CN112006718A - Early diagnosis method for early-stage pathological changes of diabetes - Google Patents
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/08—Detecting organic movements or changes, e.g. tumours, cysts, swellings
- A61B8/0891—Detecting organic movements or changes, e.g. tumours, cysts, swellings for diagnosis of blood vessels
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
- A61B5/021—Measuring pressure in heart or blood vessels
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Abstract
The invention discloses an early diagnosis method for early diabetic lesions, which comprises the following steps: s1, Doppler checking: probing peripheral arteries of the diabetic by using a Doppler blood flow detector, and acquiring an artery frequency spectrum waveform and a peak flow velocity Vmax; s2, determination of ABI: ABI assay. The invention belongs to the technical field of diabetes diagnosis, and relates to an early diagnosis method for early pathological changes of diabetes, wherein in the research of the invention, age, glycosylated hemoglobin and cholesterol are different in two groups with different ABIs, which indicates that hyperglycemia, hypercholesterolemia and aging increase are high-risk factors formed by PAD, the severe consequence of PAD is disabling and death, the incidence rate of cardiovascular events reaches 21.4 percent after PAD is diagnosed for one year, the high-risk factors are monitored in clinical work, ABI is determined as early as possible for evaluation, useful clues such as Doppler frequency harmonic waveform, peak flow rate and the like are also paid attention to, and color Doppler ultrasound examination is carried out if necessary, so that preventive measures are actively taken, and the method is helpful for preventing PAD from generating and developing.
Description
Technical Field
The invention relates to the technical field of diabetes diagnosis, in particular to an early diagnosis method for early-stage pathological changes of diabetes.
Background
Diabetes is a chronic metabolic disease caused by genetic factors and environmental factors. The main reason is a syndrome of elevated blood sugar levels due to the failure of the human pancreas to produce insulin normally or the body to utilize insulin normally. Diabetic nephropathy is one of the most important complications in diabetic patients, and can cause irreversible substantial damage to the kidney: the disease pathology involves small blood vessels and glomeruli in the kidney, which can cause albuminuria to occur. After diabetic nephropathy occurs in a patient, due to factors such as blood glucose concentration increase, glomerular filtration pressure increases and protein gradually leaks out, and if the condition is not controlled at this time, a large amount of continuous proteinuria occurs. By this stage renal pathology irreversible kidney damage occurs. According to the survey and analysis of medical data, the probability of the diabetic patients suffering from renal failure is 17 times higher than that of the non-diabetic patients.
Early diagnosis and active treatment will significantly reduce the incidence of other complications of diabetes, mainly kidney disease. However, diabetic kidney disease is asymptomatic in the early stages and is not reversible when symptoms appear. Current diagnostic methods are mainly urine albumin/creatinine ratio (ACR) and estimation of glomerular filtration rate (eGFR). ACR is a method for detecting protein in urine, can indicate the condition of kidney diseases, and eGFR refers to the amount of filtrate generated by two kidneys in unit time and is an index for measuring kidney functions. The two indexes are susceptible to metabolic disturbance and hemodynamics, such as movement, excessive protein intake, blood sugar increase and the like, and in addition, the two indexes cannot diagnose diabetes at early stage, and organ irreversible damage can be caused if the two indexes are detected too late.
Disclosure of Invention
Technical problem to be solved
Aiming at the defects of the prior art, the invention provides an early diagnosis method for early-stage pathological changes of diabetes, which has the advantages of early diagnosis of diabetes and the like and solves the problem of late diagnosis period of the existing diabetes.
(II) technical scheme
In order to achieve the purpose, the invention provides the following technical scheme: a method for early diagnosis of early stage diabetic lesions, comprising the steps of:
s1, Doppler checking: probing peripheral arteries of the diabetic by using a Doppler blood flow detector, and acquiring an artery frequency spectrum waveform and a peak flow velocity Vmax;
s2, determination of ABI: the ABI measuring method comprises the following steps: standard supine position, measuring arterial systolic pressure of both upper arms, ankle, tibioposterior, instep), ABI being maximum value of systolic pressure of ankle/maximum value of systolic pressure of both upper arms,
s3, there are three types of arterial doppler blood flow waveforms: a 3-phase normal waveform consisting of an upward big wave followed by a downward small wave and a final upward small wave, which respectively represent systolic forward blood flow, diastolic reverse blood flow (only upward big wave) to blood flow and reverse blood flow), 2-phase (lack of final upward small wave), and 1-phase (only upward big wave);
s4, grouping: any one side of the left and right ABIs is less than 0.9, the group I is formed, the left and right ABIs are more than 0.9, the group II is formed, and the right side waveform is 1: indicating that the Doppler blood flow waveform of the right tibia or the right dorsum of the foot is 1 phase or 2 phase; : right waveform 2 group: showing that the Doppler blood flow waveforms of the right tibia and the right foot artery are 3 phases, the left side is the same as the left side, the ultrasonic hardening shows that the color Doppler ultrasonic discovers lesions such as lower limb arteriosclerosis plaques, and the peak flow velocity: less than 10cm/s is 1 group, more than 10cm/s is 2 groups;
s5, processing the statistical analysis by SPSS12.0 statistical software, representing the normally distributed measurement data by XtS, and comparing the two groups by 1 test; the non-normally distributed measurement data is expressed by a median of 25-75 percent), and the two groups are compared by adopting rank sum test; the count data was examined by x2 and the match between ABI and Doppler flow waveform, peak flow rate was examined by Kappa consistency.
