高频超声在胰岛素注射皮下脂肪增生临床筛查中的应用

Clinical application of high-frequency ultrasound in the screening of lipohypertrophy in diabetic patients

目的:探讨高频超声在胰岛素注射皮下脂肪增生(LH)临床筛查中的应用。方法:为横断面研究。选择2016年11月至2020年9月在南京医科大学第一附属医院内分泌科门诊就诊及住院的548例胰岛素治疗≥半年的糖尿病患者,收集患者临床资料及胰岛素注射时长等资料。采用临床检查(视、触诊)和超声检查法筛查LH。采用t检验、非参数检验或χ^(2)检验比较组间差异。结果:548例患者中,418例临床检查发现LH,478例超声检查发现LH,390例两种方法同时发现LH。高频超声检查对LH的检出率高于临床检查[分别为76.3%(418/548)和87.2%(478/548),χ^(2)=59.998,P<0.01]。LH超声影像学特征表现为三种类型:高回声型、等回声型和低回声型及5种亚型,最常见为无血流、无包膜,伴边界不清晰的均匀一致的团状高回声型[65.9%(315/478)]。与仅超声发现的LH相比,临床检查和超声检查同时发现的LH其平均深径,长径、宽径、面积均增高,其中宽径差异具有统计学意义[分别为8.67(7.66,13.21)和13.47(8.70,18.22)mm,Z=-2.135,P<0.05]。结论:除临床检查以外,高频超声可作为糖尿病患者胰岛素注射部位皮下脂肪增生筛查的重要补充。

Objective To explore the clinical application of high-frequency ultrasound in the screening of lipohypertrophy(LH).Methods This was a cross-section study.A total of 548 diabetic patients who received insulin injection more than six months were recruited from November 2016 to September 2020 in the First Affiliated Hospital of Nanjing Medical University.Clinical data and insulin injection duration of patients were collected,the patients were examined through visual and palpation and ultrasound.The t-test,nonparametric test or Chi square test was used to compare the count data between groups.Results Of the 548 patients,418 patients were found to have LH detected by clinical examination,478 patients by ultrasound,390 patients both by clinical examination and ultrasound.The detectable rate of LH by high-frequency ultrasound was higher than that by the clinical examination[76.3%(418/548)vs.87.2%(478/548),χ^(2)=59.998,P<0.01].Compared with those detected by ultrasound only,the mean depth,median length,median width and median area of LH detected both by clinical examination and ultrasound examination were higher,with a statistically significant difference in the width diameter(P<0.05).The imaging features of LH included three types(hyperechoic,isoechoic,hypoechoic)and five subtypes.Among them,the most common type was hyperechoic type,which had no blood flow,no capsule,and uniform mass with unclear boundary,accounting for 65.9%(315/478).Compared with LH detected by high-ultrasound only,the mean deep diameter,length diameter,width diameter and area of LH detected both by clinical examination and ultrasound examination were all increased,and the difference of width diameter was statistically significant[8.67(7.66,13.21)mm vs.13.47(8.70,18.22)mm,Z=-2.135,P<0.05].Conclusion In addition to the traditional clinical examination(visualization and palpation),high-frequency ultrasound can be used as an important supplement to the examination of insulin injection site in diabatic patients.