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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 investigate the value of contrast-enhanced ultrasound in the assessment of foot microcirculation in patients with type 2 diabetes mellitus (DM) and impaired glucose tolerance. Methods: Fifty-six male patients with type 2 DM without diabetes mellitus were enrolled in this study. Patients were divided into two groups: group A (short-term duration, 10 years, 24 cases) and long-term course In addition, 15 IGT patients with impaired glucose tolerance (IGT) were selected as IGT group. Twelve other male patients with normal age, matched with DM group and normal fasting glucose and glucose tolerance test were used as control group. The right toe sonic contrast perfusion was observed in each group. Time-intensity curves were obtained by off-line software. The right toe of each group was analyzed by contrast agent arrival time (AT), average peak time , Peak intensity (PI) and area under curve (AUC). Results: The contrast-enhanced ultrasound images of the control group showed that the blood vessels of the right toe were densely populated and the color was bright. In the IGT, DM A and DM B groups, the blood vessels of the right toe were sparse and dull in the control group. The PI and the time-intensity AUC of DM group were lower than those of the control group. The PI and the time-intensity AUC of DM group were lower than those of IGT group and DM group (P <0.05) There was no significant difference in the PI and time-intensity AUC between the two groups (P> 0.05). The AT and mean peak time in DM patients were longer than those in the DM patients, but the difference was not statistically significant (P> 0.05) . CONCLUSIONS: Changes of the microcirculation in the foot of patients with type 2 DM and IGT can be assessed by contrast-enhanced ultrasound before the onset of diabetic foot in order to provide a simple, safe and reliable method for the diagnosis of diabetic foot microangiopathy.