Preferably, the Doppler blood flow detector is an ES-100V38MHz probe manufactured by Hadeco corporation of Japan.
(III) advantageous effects
Compared with the prior art, the invention provides an early diagnosis method for early diabetic lesions, which has the following beneficial effects:
1. according to the method for early diagnosis of early pathological changes of diabetes, in our research, age, glycosylated hemoglobin and cholesterol are different in two groups with different ABIs, which indicates that hyperglycemia, hypercholesterolemia and aging are high-risk factors formed by PAD, the serious consequence of PAD is disabling death, the incidence rate of cardiovascular events reaches 21.4% after PAD is diagnosed for one year, high-risk factor monitoring is carried out in clinical work, ABI is determined as early as possible for evaluation, useful clues such as Doppler frequency harmonic waveform and peak flow rate are also noticed, and color Doppler ultrasonic examination is carried out if necessary, so that preventive measures are actively taken, and the method is helpful for preventing PAD from generating and developing.
Detailed Description
The technical solutions in the embodiments of the present invention will be clearly and completely described below with reference to the embodiments of the present invention, and it is obvious that the described embodiments are only a part of the embodiments of the present invention, and not all of the embodiments. All other embodiments, which can be derived by a person skilled in the art from the embodiments given herein without making any creative effort, shall fall within the protection scope of the present invention.
A method for early diagnosis of early stage diabetic lesions, comprising the steps of:
s1, Doppler checking: probing peripheral arteries of the diabetic by using a Doppler blood flow detector, and acquiring an artery frequency spectrum waveform and a peak flow velocity Vmax;
s2, determination of ABI: the ABI measuring method comprises the following steps: standard supine position, measuring arterial systolic pressure of both upper arms, ankle, tibioposterior, instep), ABI being maximum value of systolic pressure of ankle/maximum value of systolic pressure of both upper arms,
s3, there are three types of arterial doppler blood flow waveforms: a 3-phase normal waveform consisting of an upward big wave followed by a downward small wave and a final upward small wave, which respectively represent systolic forward blood flow, diastolic reverse blood flow (only upward big wave) to blood flow and reverse blood flow), 2-phase (lack of final upward small wave), and 1-phase (only upward big wave);
s4, grouping: any one side of the left and right ABIs is less than 0.9, the group I is formed, the left and right ABIs are more than 0.9, the group II is formed, and the right side waveform is 1: indicating that the Doppler blood flow waveform of the right tibia or the right dorsum of the foot is 1 phase or 2 phase; : right waveform 2 group: showing that the Doppler blood flow waveforms of the right tibia and the right foot artery are 3 phases, the left side is the same as the left side, the ultrasonic hardening shows that the color Doppler ultrasonic discovers lesions such as lower limb arteriosclerosis plaques, and the peak flow velocity: less than 10cm/s is 1 group, more than 10cm/s is 2 groups;
s5, processing the statistical analysis by SPSS12.0 statistical software, representing the normally distributed measurement data by XtS, and comparing the two groups by 1 test; the non-normally distributed measurement data is expressed by a median of 25-75 percent), and the two groups are compared by adopting rank sum test; the count data was examined by x2 and the match between ABI and Doppler flow waveform, peak flow rate was examined by Kappa consistency.
Preferably, the Doppler blood flow detector is an ES-100V38MHz probe manufactured by Hadeco corporation of Japan.
Glycated hemoglobin and cholesterol are differentiated in two groups with different ABI, wherein 1 group is larger than the II group, and the difference has statistical significance. Sex, blood pressure, course of diabetes, triglyceride, high density lipoprotein, low density lipoprotein, uric acid. Color Doppler ultrasound suggests that the finding rate of arteriosclerosis of lower limbs is 1 group higher than that of arteriosclerosis of lower limbs II group, the difference has significance, and 58.2% of patients with ABI >0.9 group also find arteriosclerosis or plaque. ABI and ankle artery doppler flow waveforms. ABI is well matched to arterial waveforms and is statistically significant. ABI is not highly compatible with peak flow rate.
Discussion ABI is an important diagnostic index and is widely used to assess lower limb arterial lesions. ABI ≦ 0.9 is a qualitative change, and from a preventive perspective, ABI is not yet a true early indicator. In fact, PAD formation is a gradual process, and some indicators may give us earlier indications in the process. In this study, the doppler flow waveform is a valuable indicator, while the peak flow rate is a variable parameter. The reason for the variability is the difference in the probe positions. The flow rate of the blood vessels of the lower limb gradually decreases from the femoral artery to the dorsalis pedis artery, and the flow rate of the blood vessels of the ankle part is increased in the narrow section and reduced in the blood vessels after the narrow section.
