| Objective: Lower extremity vascular disease(LEAD)is one of the most common complications of type 2 diabetes mellitus(T2DM),which mainly refers to atherosclerosis.The rate of LEAD amputation and mortality is high,while there is no early diagnosis of LEAD.The intima media thickness(IMT)of the common femoral artery is closely related to LEAD at early stage.The popliteal artery(POA)among the large vessels.The sustained low level of wall shear stress(WSS)is the initial factor for the formation of atherosclerotic LEAD.Color Doppler ultrasound(DUS)has the advantages of economy,non-invasive,real-time display of blood flow and so on.The purpose of this study is to use Doppler ultrasound to analyze popliteal artery of T2 DM patients,to explore the early diagnosis value of popliteal artery WSS in T2 DM patients with LEAD,and to provide new basis for the prediction of LEAD.Methods: This study included 69 healthy volunteers(male/female: 32/37,average 58.22 ±10.35 years old)recruited in The East Hospital from March 2019 to November 2019,and 202 patients(male/female: 126/76,average 61.56±13.35 years old)with T2 DM diagnosed in endocrinology department in the same period.According to IMT thickness of popliteal artery,T2 DM was divided into three groups: T2 DM IMT of normal group: IMT < 0.6mm(48 cases,male/ female: 24/24 cases,average age 50.04 ± 13.6);IMT thickening group: 0.6 ? IMT < 0.8mm(55 cases,male/female: 38/17 cases,average age 61.53±8.83);and T2 DM plaque formation group: IMT?0.8mm(99 cases,male/female: 64/35 cases,average age 67.17±12.75.Ultrasound scanning of the lower extremity arteries was performed on all subjects: the subjects took the prone position,the knee joint was relaxed,the probe was cut longitudinally at the middle point of the popliteal fossa behind the knee,the section shown by ultrasound passed through the median axis of the blood vessel,and the medial membrane of the anterior and posterior walls of the popliteal artery was clearly visible.When the diameter of the popliteal artery was the widest,the inner diameter of the popliteal artery and the thickest part of IMT were measured,the color Doppler blood flow was started,the blood flow gain was adjusted,and the blood flow was ensured to be full The popliteal artery color Doppler flow image for 5 seconds and peak systolic velocity(PSV)data were collected.WSS quantitative analysis software was used to select the interested vessel length of 1cm,calculate the average value of popliteal artery WSS,draw 2D WSS distribution map,3D WSS spatial distribution map and WSS fusion image.The medical history,mean arterial pressure(MAP),diastolic blood pressure(DBP),systolic blood pressure(SBP),fasting plasma glucose(FPG),two-hour postprandial blood glucose(2h-PBG),hemoglobin A1c(Hb A1c),glycosylated albumin(GA),fibrinogen(Fib),hematocrit(HCT),total cholesterol(TC),triglycerides(TG),body mass index(BMI),high density lipoproteins(HDL),low density lipoprotein cholesterol(LDLC)and creatine(CR)were collected.Results:(1)Compared with the normal control group,SBP,BMI,HCT,Fib,TC,TG,LDL-C,FPG,2h-PBG,Hb Alc and GA in T2 DM group were increased,while HDL-C,PSV and WSS were decreased,the difference was statistically significant(P<0.05).(2)The WSS of popliteal artery in normal control group,T2 DM IMT normal group,T2 DM IMT thickening group and T2 DM plaque formation group were 2.36±0.43 dyne/cm2,2.11±0.60 dyne/cm2,1.81±0.44 dyne/cm2 and 1.67±0.48dyne/cm2.WSS of popliteal artery decreased in T2 DM IMT normal group,T2 DM IMT thickening group and T2 DM plaque formation group compared with the normal control group(P < 0.05).WSS of popliteal artery decreased in T2 DM IMT thickening group and T2 DM plaque formation group compared with T2 DM IMT normal group(P < 0.05).There was no significant difference in WSS between T2 DM IMT thickening group and T2 DM plaque formation group(P > 0.05).(3)The area under ROC curve of popliteal artery WSS predicting LEAD in T2 DM patients was 0.81(P < 0.05).The optimal critical value of WSS in popliteal artery was 1.82 dyne/cm 2,with sensitivity of 68% and specificity of 83%.(4)In T2 DM group,popliteal artery WSS was negatively correlated with age,course of disease,GA,Hb Alc,popliteal artery IMT(r =-0.503,-0.342,-0.18,-0.21,-0.53),and positively correlated with PSV,TC,TG,HCT(r = 0.57,0.14,0.17,0.18)(P < 0.05).Age,course of disease,PSV and popliteal artery IMT were independent risk factors of popliteal artery WSS(P < 0.05).Conclusion: The application of color Doppler ultrasound in noninvasive and quantitative analysis of popliteal artery WSS provides the imaging basis for the early diagnosis of LEAD in T2 DM patients.Popliteal artery WSS has a better predictive value for the occurrence of LEAD in T2 DM patients and is expected to become a new indicator for clinical prevention and early diagnosis and treatment of LEAD in T2DM... |
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