糖尿病周围神经病变患者上肢动脉弹性及血流动力学研究

Study onvascular elasticity and hemodynamics of upper limb artery in diabetic patients with peripheral neuropathy

目的探讨2型糖尿病(T2DM)患者及合并周围神经病变患者上肢动脉弹性及血流动力学特点。方法选取T2DM患者116例,根据是否合并周围神经病变(DPN)分为单纯T2DM组及DPN组各58例,同时纳入健康对照组104例。比较三组实验室检查资料、临床基本信息。采用彩色多普勒超声结合平面波超敏感血流显像技术测量肱动脉(BA)、尺动脉(UA)、桡动脉(RA)、掌浅弓动脉(SPAA)、指掌侧固有动脉(PPDA)、指背动脉弓(DDAA)及甲床三级动脉弓(FN3AA)的收缩期峰值血流速度(PSV)、舒张末期血流速度(EDV)、单位时间均速(TAMV)、阻力指数(RI)、血流容积速度(VFlow);测定BA前壁及后壁的弹性杨氏模量最大值、最小值和平均值。结果与正常对照组比较,DPN组与单纯T2DM组BMI增高;甲床二三级动脉弓吻合支数显示减少、肱动脉内中膜增厚;肱动脉前壁及后壁的剪切波弹性值最大值、最小值、平均值均增高;UA、RA、PPDA、DDAA、FN3AA的RI值均增大(P<0.05)。与单纯T2DM组相比,DPN组肱动脉内中膜较厚且查见斑点例数较多,DPN组RA、SPAA、PPDA、DDAA、FN3AA的RI值均高于单纯T2DM组(P<0.05);DPN组SPAA、PPDA、DDAA的EDV、VFlow较单纯T2DM组减小(P<0.05)。DPN组的糖尿病患病时间、1周内最高空腹血糖、血肌酐值高于单纯T2DM组(P<0.05)。结论T2DM患者上肢动脉管壁变硬,且伴随微小动脉管腔内血流阻力增高;DPN患者外周动脉及微循环血流动力学较单纯T2DM患者受损更严重。

Objective To investigate the arterial elasticity and hemodynamic characteristics in patients with diabetes mellitus and diabetic peripheral neuropathy(DPN).Methods One hundred and sixteen patients with type 2 diabetes mellitus(T2DM)were selected.According to whether they had DPN,the patients were divided into a simple T2DM group and a DPN group,58 in each group.At the same time,104 patients were included in a healthy control group.The data of laboratory examination and basic clinical information were collected.Peak systolic velocity(PSV),end-diastolic velocity(EDV),time average mean velocity(TAMV),resistance index(RI)and blood volume velocity(VFlow)of brachial artery(BA),ulnar artery(UA),radial artery(RA),superficial palmar arch artery(SPAA),digital palmar proper artery(PPDA),dorsal digital artery arch(DDAA)and nail bed tertiary artery arch(FN3AA)were measured by color Doppler ultrasound combined with plane wave supersensitive blood flow imaging technology.The maximum,minimum,and mean of Young's modulus of anterior and posterior wall of brachial artery were detected.Results Compared with the healthy control group,the body weight and BMI of the DPN group and the T2DM group were increased,the number of anastomotic branches of the second and third grade arch of nail bed was decreased and the intima-media thickness of brachial artery was increased.Compared with the healthy control group,the anterior and posterior walls of brachial artery were increased and the RI values of UA,RA,PPDA,DDAA and FN3AA were increased.All differences were statistically significant(P<0.05).Compared with the simple T2DM group,the intima-media of the brachial artery in the DPN group was thicker and more spots were detected,and the RI values of RA,SPAA,PPDA,DDAA,and FN3AA in the DPN group were higher than those in the simple T2DM group(P<0.05).EDV and VFlow of SPAA,PPDA and DDAA in the DPN group were lower than those in the simple T2DM group.All differences were statistically significant(P<0.05).The duration of diabetes,the highest fasting blood glucose within one week,the serum creatinine in the DPN group were higher than those in the T2DM group(P<0.05).Conclusions The arterial wall of the upper limbs in T2DM patients is hard and accompanied by higher flow resistance in the lumen of the tiny arteries.The hemodynamics of peripheral artery and microcirculation of DPN patients are more severely impaired when compared to simple T2DM patients.