The detected blood flow velocity depends in part on the operator's manipulation, such as the angle of the probe. This indicator is therefore an unstable parameter. The pulse Doppler is lack of two-dimensional images, the unobstructed degree of the blood vessel cannot be visually evaluated, and the existence of stenosis cannot be judged, so that the measured flow velocity is only a clue. But if the flow rates on both sides of the limb are found to differ too much, further examination should be made. Further examinations may include B-mode, lower extremity arteriography, etc. But the former is non-invasive and economical, is convenient for follow-up of disease progress and understanding of treatment effect, and is suitable for earlier patients. In this study, color Doppler ultrasound was used to find differences in the positive rate of arteriosclerosis in two groups of patients with different ABIs. The ABI is less than or equal to 0.9 group of patients, and the lower limb arteriosclerosis or plaque can be found by color Doppler ultrasound. While 58.2% of patients in ABI >0.9 group also found arteriosclerosis or plaque. Artery lesions discovered by color doppler ultrasound are earlier than ABI and are also more intuitive. The grouping of peak flow rates is explained below, and the clinical significance of peak flow rates is analyzed in this study using ABI as a standard. ABI less than 0.9 represents an ankle or ankle blockage may occur, resulting in a slowing of ankle blood flow. That is, even if the ankle has a stenosed vessel, the stenosed segment is accelerated, and this increase in peak ankle blood flow is not associated with a decrease in ABI.
Therefore, only the peak flow reduction is considered in the grouping in accordance with ABI.
The invention has the beneficial effects that: according to the method for early diagnosis of early pathological changes of diabetes, in our research, age, glycosylated hemoglobin and cholesterol are different in two groups with different ABIs, which indicates that hyperglycemia, hypercholesterolemia and aging are high-risk factors formed by PAD, the serious consequence of PAD is disabling death, the incidence rate of cardiovascular events reaches 21.4% after PAD is diagnosed for one year, high-risk factor monitoring is carried out in clinical work, ABI is determined as early as possible for evaluation, useful clues such as Doppler frequency harmonic waveform and peak flow rate are also noticed, and color Doppler ultrasonic examination is carried out if necessary, so that preventive measures are actively taken, and the method is helpful for preventing PAD from generating and developing.
Although embodiments of the present invention have been shown and described, it will be appreciated by those skilled in the art that changes, modifications, substitutions and alterations can be made in these embodiments without departing from the principles and spirit of the invention, the scope of which is defined in the appended claims and their equivalents.
Claims (2)
1. An early diagnosis method for early-stage diabetic lesions, which is characterized by comprising the following steps: the method comprises the following steps:
s1, Doppler checking: probing peripheral arteries of the diabetic by using a Doppler blood flow detector, and acquiring an artery frequency spectrum waveform and a peak flow velocity Vmax;
s2, determination of ABI: the ABI measuring method comprises the following steps: standard supine position, measuring arterial systolic pressure of both upper arms, ankle, posterior tibia and instep), ABI being maximum value of ankle systolic pressure/maximum value of systolic pressure of both upper arms;
s3, there are three types of arterial doppler blood flow waveforms: a 3-phase normal waveform consisting of an upward big wave followed by a downward small wave and a final upward small wave, which respectively represent systolic forward blood flow, diastolic reverse blood flow (only upward big wave) to blood flow and reverse blood flow), 2-phase (lack of final upward small wave), and 1-phase (only upward big wave);
s4, grouping: any one side of the left and right ABIs is less than 0.9, the group I is formed, the left and right ABIs are more than 0.9, the group II is formed, and the right side waveform is 1: indicating that the Doppler blood flow waveform of the right tibia or the right dorsum of the foot is 1 phase or 2 phase; : right waveform 2 group: showing that the Doppler blood flow waveforms of the right tibia and the right foot artery are 3 phases, the left side is the same as the left side, the ultrasonic hardening shows that the color Doppler ultrasonic discovers lesions such as lower limb arteriosclerosis plaques, and the peak flow velocity: less than 10cm/s is 1 group, more than 10cm/s is 2 groups;
s5, processing the statistical analysis by SPSS12.0 statistical software, representing the normally distributed measurement data by XtS, and comparing the two groups by 1 test; the non-normally distributed measurement data is expressed by a median of 25-75 percent), and the two groups are compared by adopting rank sum test; the count data was examined by x2 and the match between ABI and Doppler flow waveform, peak flow rate was examined by Kappa consistency.
2. The method for early diagnosis of early stage diabetes mellitus lesion according to claim 1, wherein: the Doppler blood flow detector adopts an ES-100V38MHz probe manufactured by Hadeco corporation of Japan.
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