2型糖尿病患者胰岛素注射部位温度与皮下脂肪增生的相关性研究  

Correlation between insulin injection site temperature and subcutaneous fat hyperplasia in patients with type 2 diabetes mellitus

作　　者：程富明 余舒婷 张江南 陆静尔 徐吉 叶清清 戴盈 Cheng Fuming;Yu Shuting;Zhang Jiangnan;Lu Jinger;Xu Ji;Ye Qingqing;Dai Ying(Department of Endocrinology,the Afiliated People's Hospital of Ningbo University,Ningbo 315040,China;Department of Ultrasound,the Affiliated People's Hospital of Ningbo University,Ningbo 315040,China)

机构地区：[1]宁波大学附属人民医院内分泌科,宁波315040 [2]宁波大学附属人民医院超声科,宁波315040

出　　处：《中华糖尿病杂志》2024年第11期1240-1246,共7页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：浙江省医学会项目(2023ZYC-Z13);浙江省宁波市鄞州区科技局项目(2023AS046)。

摘　　要：目的探讨2型糖尿病(T2DM)患者胰岛素注射部位皮肤温度与皮下脂肪增生(LH)之间的相关性。方法为横断面研究。选取2023年4—10月就诊于宁波大学附属人民医院内分泌科门诊或住院的T2DM患者为研究对象。采用高频超声法对患者注射部位及正常部位皮肤进行检查,采用热电偶点测温法测量注射部位及正常部位皮肤平均温度并计算温差,并根据高频超声及热成像结果判断患者是否有LH。采用配对样本t检验比较正常部位与LH部位皮肤温度及温差的差异,采用Cohen′s Kappa系数分析红外线热成像与超声检查对LH的诊断一致性。结果共纳入92例T2DM患者,其中,有81例合并LH,81例中有71例患者LH部位皮肤温度下降,10例出现温度升高。LH部位的腹部皮肤温度较正常部位皮肤温度降低[分别为(32.40±1.12)℃和(33.13±1.16)℃,t=-9.039,P<0.001],LH部位皮肤温差大于正常部位[分别为(1.50±0.55)℃和(0.44±0.20)℃,t=15.749,P<0.001]。同时热成像与超声提示的LH病变部位一致性Cohen′s kappa系数为0.897,95%CI为0.756~1.038,P<0.001。结论LH会导致局部皮肤温度下降。使用热成像对LH进行诊断筛查及指导胰岛素注射部位轮换有一定临床应用价值。Objective To investigate the correlation between skin temperature at insulin injection sites and lipohypertrophy(LH)in patients with type 2 diabetes mellitus(T2DM).Methods This was a cross-sectional study.Outpatients or inpatients with T2DM who visited the Department of Endocrinology of the People′s Hospital Affiliated to Ningbo University from April to October 2023 were selected for the study.The skin at the injection site and at the patient′s normal site was examined using high-frequency ultrasound,while thermocouple point temperature measurement was employed to determine the average skin temperature at these sites and calculate the temperature difference.Additionally,LH presence in the patient was determined based on the results of the high-frequency ultrasound and thermal imaging.The paired samples t-test was used to compare the differences in skin temperature and temperature variation between the normal and the LH regions,while Cohen′s kappa coefficient was used to assess the consistency of LH diagnosis by infrared thermal imaging and ultrasound.Results A total of 92 patients with T2DM were included,of whom 81 had comorbid LH.Among the LH patients,decreased skin temperature at the ulcer site was observed in 71 cases,while increased temperature was observed in 10 cases.The abdominal skin temperature at the LH site was significantly lower than the normal site,with average temperatures of(32.40±1.12)℃and(33.13±1.16)℃(t=-9.039,P<0.001).Additionally,the skin temperature difference at the LH part was significantly higher than that at the normal part,with average temperature differences of(1.50±0.55)℃and(0.44±0.20)℃(t=15.749,P<0.001).Meanwhile,Cohen′s kappa coefficient of LH lesions indicated by thermal imaging and ultrasound was 0.897(95%CI 0.756-1.038,P<0.001).Conclusion sLH decreases local skin temperature.There are some clinical applications of thermography for diagnostic screening for LH and for guiding rotation of the insulin injection site.

关 键 词：糖尿病 2型 胰岛素注射 皮下脂肪增生 温度 热成像 

分 类 号：R587.1[医药卫生—内分泌]