超声造影评估2型糖尿病骨骼肌微循环功能的研究  

Evaluation of skeletal muscle microcirculation in patients with type 2 diabetes by contrast-enhanced ultrasonography

作　　者：徐振宏[1] 颜小斌 李丽雅[1] XU Zhenhong;YAN Xiaobin;LI Liya(Department of Ultrasound,the Second Affiliated Hospital of Fujian Medical University,Quanzhou 362000,China)

机构地区：[1]福建医科大学附属第二医院超声医学科,泉州362000

出　　处：《中国糖尿病杂志》2021年第3期200-204,共5页Chinese Journal of Diabetes

基　　金：泉州市科技计划项目(2018N037S)。

摘　　要：目的探讨超声造影(CEUS)对评估T2DM合并微血管病变骨骼肌微循环及动脉灌注储备的临床应用价值。方法选取2016年10月至2017年1月于我院内分泌科确诊的单纯T2DM患者(T2DM组)10例,T2DM合并微血管病变患者(T2DM+MC组)12例,另选取10名同期我院体检健康人群为正常对照(NC)组。短暂动脉闭塞前后分别进行CEUS观察各组小腿腓肠肌血流灌注情况,分析预选的感兴趣区小动脉、肌肉组织和小静脉,获取时间-强度曲线、造影剂到达时间、造影剂渡越时间(CTTs)等灌注参数。检测各组FPG、C-P、胰岛素抵抗指数(HOMA-IR)、HbA1c、D-二聚体、C-RP等。结果短暂动脉闭塞前,T2DM+MC组部分CTTs较T2DM、NC组延长(P<0.05)。短暂动脉阻塞后,T2DM+MC组CTTs较T2DM、NC组延长(P<0.05),T2DM、NC组动脉到肌肉(△A-M)、动脉到静脉(△A-V)、肌肉到静脉(△M-V)及T2DM+MC组△A-M的CTTs较闭塞前缩短(P<0.05),而T2DM+MC组△A-V、△M-V的CTTs较闭塞前差异无统计学意义。Pearson相关性分析显示,HOMA-IR、HbA1c、D-二聚体与M-V、A-V及△M-V、△A-V的CTTs呈正相关(P<0.01)。结论CEUS结合短暂动脉闭塞一定程度上可评价T2DM微血管病变患者骨骼肌微循环障碍及动脉储备功能。微循环障碍及动脉储备功能可能与HOMA-IR及相关参数异常有关。Objective To explore the applicability of contrast-enhanced ultrasound(CEUS)as a new method to quantify skeletal muscle microcirculation and arterial perfusion reserve in type 2 diabetes mellitus(T2DM)patients with microvascular complications(MC).Methods In this study,we enrolled 10 uncomplicated T2DM patients(T2DM group)and 10 T2DM patients with MC(T2DM+MC group)from Endocrinology department in our hospital during October 2016 to January 2017.Meanwhile,another 10 healthy subjects doing physical examination in our hospital were enrolled as control group(NC group).Before and after transient arterial occlusion,CEUS was used to observe the arterial perfusion in in the calf muscle.With time-CEUS-intensity curves obtained from pre-selected regions of interest in the small arteries,muscular tissue and small veins within calf muscles,we derived the arrival times(ATs)and contrast transit times(CTTs).Fasting plasma glucose(FPG),C-peptide(C-P),insulin resistance index(HOMA-IR),HbA1c,D-Dimmer and C-reactive protein were tested in each group.Results Before transient arterial occlusion,some part of CTTs were longer in T2DM+MC group than in T2DM and control groups(P<0.05).After transient arterial occlusion,T2DM+MC group tended to have longer CTTs than the T2DM group(P<0.05).After arterial occlusion,CTTs were significantly shorter in T2DM group,NC group(Afterthe arterial occlusion△A-M、after the arterial occlusion△A-V,After the arterial occlusion△M-V)and T2DM+MC group(After the arterial occlusion△A-M)(P<0.05).There was no significant difference in CTTs between after the arterial occlusion△A-V and after the arterial occlusion△M-V in the T2DM+MC group.Pearson correlation analysis showed that HOMA-IR,HbA1c and D-Dimer were positively correlated with CTTs of M-V,A-V and△M-V and△A-V(P<0.01).Conclusion CEUS combined with transient arterial occlusion can be used to evaluate skeletal muscle microcirculation and arterial reserve function in patients with T2DM,and microcirculation and arterial reserve may be related to H

关 键 词：糖尿病 2型 超声造影 骨骼肌 微循环 

分 类 号：R587.1[医药卫生—内分泌] R445.1[医药卫生—内科学]