二维及彩色多普勒超声评价2型糖尿病患者跟下脂肪垫的异常改变

Abnormal changes in heel pad of patients with type 2 diabetes mellitus evaluated by two-dimensional and color Doppler ultrasonography

目的:探讨应用二维及彩色多普勒超声评价2型糖尿病(T2DM)患者跟下脂肪垫异常改变的临床应用价值。方法:根据糖尿病病程将104例T2DM患者分为2组,<10年为B组(50例),≥10年为C组(54例),另选同期38例健康志愿者为对照组(A组)。应用二维及彩色多普勒超声观察跟下脂肪垫内部回声、厚度及能量多普勒血流信号,测量微腔室、大腔室和整个跟下脂肪垫的厚度。结果:A组跟下脂肪垫的超声检查表现为高低回声相间、均匀分布,即高回声的纤维间隔在低回声脂肪区之间穿插排列。A组跟下脂肪垫内部回声异常改变4例,B组19例,C组46例,B、C组均大于A组,具有显著性差异(P均<0.05),C组大于B组,具有显著性差异(P<0.05)。3组间微腔室厚度比较,B、C组均较A组增厚,具有显著性差异(P均<0.05),B组与C组间比较无显著性差异(P>0.05)。3组间大腔室厚度及整个脂肪垫厚度比较,B组较A、C组增厚,具有显著性差异(P均<0.05),A组与C组间比较无显著性差异(P>0.05)。能量多普勒超声显示3组间血流等级比较,B、C组血流数目均小于A组,具有显著性差异(P均<0.05),C组血流数目小于B组,具有显著性差异(P<0.05)。结论:二维及彩色多普勒超声检查能准确、客观地评估T2DM患者跟下脂肪垫随病程进展其内部回声、厚度及血流信号的异常改变,对糖尿病足的早期预防和诊治具有重要的临床意义。

Objective:To explore the clinical value of two-dimensional and color Doppler ultrasonography in evaluating the abnormal changes in heel pad of patients with type 2 diabetes mellitus(T2DM).Methods:One hundred and four patients with T2DM were divided into two groups according to the course of diabetes mellitus:group B(50 cases,the course<10 years)and group C(54 cases,the course≥10 years).Thirty-eight healthy volunteers were enrolled as control group(group A).The echotexture and power Doppler signal were observed by two-dimensional and color Doppler ultrasonography,and the thickness of microchamber layer,macrochamber layer and entire heel pad were measured.Results:The echotexture of the heel pad in group A showed a pattern of uniform heterogeneity in which hypoechoic fat pockets were separated by hyperechoic fiber septa.The rate of abnormal echotexture change in group B(19 cases)and group C(46 cases)were larger than that of group A(4 cases)(all P<0.05),the rate of abnormal echotexture change in group C was larger than that of group B(P<0.05).The thickness of microchamber layer in group B and group C were significantly thicker than that of group A(all P<0.05),but there was no significant difference between group B and group C(P>0.05).The thickness of macrochamber layer and the entire heel pad in group B were significantly thicker than those of group A and group C(all P<0.05),but there was no significant difference between group A and group C(P>0.05).Doppler signal grades showed that the number of vessels in group B and group C were smaller than that of group A(all P<0.05),and the number of vessels in group C was smaller than that of group B(P<0.05).Conclusion:The abnormal changes in heel pad of T2DM patients can be evaluated by two-dimensional and color Doppler ultrasound accurately and objectively.It has important clinical significance for the early prevention,diagnosis and treatment of diabetic foot.