糖尿病增加腕管综合征患者的正中神经横截面积，但不增加疾病严重程度。
Diabetes Increases Median Nerve Cross-Sectional Area but Not Disease Severity in Patients with Carpal Tunnel Syndrome.
作者信息
Beckwitt Colin H, Schulz William, Carrozzi Sabrina, Wera Jeffrey, Wasil Karen, Fowler John R
机构信息
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, United States.
Department of Orthopaedic Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, United States.
出版信息
J Hand Microsurg. 2024 May 14;16(2):100030. doi: 10.1055/s-0043-1764163. eCollection 2024 Jun.
BACKGROUND
Ultrasonography (US) is a useful diagnostic modality for diagnosis of carpal tunnel syndrome (CTS). Diabetes mellitus is increasingly prevalent and is a risk factor for CTS. Given the increasing use of US in the diagnosis of CTS, our goal was to evaluate the influence of diabetes on CTS severity and the cross-sectional area (CSA) of the median nerve in patients with CTS.
METHODS
Patients with clinically diagnosed CTS were seen in the outpatient setting from October 2014 to February 2021. Median nerve CSA and patient reported severity measures were obtained: Boston Carpal Tunnel Syndrome Questionnaire (BCTSQ) and CTS-6. For patients with diabetes, additional parameters were collected including most recent A1c, insulin pharmacotherapy, and polypharmacy.
RESULTS
Ninety-nine patients (122 nerves) without diabetes and 55 patients (82 nerves) with diabetes were recruited for the study. Patients in the diabetes group were more obese and older and had a significantly increased median nerve CSA compared with patients without diabetes. Obesity was associated with higher median nerve CSA in all patients but not in patients with diabetes. There was no difference in disease severity in patients with and without diabetes as reported by BCTSQ or CTS-6 scores. In patients with diabetes, there was significantly decreased median nerve CSA with A1c of 6.5 or higher and a trend to decreased CSA with polypharmacy. There was no influence of insulin therapy on median nerve CSA.
CONCLUSION
Diabetes is associated with higher median nerve CSA in patients with CTS of similar disease severity. The increased median nerve CSA in patients with diabetes may be reflective of diabetes-related microvascular changes. Interestingly, the trend to decreased median nerve CSA in patients with suboptimal diabetic control (A1c ≥ 6.5) may suggest eventual degenerative changes to the median nerve. In summary, clinicians should be cautious with interpreting a larger median nerve CSA as more severe CTS in patients with diabetes.
LEVEL OF EVIDENCE
Level 3 Diagnostic.
背景
超声检查（US）是诊断腕管综合征（CTS）的一种有用的诊断方法。糖尿病日益普遍，是CTS的一个危险因素。鉴于US在CTS诊断中的应用越来越多，我们的目标是评估糖尿病对CTS严重程度以及CTS患者正中神经横截面积（CSA）的影响。
方法
2014年10月至2021年2月在门诊对临床诊断为CTS的患者进行观察。获取正中神经CSA以及患者报告的严重程度指标：波士顿腕管综合征问卷（BCTSQ）和CTS-6。对于糖尿病患者，收集额外的参数，包括最近的糖化血红蛋白（A1c）、胰岛素药物治疗和联合用药情况。
结果
招募了99例无糖尿病患者（122条神经）和55例糖尿病患者（82条神经）进行研究。糖尿病组患者更肥胖、年龄更大，与无糖尿病患者相比，正中神经CSA显著增加。肥胖与所有患者较高的正中神经CSA相关，但与糖尿病患者无关。根据BCTSQ或CTS-6评分，糖尿病患者和非糖尿病患者的疾病严重程度没有差异。在糖尿病患者中，A1c为6.5或更高时正中神经CSA显著降低，联合用药时有正中神经CSA降低的趋势。胰岛素治疗对正中神经CSA没有影响。
结论
在疾病严重程度相似的CTS患者中，糖尿病与较高的正中神经CSA相关。糖尿病患者正中神经CSA增加可能反映了糖尿病相关的微血管变化。有趣的是，糖尿病控制不佳（A1c≥6.5）的患者正中神经CSA降低的趋势可能表明正中神经最终会发生退行性变化。总之，临床医生在解释糖尿病患者正中神经CSA较大意味着CTS更严重时应谨慎。
证据水平
3级诊断性研究。
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