[1]周长江,吴桂花,赵浩,等.超声造影与高频超声评估2型糖尿病患者腓肠肌肌病的应用比较[J].国际内分泌代谢杂志,2021,41(06):612-616.[doi:10.3760/cma.j.cn121383-20201221-12059]
　Zhou Changjiang,Wu Guihua,Zhao Hao,et al.Comparison of contrast-enhanced ultrasound and high-frequency ultrasound in the evaluation of gastrocnemius myopathy in patients with type 2 diabetes mellitus[J].International Journal of Endocrinology and Metabolism,2021,41(06):612-616.[doi:10.3760/cma.j.cn121383-20201221-12059]
点击复制

超声造影与高频超声评估2型糖尿病患者腓肠肌肌病的应用比较()
分享到：

《国际内分泌代谢杂志》[ISSN:1673-4157/CN:12-1383/R]

卷:
41
期数:
2021年06期
页码:
612-616
栏目:
论著
出版日期:
2021-12-20

文章信息/Info

Title:
Comparison of contrast-enhanced ultrasound and high-frequency ultrasound in the evaluation of gastrocnemius myopathy in patients with type 2 diabetes mellitus
作者:
周长江1; 吴桂花1; 赵浩1; 张凤梅2; 巩新玲1; 刘鹏2
1山东第一医科大学附属济南人民医院超声科 271100; 2山东第一医科大学附属济南人民医院内分泌科 271100
Author(s):
Zhou Changjiang1;  Wu Guihua1;  Zhao Hao1;  Zhang Fengmei2;  Gong Xinling1;  Liu Peng2.
1Department of Ultrasound, Jinan People's Hospital Affiliated to Shandong First Medical University, Jinan 271100, China; 2Department of Endocrinology, Jinan People's Hospital Affiliated to Shandong First Medical University, Jinan 271
关键词:
超声造影;  高频超声;  2型糖尿病;  腓肠肌肌病
Keywords:
Contrast-enhanced ultrasound;  High-frequency ultrasound;  Type 2 diabetes mellitus;  Gastrocnemius myopathy
DOI:
10.3760/cma.j.cn121383-20201221-12059
摘要:
目的 比较超声造影与高频超声评估2型糖尿病(T2DM)患者腓肠肌病变的效果。方法 选取2017年6月至2019年9月山东第一医科大学附属济南人民医院内分泌科收治的T2DM患者108例作为研究组,其中47例合并腓肠肌病变,61例为单纯T2DM患者,同期选取50名健康体检者为对照组。对所有T2DM患者均进行患肢高频超声和超声造影检查,采集其小腿腓肠肌肌肉声像图,先观察二维腓肠肌肌束宽度、内部回声,后观察造影剂灌注情况,利用软件获取病变区域达峰时间(PT)及峰值强度(PS); 测定空腹血糖(FBG)、糖化血红蛋白A1c(HbA1c)、总胆固醇(TC)、C-反应蛋白(CRP)、胰岛素水平; 利用四格表评价超声造影和高频超声对T2DM腓肠肌病变的诊断价值。结果 T2DM合并腓肠肌病变组、单纯T2DM组患者血清FBG、HbA1c、TC、CRP、胰岛素水平均明显高于对照组(P均<0.05); T2DM合并腓肠肌病变组患者腓肠肌肌束宽度显著低于单纯T2DM组(P<0.05); 腓肠肌回声不均匀减低显著多于对照组(P<0.05),造影后低灌注区域PS显著低于周围区域(P<0.05),PT与周围区域差异无统计学意义(P>0.05); 四表格结果显示,超声造影诊断腓肠肌病变及严重程度的灵敏度、特异度、阳性预测值、阴性预测值、准确率均高于高频超声(P均<0.05)。结论 超声造影诊断T2DM患者腓肠肌病变的准确率明显高于二维高频超声,经造影后可定量反映骨骼肌的灌注情况,有望成为检测T2DM患者腓肠肌病变的更有效方法。
Abstract:
Objective To detect and compare the effects of contrast-enhanced ultrasound and high-frequency ultrasound in the evaluation of gastrocnemius myopathy in patients with type 2 diabetes mellitus(T2DM).Methods From June 2017 to September 2019, 108 patients with T2DM admitted to the Department of Endocrinology, Jinan People's Hospital Affiliated to Shandong First Medical University were selected as the study group(47 cases were complicated with gastrocnemius myopathy, 61 cases were pure T2DM patients), and 50 healthy subjects were selected as the control group during the same period. All patients with T2DM underwent high-frequency ultrasound and contrast-enhanced ultrasound examination of the affected limb, and their calf gastrocnemius muscle sonogram were collected. The 2-D band width and internal echo of the gastrocnemius were first observed, and then the contrast agent perfusion was observed. Software was used to obtain the peak time(PT)and peak strength(PS)of the lesion area; the fasting blood glucose(FBG), glycosylated hemoglobin Alc(HbA1c), total cholesterol(TC), C-reactive protein(CRP)and insulin level were measured; and the diagnostic values of contrast-enhanced ultrasound and high-frequency ultrasound in T2DM gastrocnemius were evaluated by fourfold table.Results The serum levels of FBG, HbA1c, TC, CRP and insulin in T2DM combined with gastrocnemius disease group and the pure T2DM group were significantly higher than those in the control group(all P<0.05). The width of the gastrocnemius muscle bundle in the T2DM combined with gastrocnemius disease group was significantly lower than that in the the pure T2DM group(P<0.05). The unevenness of the gastrocnemius echo was reduced more than the control group(P<0.05). The peak intensity of the hypoperfusion area was significantly lower than the surrounding area after the contrast(P<0.05). There was no statistically difference between the peak time and the surrounding area(P>0.05). The results of the four-fold tables showed that the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of contrast-enhanced ultrasound in diagnosing gastrocnemius disease and its severity were higher than those of high-frequency ultrasound(all P<0.05).Conclusion The accuracy of contrast-enhanced ultrasound in the diagnosis of gastrocnemius lesions in T2DM patients is significantly higher than that of two-dimensional high-frequency ultrasound. After contrast, it can quantitatively reflect the perfusion of skeletal muscle, which is expected to become a more effective method for the detection of gastrocnemius lesions in T2DM patients.

