| Background International Diabetes Federation estimated that 425 million adults worldwide have diabetes in 2017.China has the world's largest diabetes epidemic,the number of diabetic patients in China is about 114.4 million.Among them,type 2 diabetes accounted for 90%.Chronic hyperglycemia in type 2 diabetes mellitus(T2DM)induces oxidative stress and more advanced glycation end products,and then damages capillary endothelial cells through various molecular signaling pathways,leading to thickening of capillary basement membrane and deposition of extracellular matrix,which leads to systemic microangiopathy.The classical microvascular complications are diabetic retinopathy,diabetic nephropathy,and diabetic peripheral neuropathy.Sommoon Mohapatra regarded diabetes as a type of chronic pancreatitis with the compromise of both pancreatic endocrine and exocrine function.The chronic impairment in both islet and exocrine tissue in patients with type T2DM bring about pancreatic fibrosis and the loss of acinar-parenchymal tissue.Lazarus and Volk suggested that microangiopathy could be the primary factor causing pancreatic fibrosis.However,we know little about the corresponding pancreatic changes during the progression to diabetic microangiopathy since nowadays it is difficult to obtain a pancreatic biopsy specimen from diabetic patients.The SWV in pancreas could be detected by VTQ technology noninvasively,reflecting the changes in pancreatic stiffness,and futher reflecting the changes in pancreatic microangiopathy,which is of great clinical significance.We have been engaged in the the correlation between pancreatic stiffness and microangiopathy in T2DM for several years,systematically elaborating the correlation between the pancreatic SWV and microangiopathy in T2DM.With the development of diabetes mellitus,the scope of microangiopathy is expanded,and more organs are involved.Objective The aim was to noninvasively explore the diagnostic efficacy of pancreatic SWV on diabetic microvascular complications and the risk factors of increased types of microvascular complications in T2DM,and to provide a new potential imaging marker for evaluation of microangiopathy in T2DMMethods The 148 T2DM patients meeting the 1999 WHO diagnostic criteria were enrolled.Diabetic microangiopathy mainly includes diabetic retinopathy(DR),diabetic peripheral neuropathy(DPN)and diabetic nephropathy(DN).The diagnosis of DR,DN and DPN is based on the diagnostic criteria of Standards of care for type 2 diabetes in China(2017),and all patients were divided into 4 groups according to the number of microvascular complications: L0 without complications(40cases,Male 30,Female 10,aged 27-80,with an average age of48.48±13.44 years);L1 with one complications(65 cases,Male 31,Female 34,aged 38-83,with an average age of 57.98±10.12 years);L2with two complications(35 cases,Male 22,Female 13,aged 36-78,with an average age of 58.43±8.68years);L3 with three complications(8 cases,Male 5,Female 3,aged 49-69,with an average age of 60.00±5.63years).The pancreas of each patient was detected by two-dimensional ultrasound and ARFI with Siemens ACUSON S2000 color Doppler ultrasonic diagnostic instrument,equipped with VTQ.The height,weight,age,gender,duration of diabetes,systolic blood pressure were recorded and the BMI was calculated.All patients who were fasting for 8-12 hours were taken the elbow venous blood in the morning for fasting blood glucose,fasting C peptide,glycosylated hemoglobin,triglyceride,total cholesterol,high-density lipoprotein cholesterol and low-density lipoprotein cholesterol.SPSS 22.0 statistical software was used to test the normal distribution of the experimental data.The differences between groups were compared by the Kruskal-Wallis test or one-way ANOVA of variance.Pearson or Spearman bivariate correlation analysis was performed to evaluate the correlation between the SWV in pancreatic body and other parameters.Draw ROC curve and calculate the area under the curve to evaluate the diagnostic efficacy of SWV in pancreas on microangiopathy,and then explore the risk factors of more microangiopathy in T2DM by multiple ordered logistic regression analysis.A value of P<0.05 was considered statistically significant.Result1.Comparison of clinical data between the four groups The duration of diabetes increased with the number of microvascular complications in four groups(P < 0.05);there was significant difference in age,systolic blood pressure and duration of diabetes in L1,L2 and L3 compared with L0(P < 0.05);there was significant difference in duration of diabetes between L1,L2 and L3.(P< 0.05)2.Comparison of laboratory parameters between four groups There was no significant difference in FBG,FCP,Hb A1 c,TG,TC,LDL-C and HDL-C between the four groups(P > 0.05).The urinary microalbumin in L1,L2 and L3 was higher than that of L0.(P < 0.05).3.Comparison of ultrasonic parameters between four groups There was no significant difference in thickness of pancratic body between four groups(P>0.05).The SWV in the head,body and tail of pancreas in the T2DM groups with microvascular complications(L1,L2,L3)was greater than that in the L0 group without complications(P < 0.05).There was no significant difference in pacreatic SWV between L1 and L2(P > 0.05).There was significant difference between L1 and L3,L2 and L3(P <0.05).4.Evaluation of SWV in different parts of pancreas for microvascular complications in T2DM The area under the ROC curve of SWV in pancreatic body was 0.76,which was higher than that of SWV in head and tail of pancreas.According to Youden index,the best cut off value was 1.31m/s,and the corresponding Youden index,sensitivity and specificity were 51.4%,63.9%,and 80.0%,respectively.5.The factors influencing the SWV in pancreatic body To investigate the correlations of the SWV in the pancreatic body with the clinical and biochemical parameters,Pearson or Spearman bivariate correlation analysis was performed.The results showed that SWV in pancreatic body was positively correlated with age,duration of diabetes,TC,LDL-C,number of microvascular complications,and negatively correlated with the thickness of pancreatic body.6.Risk factors of more microvascular complications The number of microvascular complications was positively correlated with age,duration of diabetes,the SWV value of pancratic body and microalbuminuria.Multivariate adjusted ordinal logistic model analysis showed there was a significant shift towards the occurrence of more microvascular complications for patients with increasing of the SWV in pancreatic body(OR 32.33),long duration of diabetes(OR1.121),and elevation of microalbuminuria(OR 1.003).Conclusion(1)When the SWV of pancreatic body is greater than 1.31m/s,it indicates the occurrence of diabetic miacrovascular complications,and the SWV in pancreatic body has the potential value for diabetic microangiopathy and its occurrence.(2)The SWV in pancreatic body is the most important risk factor for more microvascular complications.With the increase of SWV of pancreas,the number of diabetic complications is increasing,and the scope of T2DM systemic microvascular disease is also expanded,.(3)As a non-invasive imaging modality to assess pancreatic fibrosis,the SWV in pancreatic body may not only reflect the microvascular changes inside the pancreas,but also possess the possibility of serving as a new marker to reflect the occurrence of microangiopathy outside the pancreas. |
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