Evaluation Of Skeletal Muscle Microcirculation Andperfusion Reserve Inpatients With Type 2 Diabetes By Contrast-enhanced Ultrasonography

Objective To explore the applicability of contrast-enhanced ultrasound(CEUS)and transient arterial occlusion as a new method to quantify skeletal muscle microcirculation and arterialperfusion reserve in type 2 diabetes mellituspatients with microvascular complications(DM+MC).Methods(1)Ultrasound contrast agent was injected into elbow vein of 10 patients with DM+MC,10 uncomplicated type 2 diabetes mellitus(DM)patients,and 10 control subjects.Its appearance in the calf muscle was detected by contrast-enhanced ultrasound.With time–CEUS–intensity curves obtained frompre-selected regions of interest in the small arteries,muscular tissue and small veins within calf muscles,we derived the arrival times(ATs)and contrast transit times(CTTs),CTTs were calculated as the differences between arrival times.(2)After transient arterial occlusion at mid-thigh level simulatedphysical exercise,each group was subjected to ultrasound angiography again to obtain ATs and CTTs.(3)With all subjects under fasting conditions,plasma glucose and insulin,insulin resistance index,glycosylated hemoglobin,D-dimer,C-reactiveprotein and other blood rheologicalparameters were measured.The relationship between insulin resistance index,glycosylated hemoglobin,D-dimer,C-reactiveprotein and the transit time of each group was analyzed bypearson correlation analysis.Results(1)DM+MC group tended to have longer CTTs than the DM and control groups(M-V,39.3±7.7 VS 12.3±4.4 VS 4.9±1.7,P<0.05),(A-V,46.5±6.2 VS 16.9±5.4 VS 8.8±1.6);(2)After transient arterial occlusion,DM+MC group tended to have longer CTTs than the DM group(?A-M,7.1±2.1 VS 4.5±1.4 VS 3.8±1.5,P<0.05),(?M-V,39.3±7.7 VS 12.3±4.4 VS 4.9±1.7,P<0.05),(?A-V,46.5±6.2 VS 16.9±5.4 VS 8.8±1.6,P<0.05);(3)after arterial occlusion,contrast agent transit time of DM group,control group(?A-M??A-V??M-V)and DM + MC group(?A-M)were significantly shorter,P<0.05;there was no significantly shorter in the time of contrast between ?A-Vand ?M-V of the DM + MC group.(4)There were significant differences in blood glucose,insulin,insulin resistance index and related hemorheology between DM + MC group and DM group and control group,the difference was statistically significant;(5)There was a good correlation between insulin resistance index,glycosylated hemoglobin,D-dimer and C-reactiveprotein andpartial transit time(A-V,M-V,?A-V,?M-V),and the correlation was statistically significant(P <0.05).Conclusion Ultrasonography combined with transient arterial occlusion can be used to evaluate skeletal muscle microcirculation and arterial reserve function inpatients with type 2 diabetes mellitus,and microcirculation and arterial reserve may be related to insulin resistance index and abnormal blood rheologicalparameters.