目的: 探讨超声造影检查在评估2型糖尿病(diabetes mellitus,DM)及糖耐量减低患者足部微循环改变中的应用价值。方法: 选取56例无糖尿病足的男性2型DM患者,分为短病程组(A组,患病时间<10年,24例)和长病程组(B组,患病时间≥10年,32例);另选取15例糖耐量减低(impaired glucose tolerance,IGT)患者组作为IGT组;12例年龄与DM组匹配、空腹血糖及糖耐量实验均正常的男性其他疾病患者作为对照组。观察各组患者右足拇趾(右足趾)的超声造影灌注情况;通过脱机软件获得时间-强度曲线,分析各组研究对象右足趾的对比剂到达时间(arrival time,AT)、平均达峰时间、平均峰值强度(peak intensity, PI)、时间-强度曲线下面积(area under curve, AUC)等指标。结果: 对照组患者的超声造影图像显示,右足趾血管密集,色彩明亮;而IGT组、DM A组及DM B组患者的右足趾血管较对照组稀疏,色彩黯淡;IGT组、DM A组及DM B组的PI及时间-强度AUC较对照组降低,DM B组的PI及时间-强度AUC较IGT组及DM A组降低,差异有统计学意义(P<0.05);IGT组与DM A组间的PI及时间-强度AUC差异无统计学意义(P>0.05);DM患者的AT及平均达峰时间虽然随着病程的增加有所延长,但差异无统计学意义(P>0.05)。结论: 通过超声造影检查可在患者出现糖尿病足之前即评估2型DM及IGT患者足部的微循环改变,从而为诊断DM足部微血管病变提供一种简便、安全、可靠的方法。
Objective: To evaluate the foot microcirculation in type 2 diabetes mellitus and impaired glucose tolerance patients using contrast-enhanced ultrasound. Methods: Contrast-enhanced ultrasound (CEUS) was performed for examining the blood flow of right foot great toe (TIC) in 56 patients with type 2 diabetes mellitus but without diabetic foot (DM group), 15 patients with impaired glucose tolerance (IGT group) and 12 male control subjects(control group). DM group was divided into two groups according to the course of DM: DM(A) group with course <10 years and DM(B) group with course≥10 years. All the subjects were elderly male patients. Perfusion characteristics of CEUS and parameters of TIC were analyzed. Results: Compared with control group, CEUS image showed lower microvascular density and pale in appearance in IGT, DM and DM(B) groups. Peak intensity (PI) and area under time-intensity curve (AUC) in IGT, DM(A) and DM(B) groups were significantly reduced (P<0.05); PI and AUC of DM(B) group were lower than those of IGT and DM(A) group (P<0.05); and no significant differences in PI and AUC were found between IGT and DM(A) group (P>0.05). The arrival times (AT) and time to peak (TTP) tended to be increased with the extension of DM course, but the difference was not statistically significant (P>0.05). Conclusions: Contrast-enhanced ultrasound can detect the change in foot microcirculation of DM and IGT patients before diabetic foot occurres.
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