参考文献/References:

[1] Lui PPY.Tendinopathy in diabetes mellitus patients-Epidemiology,pathogenesis,and management[J].Scand J Med Sci Sports,2017,27(8):776-787.DOI:10.1111/sms.12824.Epub 2017 Jan 20.PMID:28106286.
[2] 梁愿,李章春,卢薇,等.血清分泌型卷曲相关蛋白5与中老年2型糖尿病代谢性炎症综合征的关系[J].中国老年学杂志,2019,39(7):1573-1576.DOI:10.3969/j.issn.1005-9202.2019.07.013.
[3] 何清华,常鑫淼,孙明晓,等.2型糖尿病患者肌肉质量和力量的变化特点[J].中华老年医学杂志,2020,39(5):550-554.DOI:10.3760/cma.j.issn.0254-9026.2020.05.015.
[4] 赵海燕.探讨高频超声在2型糖尿病(T2DM)足部肌及小腿腓肠肌早期病变中的临床价值[J].实用糖尿病杂志,2020,16(6):63-64.
[5] 田勍,洪天配.美国糖尿病学会2017年版糖尿病医学诊疗标准的解读[J].中国糖尿病杂志,2017,25(7):577-581.DOI:10.3969/j.issn.1006-6187.2017.07.001.
[6] 芦佳,王春辉,袁红维.高频超声诊断在人体大运动后颈部肌肉骨骼损伤中的应用价值[J].实用临床医药杂志,2019,23(16):79-81.DOI:10.7619/jcmp.201916021.
[7] Li Y,Li C,Yang M,et al.Association of single nucleotide polymorphisms of miRNAs involved in the GLUT4 pathway in T2DM in a Chinese population[J].Mol Genet Genom Med,2019,7(9):e907.DOI:10.1002/mgg3.907.
[8] van der Schaft N,Schoufour JD,Nano J,et al.Dietary antioxidant capacity and risk of type 2 diabetes mellitus,prediabetes and insulin resistance:the Rotterdam Study[J].Eur J Epidemiol,2019,34(1):853-861.DOI:10.1007/s10654-019-00548-9.
[9] Liu F,Chen G,Huo W,et al.Associations between long-term exposure to ambient air pollution and risk of type 2 diabetes mellitus:a systematic review and meta-analysis[J].Environ Pollut,2019,252(Pt B):1235-1245.DOI:10.1016/j.envpol.2019.06.033.
[10] 刘俊谷,张进.超短回波时间磁共振成像技术在骨肌系统中的应用进展[J].磁共振成像,2020,11(2):158-160.DOI:10.12015/issn.1674-8034.2020.02.017.
[11] 邱艺琼,马晓芹,赵海燕.高频超声在糖尿病足部肌及小腿腓肠肌早期病变诊断中的意义[J].中国实用医刊,2018,45(10):13-15.DOI:10.3760/cma.j.issn.1674-4756.2018.10.004.
[12] 易芳,王小书,秦素兰.彩色多普勒超声检查老年2型糖尿病下肢血管病变的临床应用[J].医学影像学杂志,2019,29(5):878-881.
[13] 崔艳华,严继萍,赵文莉,等.心肌超声造影对大动脉炎冠状动脉受累患者心肌血流灌注的评价价值[J].中华临床医师杂志(电子版),2020,14(8):599-603.DOI:10.3877/cma.j.issn.1674-0785.2020.08.003.
[14] 郑伟坤,吕国荣,徐振宏,等.超声造影评估早期糖尿病兔骨骼肌病变[J].中华超声影像学杂志,2019,28(3):267-271.DOI:10.3760/cma.j.issn.1004-4477.2019.03.015.
[15] Wu H,Wen F,Jiang M,et al.LncRNA uc.48+ is involved in the diabetic immune and inflammatory responses mediated by P2X7 receptor in RAW264.7 macrophages[J].Int J Mol Med,2018,42(2):1152-1160.DOI:10.3892/ijmm.2018.3661.
[16] Kollia C,Antonopoulos AS,Siasos G,et al.Associations between adiponectin gene variability,proinflammatory and angiogenetic markers:implications for microvascular disease development in type 2 diabetes mellitus?[J].Curr Vasc Pharmacol,2019,17(2):204-208.DOI:10.2174/1570161116666180108113825.
[17] Nagatomo F,Takemura A,Roy RR,et al.Mild hyperbaric oxygen inhibits the growth-related decline in skeletal muscle oxidative capacity and prevents hyperglycemia in rats with type 2 diabetes mellitus[J].J Diabetes,2018,10(9):753-763.DOI:10.1111/1753-0407.12666.

备注/Memo

备注/Memo:
基金项目:山东省医药卫生科技发展计划项目(2018WS292)
通信作者:刘鹏,邮箱:Sdlpjnrm@126.com
更新日期/Last Update: 2021-12-10