| Research Background: Diabetes mellitus has become a global problem, which can cause multi-vessel hemodynamic change and complex complications of multi-system, the most outstanding impacts were the atherosclerosis of the large and medium artery, and the angiosclerosis of the small artery. The pathological characteristics of early atherosclerosis, which include the lipid deposition under the endothelium, the infiltration of the foam cells, and the proliferation of smooth muscle cell, which make the change to the interaction between the artery and heart. In past time, the study of large artery function mostly based on morphology of the artery wall with two-dimensional ultrasound equipment, due to the limited current conditions of the ultrasonic, which make it difficult to finger out the subtleties change between the artery and heart. The appearance of wave intensity (wave intensity, referred to as WI) bring us a new vision about the detection, assessment of the hemodynamic changes during the early atherosclerosis. As a new measurement method of the hemodynamic, which is a real-time measurement system, developed from a traditional technology, e-Tracking. The definition of traditional wave intensity is the wave energy flow, penetrating perpendicular, per unit as a unit time, which called the flowing energy density or the intensity of wave, is the mean value of one period as usual. According to the formula ,WI=(dp/dt)×(dU/dt) we can find out that WI is the product between pressure on the time derivative and velocity on the time derivative. Translated WI into instantaneous wave intensity, it enable us to differentiate the traditional wave intensity from instantaneous wave intensity.The echo tracking (e-Tracking, E-T) technology is a curve from the automatic calculation of the vessel diameter changes which collected from real-time tracking and the tracing of the vascular anterior and posterior wall, generated by the artery pulse radio-frequency signal. The previous studies show that the trail gate placed on intima-media of the wall is more repeatable than placed on the intima. Through the immense amounts of concrete research and verification by the international experts, they demonstrate that the trail gate placed on extine-media is more repeatable than placed on intima-media. WI is a higher level technological development on the basis of E-T, its technical principle is based on endometrial tracking technology combined with pressure, which has a linear relationship with diameter. The amplitudes of forward wave and backward wave, reflecting the change of the blood flow energy changing per unit area in the arteries, which can quantify and evaluate the cardiac function and the hemodynamic change of arteries. As a new non-invasive technique, WI not only provide the volatility parameters of the arterial wall as E-T, but also provide the hemodynamic index of the vessel and the both relationship in the time-related parameters, which open a new vision for the clinical research of cardiovascular. WI technology can detect the early morbid change of the artery, revealing the interaction mechanism between the heart and artery, assessing the cardiac contractile function and the change of myocardial relaxation.Objective: Detect the carotid artery hemodynamic change of diabetics through WI technology, and provides more accurate for clinical to screen objective and evaluate the intervention treatment's effect for diabetics' macroangiopathy. And further explore the application value of WI technology on non-invasive evaluation of hemodynamic performance and relationship between heart and vascular system.Subjects and Methods: Ultrasonic examination with the hospitalized diabetes mellitus patient in endocrinology department in our hospital from February 2011 to April 2011, exclude carotid artery plaque and heart failure patients (EF <55%, FS <25%), successfully detected 27 cases (the selected patients are according the established diagnostic standard with the World Health Organization in 1999), and 23 ordinary people, whose age, gender and body mass index match the above patients. The selected patients have one or more than one year disease course, and rule out secondary hypertension, severe liver, kidney and other diseases. Use Aloka10 color Doppler ultrasound diagnostic apparatus to detect subjects' carotid intima-media thickness IMT and use WI techniques to detect the related hemodynamic indices, including Strong transient acceleration wave intensity W1, Strong transient deceleration wave intensity W2, stiffnessβ, Contingency coefficient of pressure Ep, compliance AC, Augmentation Index AI, Pulse wave velocity PWVβ, Negative area NA, the time between the peak of R wave and W1 R-W1, the time between the peak of W1 and W2 W1-W2.Result: Comparison of the clinical basic data between the two groups: there are no significant difference about age, height, body mass index, systolic blood pressure diastolic blood pressure and pulse pressure. The concentrations of Fasting plasma glucose and total cholesterol increased higher in the diabetes mellitus group than the control group, while triglycerides, high density lipoprotein cholesterol and low density lipoprotein cholesterol in diabetes mellitus group are little bit higher than the control group, but not significant difference. The IVST and LVPWT in diabetes mellitus group are thickener than the control group. There are no significant difference about LVFS and LVEF. IMT, Ep,β, AI and PWVβwere gradually increased in the diabetes mellitus group, while AC reduce,there is significant difference. W1, NA: increased in diabetes mellitus group than the control group. W2: it seems increased a little bit in diabetes mellitus group, but there is no significant difference between diabetes mellitus group and the control group. The intervals of R-W1 and W1-W2 reduced a little bit in diabetes mellitus group, but no significant difference.Conclusion: WI measurement system evaluates the change of arterial hemodynamic and heart's function comprehensively in the early atherosclerosis, through measuring the arterial diameter (systolic and diastolic) and the change of arterial blood flow velocity. This technology has many advantages, such as original data's real-time collection, good reproducibility, non-invasive, etc. Providing as a new accurate and rapid method for clinic to screen for detecting follow-up and evaluate the treatment about atherosclerosis objectively, thereby guides treatment and prevention. |
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