Study On Vascular Elasticity And Hemodynamics Of Upper Limb Artery In Diabetic Patients With Peripheral Neuropathy

Part One:Hemodynamic Gradient Changes of Normal Upper Extremity Artery from Brachial Artery to Fingertip ArteriolesObjectives:To investigate the hemodynamic characteristics and change trend in healthy adults from brachial artery to ipsilateral fingertip arterioles.Methods:104 healthy adults from the Health Management Center of North Sichuan Medical College were enrolled in this study from April 2020 to December 2020.There were 47 males and 57 females,aged 27～70(56.06±8.53).There was no statistically significant difference in age between sexes(P<0.05).The brachial artery,radial artery,superficial metacarpal artery,palmar proper digital artery(PPDA)and third grade artery arch of fingernail bed(FN3AA)in bilateral arms were detected by CDFI and Angio PLUS.The Anatomical and hemodynamic parameters were obtained to analyze the differences and trends of the parameters among the arteries.Results:(1)The Doppler spectrum of the upper extremity artery mainly showed four types:monophasic waveform,typical triphasic waveform,atypical triphasic waveform and other rare waveforms.The proportion of monophasic waveform from brachial artery to palmar proper digital artery increased gradually(Mantel-Haenszel χ2=197.952,Spearman’s R=-0.453,P<0.001).The waveform of PPDA and FN3AA were all monophasic.(2)When the blood flow spectrum of brachial artery or radial artery showed monophasic waveform,their branch arteries showed monophasic waveform.(3)There were statistically significant differences in vessel diameter,PSV,RI,PI,S/D,blood flow volume velocity and systolic blood flow acceleration from brachial artery to FN3AA(Kruskal Wallis test:H=980.569,780.085,690.868,739.321,635.824,889.365,863.741,P<0.001),and above parameters which showed a decreasing trend were related to the anatomical position of arteries(Spearman’s R=-0.971,-0.856,-0.811,-0.841,-0.804,-0.924,-0.903;P<0.001).Conclusion:The hemodynamic parameters present regular gradient changes among upper extremity arteries.Conventional high-frequency color Doppler combined with Angio PLUS could be used to precisely monitor the hemodynamic status of upper extremity arteries among different levels.Part Two:Study on Vascular Elasticity and Hemodynamics of Upper Limb Artery in Diabetic Patients with Peripheral NeuropathyObjectives:To investigate the characteristics of arterial elasticity and hemodynamics in patients with diabetes mellitus and diabetic peripheral neuropathy.Methods:116 patients with type 2 diabetes mellitus were enrolled from the Department of Endocrinology,Affiliated Hospital of North Sichuan Medical College from April 2020 to December 2020,which included 58 males and 58 females.All kinds of congenital and secondary heart disease,hyperthyroidism,hypothyroidism,liver failure,renal failure and other diseases affecting peripheral arterial hemodynamics and vascular structure were excluded.All kinds of upper limb vascular variation,nerve injury,surgical operation,pregnant and lactating women were excluded.According to the clinical diagnostic criteria of diabetic peripheral neuropathy(DPN),the patients were divided into simple T2DM group(n=58)and DPN group(n=58).At the same time,104 health examination personnel matched with gender and age were included.The data of laboratory examination and basic clinical information were collected.The brachial artery(BA),ulnar artery(UA),radial artery(RA),superficial palmar arch artery(SPAA),proper palmar digital artery(PPDA),dorsal digital artery arch(DDAA)and third grade artery arch of fingernail bed(FN3AA)of bilateral arms were detected by conventional high frequency color Doppler ultrasound combined with Angio PLUS,and the hemodynamic parameters such as diameter,PSV,EDV,RI,PI,S/D and VFlow were obtained.Shear wave elastography was used to obtain the maximum(max),minimum(min),mean(mean)and dispersion(SD)of Young’s modulus of anterior and posterior wall of brachial artery.The differences and correlations of various parameters among diabetic group,diabetic peripheral neuropathy group and normal control group were analyzed.Results:(1)Compared with the normal control group,the heart rate,body weight and BMI of DPN group and T2DM group were increased;the number of anastomotic branches of the second and third grade arch of nail bed was decreased and the intima-media thickness of brachial artery was increased;the shear wave elastic values of the anterior and posterior wall of brachial artery were increased;the RI,PI and S/D values of UA,RA,PPDA,DDAA and FN3AA were increased;the differences were statistically significant(P<0.05).(2)Compared with T2DM group,the proportion of monophasic wave spectrum of BA,UA,RA and SPAA in DPN group was smaller,and the difference was statistically significant(P<0.05);there were 4 cases,2 cases and 1 case of abnormal waveform at the arterial level of BA,UA and RA respectively.(3)Compared with T2DM group,the intima-media of brachial artery was thicker and more atherosclerosis spots were found in DPN group;the EDV and VFlow of SPAA,PPDA,DDAA were lower(P<0.05);the RI,PI and S/D of upper limb arteries in DPN group were higher than those in T2DM group,and the differences in RA,SPAA,PPDA,DDAA and FN3AA artery levels were statistically significant(P<0.05)(4)The duration of diabetes,the highest fasting blood glucose in 3 months,the fluctuation of fasting blood glucose in 3 months,the proportion of hypoglycemic reaction,serum creatinine and the proportion of renal function injury in DPN group were higher than those in T2DM group(P<0.05).Conclusion:The arterial wall of the upper extremity in T2DM patients is hard and accompanied by abnormal changes of arterial hemodynamics.The blood glucose control of DPN patients was poor,and the hemodynamics of peripheral artery and microcirculation were more easily damaged than those of simple T2DM patients.The combined application of multimodal ultrasound imaging technology can detect the changes of peripheral arterial wall elasticity and hemodynamics earlier.