Objective: To investigate the value of shear wave elastography (SWE) in the early diagnosis of diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes mellitus. Methods: This study was a diagnostic case-control study. From May 2021 to October 2022, 68 patients with type 2 diabetes mellitus who met the inclusion criteria were admitted to the Department of Burns and Plastic Surgery of Affiliated Hospital of Zunyi Medical University, including 45 males and 23 females, aged (57±10) years. According to whether the DPN was present, the patients were divided into DPN group (38 patients) and non-DPN group (30 patients). During the same period, 30 healthy volunteers who underwent physical examinations at the health examination center of the hospital were recruited as healthy control group, including 19 males and 11 females, aged (56±10) years. Cross-sectional areas of the bilateral common peroneal nerves and tibial nerves measured by a color Doppler ultrasonography system in two-dimensional ultrasonography mode, and the stiffness of the bilateral common peroneal nerves and tibial nerves measured in SWE mode were compared between volunteers in healthy control group and two groups of patients at admission. Independent risk factors for the development of DPN were screened in the three groups of participants. Receiver operating characteristic curves were used to evaluate the diagnostic value of common peroneal nerve stiffness, common peroneal nerve cross-sectional area, tibial nerve stiffness, and tibial nerve cross-sectional area for DPN in two groups of patients. The correlations of common peroneal nerve stiffness and common peroneal nerve cross-sectional area with the Toronto clinical scoring system (TCSS) score were analyzed in patients of DPN group. Results: At admission, the cross-sectional areas of the bilateral common peroneal nerves of patients in DPN group were significantly larger than those of patients in non-DPN group and volunteers in healthy control group (P<0.05); there was no statistically significant difference in the cross-sectional area of the bilateral tibial nerves between volunteers in healthy control group and two groups of patients (P>0.05). At admission, the stiffness of the bilateral tibial nerves and common peroneal nerves of patients in both non-DPN group and DPN group was significantly greater than that of volunteers in healthy control group (P<0.05); the stiffness of the left tibial nerve and the bilateral common peroneal nerves of patients was significantly greater in DPN group than in non-DPN group (P<0.05). The results of multivariable ordinal logistic regression analysis showed that common peroneal nerve stiffness, tibial nerve stiffness, and common peroneal nerve cross-sectional area were all independent risk factors for the development of DPN among the participants in the three groups (with ORs of 0.91, 0.93, and 0.75, respectively, 95% CIs of 0.89 to 0.95, 0.89 to 0.97, and 0.58 to 0.96, respectively, P<0.05). In the two groups of patients, common peroneal nerve stiffness yielded the largest area under the curve for diagnosing DPN, which was 0.85 (with a 95% CI of 0.74 to 0.92). The optimal cutoff value was 75.29 kPa, with a sensitivity of 76.32% and a specificity of 90.00% at the optimal cutoff value. In DPN group, common peroneal nerve stiffness and common peroneal nerve cross-sectional area of patients were significantly positively correlated with the TCSS score (with rs values of 0.83 and 0.89, respectively, P<0.05). Conclusions: SWE demonstrates excellent performance in assessing peripheral nerve stiffness in patients with type 2 diabetes mellitus. In particular, common peroneal nerve stiffness measured by SWE has high diagnostic value for patients complicated with DPN and is correlated with clinical severity. It may serve as an auxiliary imaging marker for the early screening and severity assessment of DPN. 目的： 探讨剪切波弹性成像（SWE）对2型糖尿病患者并发糖尿病周围神经病变（DPN）的早期诊断价值。 方法： 该研究为诊断性病例对照研究。2021年5月—2022年10月，遵义医科大学附属医院烧伤整形外科收治68例符合入选标准的2型糖尿病患者，其中男45例、女23例，年龄（57±10）岁，根据是否并发DPN将患者分为DPN组（38例）和非DPN组（30例）；同期招募在该院体检中心体检的30名健康志愿者作为健康对照组，其中男19名、女11名，年龄（56±10）岁。比较健康对照组志愿者和2组患者入院时采用彩色多普勒超声诊断仪在二维超声模式下测量的双侧腓总神经和胫神经横截面积、在SWE模式下测量的双侧腓总神经和胫神经硬度。在3组受试者中，筛选DPN发病的独立危险因素。在2组患者中，采用受试者操作特征曲线评价腓总神经硬度、腓总神经横截面积、胫神经硬度和胫神经横截面积诊断DPN的价值。分析DPN组患者腓总神经硬度、腓总神经横截面积与多伦多临床评分系统（TCSS）评分的相关性。 结果： DPN组患者入院时双侧腓总神经横截面积均显著大于非DPN组患者和健康对照组志愿者（P<0.05）；但健康对照组志愿者与2组患者入院时双侧胫神经横截面积比较，差异均无统计学意义（P>0.05）。非DPN组与DPN组患者入院时双侧胫神经和腓总神经硬度均显著高于健康对照组志愿者（P<0.05），DPN组患者入院时左侧胫神经和双侧腓总神经硬度均显著高于非DPN组（P<0.05）。多因素有序logistic回归分析结果显示，在3组受试者中，腓总神经硬度、胫神经硬度、腓总神经横截面积均为DPN发病的独立危险因素（OR分别为0.91、0.93、0.75，95%CI分别为0.89~0.95、0.89~0.97、0.58~0.96，P<0.05）。在2组患者中，腓总神经硬度诊断DPN的曲线下面积最大，为0.85（95%CI为0.74~0.92），其最佳截断值为75.29 kPa，最佳截断值下的敏感度为76.32%、特异度为90.00%。在DPN组患者中，腓总神经硬度、腓总神经横截面积均与TCSS评分呈显著正相关（rs值分别为0.83、0.89，P<0.05）。 结论： SWE在评估2型糖尿病患者周围神经硬度方面表现优异，其中SWE测量的腓总神经硬度对患者并发DPN具有较高的诊断价值，并与临床严重程度相关，可作为DPN早期筛查和病情评估的辅助影像学指标。.
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