, 田臻, 吴成蓉, 等. 高频超声及剪切波弹性成像技术对 2 型糖尿病下肢神经病变的定量评估. 中国临床医学影像杂志, 2023, 34(7): 512-516.
3. 侯爱莲, 邹好楠, 杨德, 等. 超声剪切波弹性成像对 2 型糖尿病尺神经病变诊断价值的初步研究. 中华保健医学杂志, 2020, 22(2): 180-183.
4. 唐晓蕾, 代艳, 丁倩, 等. LncRNA H19 和 VEGF-b 在糖尿病视网膜病变患者中的表达及临床意义. 中国实验诊断学, 2022, 26(5): 642-647.
5. 石敏, 邹健, 李乔岳, 等. 2 型糖尿病患者糖化白蛋白和糖化血红蛋白比值与周围神经病变相关性研究. 陕西医学杂志, 2020, 49(12): 1557-1560.
6. 中华医学会糖尿病学分会. 中国 2 型糖尿病防治指南(2020 年版). 国际内分泌代谢杂志, 2021, 41(5): 482-548.
7. 中华医学会糖尿病学分会神经并发症学组. 糖尿病神经病变诊治专家共识(2021 年版). 中华糖尿病杂志, 2021, 13(6): 540-557.
8. Franceschi R, Mozzillo E, Di Candia F, et al. A systematic review of the prevalence, risk factors and screening tools for autonomic and diabetic peripheral neuropathy in children, adolescents and young adults with type 1 diabetes. Acta Diabetol, 2022, 59(3): 293-308.
9. 李雪花, 邹汶兵, 陈一平. 2 型糖尿病合并糖尿病周围神经病变患者血清神经胶质纤维酸性蛋白水平及其临床意义. 广西医学, 2020, 42(5): 562-565.
10. 孙冉, 梁丹艳, 吴国柱, 等. 高频超声与剪切波弹性成像结合临床指标评估糖尿病患者胫神经病变风险. 临床超声医学杂志, 2020, 22(3): 189-193.
11. Vas PRJ, Papanas N. Diabetic peripheral neuropathy and depression: dancing with wolves? - Mini-review and commentary on Alghafri et al. “Screening for depressive symptoms amongst patients with diabetic peripheral neuropathy”. Rev Diabet Stud, 2021, 17(1): 17-20.
12. 唐一植, 陈伟, 靳丽嘉, 等. 高频超声结合剪切波弹性成像在诊断糖尿病周围神经病变中的应用价值. 四川医学, 2020, 41(12): 1217-1222.
13. 邓红菊, 张宇虹, 张萍, 等. 常规超声及二维超声剪切波弹性成像技术评价 2 型糖尿病周围神经病变患者股四头肌异常改变. 中国临床医学影像杂志, 2023, 34(3): 199-203.
14. 李艳飞, 王晶, 陈定章, 等. 下肢神经剪切波弹性成像对不同程度糖尿病周围神经病变的诊断效能分析. 陕西医学杂志, 2022, 51(9): 1102-1105.
15. 陆倩, 吴意赟, 王丽娟, 等. 剪切波弹性成像技术对 2 型糖尿病周围神经病变评价价值. 临床军医杂志, 2022, 50(3): 305-307.
16. 靳丽嘉, 唐一植. 多模态超声成像可诊断糖尿病患者的周围神经病变. 分子影像学杂志, 2020, 43(3): 404-409.
17. 王菲, 马麒, 郑苗. 剪切波弹性成像联合多伦多临床评分系统对糖尿病周围神经病变的诊断价值. 中国医学影像学杂志, 2022, 30(2): 159-163, 166.
18. 靳丽嘉, 唐一植, 陈鹏, 等. 基于 Logistic 回归模型筛选 CEUS 及 SWE 诊断 2 型糖尿病周围神经病变的定量参数. 河北医学, 2022, 28(9): 1550-1554.
19. 赖诚, 李明新. 血管内皮生长因子-B 对高糖环境下人视网膜色素上皮细胞凋亡的保护作用. 眼科新进展, 2020, 40(5): 430-434.
20. 童国玉, 李翠柳, 杨东辉, 等. 糖尿病前期和新诊断 2 型糖尿病患者血清血管内皮生长因子 B 水平与胰岛素抵抗的相关性. 现代生物医学进展, 2019, 19(21): 4049-4054.
21. Hagberg CE, Falkevall A, Wang X, et al. Vascular endothelial growth factor B controls endothelial fatty acid uptake. Nature, 2010, 464(7290): 917-921.
22. Sugimoto K, Yasujima M, Yagihashi S. Role of advanced glycation end products in diabetic neuropathy. Curr Pharm Des, 2008, 14(10): 953-961.

West China Medical Journal

Latest ArticlesDiagnostic value of shear wave elastography combined with vascular endothelial growth factor B and hemoglobin A1c in early diabetic peripheral neuropathy

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