The Clinical Study Of Using Ultrasonic Evaluation To Early Diabetic Pancreas Fat Deposition And Renal Tissue Perfusion

BackgroundDiabetes is a chronic metabolic disorder disease.With the morbidity increase,diabetes has become one of major sources threating human health.Pancreatic fat deposition could greatly increase the risk of the Type II diabetes.Recently,many studies have focused on exploring the relationship between the pancreatic fact deposition and glycometabolism anomaly.As a convenient,cost-effective,fast,and repeatable detection approach,ultrasound is used to evaluate the pancreatic fat deposition of people with abnormal glycometabolism,and analyze the correlation between pancreatic fat deposition and high-risk factors of diabetes.Thus,prevention measures can be taken in advance to reduce the pancreatic fact deposition rate,which could reduce the morbidity of the Type II diabetes and delay the progress of diabetes.Purpose1.Explore the feasibility of using the ultrasound to evaluate the pancreatic fat deposition.2.Make statistical analysis to the pancreatic fact deposition rates of healthy people,diabetics,and IGR patients.3.Analyze the correlation between the pancreatic fat deposition and multiple diabetes high-risk factors.Methods294 diabetes high-risk individuals with age between 45 to 60 years(58 ± 2)were selected to participate in the DM screening in the East Branch of No.6 People Hospital of Shanghai Jiaotong University from Oct.2015 to Jan.2016,where people with serious heart and cerebral vessels diseases,abnormal liver and kidney disease,acute infectious diseases,accurate or chronic pancreatitis,pancreatic tumors,spleen diseases,surgery or other inappropriate scenarios,were excluded.The demographics,current medical condition,medical history,and somatology indicators are collected.The biochemical indicators and pancreas were examined by the ordinary ultrasound.The pancreatic fat deposition was estimated referring to the rectus abdominis.The pancreatic ultrasounds were divided into 3levels: 1,2,and 3.111 diabetics were classified as the DM group,54 people with abnormal glycometabolism were classified as the IGR group,and 129 people with normal glycometabolism were classified as the health group.SPSS 16.0 was used to make statistical analysis.The ANOVA method was used to evaluate differences of indicators of different groups,and the logistic regression was used to identify the factors related to the pancreatic fat deposition.The confidence level was 95%.Results1.42 out of 129 people in the health group were detected with the pancreatic fat deposition(33.3%),with 19 level 1 cases,16 level 2 cases,and 19 level 3 cases.30 out of54 people in the IGR group were detected with the pancreatic fat deposition(55.6%),with14 level 1 cases,11 level 2 cases,and 5 level 3 cases.67 out of 111 people in the DM group were detected with the pancreatic fact deposition(47.6%),with 37 level 1 cases,18 level 2 cases,and 12 level 3 cases.The pancreatic fat deposition rates of the three groups are statistically significantly different(P<0.01).2.TC(P=0.01)?TG(P=0.01)?LDL-C(P=0.00)?FPG(P=0.00)?HOMA2-IR(P=0.03)?HOMA-IS(P=0.00)of the IGR and DM groups are significantly higher than the control group.3.BMI,HOMA2-IR,TG,and TC might be the high-risk factors contributing to the pancreatic fat deposition of IGR and T2 DM patients.Conclusion1.The pancreatic fat deposition detection rate increases with the progress of diabetes(c2=19.14,P<0.01).2.Body mass index(BMI),insulin resistance(HOMA2-IR),high triglycerides(TG),and total cholesterol(TC)may be the high-risk factors for the pancreatic fat deposition ofIGR and T2 DM patients.3.It is feasible to utilize the ultrasound to evaluate the pancreatic fat deposition,and the pancreatic fat deposition is related to multiple high-risk factors of diabetes.Background Diabetic nephropathy(DN)is a common chronic complication of diabetes,and it belongs to microangiopathy of diabetes.DN is one of major causes of end-stage renal diseases and diabetic deaths,and has risen increasingly.Currently,DN is clinically diagnosed mainly based on the urine microalbumin,while the renal damage has become irreversible the DN is confirmed.However,the pathology and blood perfusion of kidney hasvechanged before the appearance of urine microalbumin.Thus,it is important to develop a safe,simple,and effective diagnosis technique to reflect these changes.Purpose1.Use the quantitative analyze technique to explore tthe glycometabolism anomoly and the change of early DN kidney tissue blood perfusion.2.Evaluate the reliability and feasibility of using the CEUS quantitative analysis technique to analyze DN kidney tissue blood perfusion.It would provide a new iconography diagnostic tool to evaluate the glycometabolism anomaly ang the change of kidney blood perfusion of DN patients.Methods34 glycometabolism patients participated in a diabetes epidemiology survey organized by the east branch of Shanghai No.People's Hospital from Oct.2015 to Jan.2016,where there were 10 cases in the IGR group,24 cases in the DN group(m Alb20-200mg/mmol),and 10 cases in the control group.The m A1 b,m A1b/Cr,Scr,Hb A1 c,UA,and BUN of these participants are collected.The MDRD formula is used to calculate the GFR for comparison.Firstly,both kidneys of each participant are examined by the ordinary ultrasound examination with the PHILIPS i U Elit.Then,the real-time ultrasound contrast perfusion imaging is made,where 1.2ml Son Vue ultrasound contrast agent is injected intoeach kidney through the elbow vein mass.ROI is defined as the freedom shape.QLAB(Philips)is used to measure the parameters of kidney issue ultrasound imaging perfusion(DTPM)to produce the TIC perfusion curve.QLAB could automatically produce measurements,including area under curve(AUC),peak intensity(DPI),the curve slope(A),and time to peak(TTP).Results1.Basic indicator comparison of examinees: the m Alb(P=0.00),Hb A1c(P=0.00),and UA(P=0.03)of the IGR group and DN group are higher than the control group.2.The real-time observation of kidney tissue perfusion: After ultrasound contrast agent is injected into each kidney through the elbow vein mass,the renal aorta,segment,leaf between artery,renal cortex and medulla,renal sinus were reinforcement in turn.Renal artery and artery between leaf are rapid reinforcement to a "dendritic",with the renal cortex uniform reinforcement,the strengthening of the renal medulla,renal sinus relatively slow.Contrast enhancement after peak strength,subside until disappear.In NC subjects,after perfusion of Sono Vue into renal,the echo intensity of renal ortex is higher than the medulla area;In IGR subjects,cortex echo intensity is higher than the medulla area.The order of the expurgation of Contrast agent as renal sinus,renal medulla,renal cortex.3.Kidney tissue quantitative perfusion indicators: the AUC and DPI of the renal cortex and renal medulla of the DN group are larger than the NC group and IGR group(P<0.05).There are no statistical differences for the AUC and DPI of the renal cortex and renal medulla between the IGR group and NC group.Conclusion1.CEUS can diagnose the blood perfusion anomaly of the early-stage DN.It can effectively to analysis and evaluation early DN blood perfusion change.2.CEUS finds no significant renal cortex and renal medulla blood perfusion changes during the impaired glucose regulation.Thus,CEUS cannot effectively evaluate the kidney blood perfusion change during the impaired glucose regulation.