Evaluation Of Diaphragmatic Motion Abnormalities In Patients Of Type 2 Diabetes Mellitus By M-mode Ultrasonography

Objective : To discuss the diagnostic value of M-mode ultrasonography in evaluating diaphragmatic motion abnormalities in the patients of type 2 diabetes mellitus(T2DM)of different courses.Methods:67 patients of T2 DM were enrolled and divided into the following groups: group A(the course >10 years,32 cases),group B(the course ?10 years,35 cases)and group C(control group,36 cases).And the diagnosis of T2 DM was conform to the standards set by WHO.Before the inspection,all inspectors were required to take a rest for at least 30 minutes or more,and all subjects remained in the supine position,with a 30° incline of the upper part of the body.First,two-dimensional ultrasonography was used to show the diaphragm.When a clear two-dimensional image was obtained,M-mode ultrasonography was used to examine the diaphragmatic motion degrees of each group in quiet breathing,volunntary sniffing and deep breathing.Quiet breathing means that the patient is in a state of quiet calm and smooth breath.Volunntary sniffing means that the patient breathes with nose with a faster frequency.Deep breathing means that the patient breathes in the most expiration after maximal inspiration with his nose,at the end of a calm exhalation.On the right side of the diaphragmatic muscle movement measurement,the transducer was placed on the anterior subcostal region at the right mid-clavicular line with the liver as an acoustic window.The right diaphragm is displayed as a hyperechogenic line on the B-mode scanning.The inferior vena cava(IVC)is visible on the right side of the screen,and the gall bladder is present in the center of the screen.The M-mode sample line is angled approximately 30° to the vertical line which can make ultrasonic beam perpendicular to the diaphragm.On the left side of the diaphragmatic muscle movement measurement,the transducer was placed on the anterior subcostal region between the anterior and midaxillary lines.The left diaphragm is displayed as a hyperechogenic line on the B-mode scanning with the spleen as the acoustic window.The hilum of the spleen is displayed in the center of the screen.The M-mode sample line is angled approximately 30° to the vertical line which can make ultrasonic beam perpendicular to the diaphragm.In order to guarantee the reliability of the results,the measurements were repeated three times to obtain the average values(every time to take the maximum five respiratory cycle),and the whole measurement process should be performed by one person.There were no significant differences of the height,the weight and the BMI of the groups A,B and C.At the same time,the following conditions should be excluded: the respiratory disease history,the surgery of pleuroperitoneal cavity,the thoracic deformity,the large tumors of pleuroperitoneal cavity,the pleural effusion,the hydrops abdominis,the hiccup,the smoking history and the drugs which affect the function of muscle.The parameters of pulmonary function were obtained: FEV1,FEV1(% of predicted),FVC,FVC(% of predicted),FEV1/FVC(%)and VC,and the measurement was repeated 3 times.The correlation among the diaphragmatic motion degrees and the parameters of pulmonary function were analyzed.Results:There were no significant differences in the diaphragmatic motion degrees in quiet breathing among the groups A,B and C(all P>0.05).The diaphragmatic motion degree of group A was larger than those of group B and C(all P<0.05)in volunntary sniffing and deep breathing.And so was it with group B and C(P<0.05).There was no significant difference in in quiet breathing,volunntary sniffing and deep breathing between the the left and right side of the diaphragm motion among the groups A,B and C.The FEV1 of group A was smaller than those of group B and C(all P<0.05).There was no significant difference in the FEV 1 between group B and C(P>0.05).There was no significant differences in the FEV1(% of predicted),FVC,FVC(% of predicted),FEV1/FVC(%)and VC among the group A,B and C(all P>0.05)The diaphragmatic motion degree in deep breathing was positively and significantly correlative with the FEV1?FVC and VC(all P<0.05).Conclusions:Diaphragmatic motion amplitude is decreased with the increase of diabetes duration in volunntary sniffing and deep breathing,and the movement of the diaphragm by FEV1,FVC and VC have positive correlation in deep breathing.The diaphragmatic motion and the lung function are damaged in the patients of T2 DM.And the diaphragm and lung function also interrelate.The diaphragmatic motion can be measured by M-mode ultrasonography directly,conveniently and invasively,which provides the objective diagnostic evidence for the patients of T2 DM with diaphragmatic motion abnormality.