Color Doppler and duplex sonography in 5 patients with thoracic outlet syndrome.

PURPOSE: To evaluate the use of color Doppler sonography in the diagnosis of thoracic outlet syndrome. METHODS: We studied color Doppler sonographic findings in 5 clinically suspected cases of thoracic outlet syndrome. The subclavian artery and vein were studied in varying degrees of abduction to assess the severity of the syndrome. RESULTS: Significant changes, i.e., stages of increased velocities, preocclusion, and occlusion in the subclavian artery in varying degrees of abduction, were noted in 4 of 5 cases. Blunted flow in the axillary artery (4 patients) and a rebound increase in velocities on release of abduction were noted in 3 patients. These changes suggested that significant narrowing was causing symptoms. CONCLUSION: Color Doppler sonography is a noninvasive, effective method compared with digital subtraction angiography in the diagnosis of thoracic outlet syndrome.     

Nonalcoholic fatty liver disease (NAFLD) in nonobese patients with diabetes: Prevalence and relationships with hemodynamic alterations detected with Doppler sonography

Aim

To evaluate the prevalence, severity, and hemodynamic features of nonalcoholic fatty liver disease (NAFLD) in nonobese diabetics.

Methods

We studied 100 consecutive nonobese (body mass index [BMI] < 30) patients with type 1 (n = 17) or type 2 (n = 83) diabetes and no known causes of liver disease. Steatosis was diagnosed and graded with ultrasonography. Digital sonographic images of the liver and right kidney were analyzed with dedicated software (HDI-Lab), and the liver/kidney ratio of grey-scale intensity was calculated as an index of the severity of the steatosis. Severity scores ranging from 0 (none) to 5 (severe) were compared with sonographic and Doppler findings (right liver size, portal vein diameter and flow velocity, hepatic and splenic arterial pulsatility indices, hepatic-vein flow profile and A- and S-wave velocities).

Results

The prevalence of steatosis was 24% in type I and 80% in type II diabetes (grade 1 in 17%, grade 2 in 34%, grade 3 in 33%, grade 4 in 9%, grade 5 in 7%). In patients with steatosis (especially those with grades 4–5 disease), hepatic volume was increased (p < 0.005). Portal vein diameter was increased in grade 5 steatosis. The hepatic artery pulsatility index was significantly increased, particularly in grades 4 and 5 (p < 0.0001); portal and A-wave velocities were significantly reduced in grades 3–5 (p < 0.001); and the hepatic vein flow profile was altered in 27% (biphasic: 20%, flat: 7%) patients with steatosis, although there was no correlation with severity.

Conclusions

NAFLD is very frequent in nonobese diabetics with type 2 but not type 1 disease, and it is associated with hepatomegaly and liver hemodynamic alterations only when it is severe.     

Metabolic and hemodynamic effects of pioglitazone in obese patients with type 2 diabetes

The purpose of the study was to evaluate the effectiveness and safety of pioglitazon, a hypoglycemizing preparation belonging to the group of thiazolidinediones, in treatment of diabetes mellitus (DM) type 2. Twenty DM type 2 patients were included in the study. The use of pioglitazon during 12 weeks resulted in a significant decrease in glycated hemoglobin, fasting glycemia, and postprandial reduction in insulinemia and insulinoresistance index HOMA-IR, as well as an improvement of lipid blood spectrum and the lessening of visceral obesity. Besides, a positive effect on arterial pressure was noted. The study revealed no significant adverse effects; good tolerance to treatment was noted in 90% of the patients.     

Metabolic and hemodynamic markers of endothelial dysfunction in patients with hypertension and patients with type 2 diabetes during the cold pressor test

Leptin, a 167-amino acid peptidic hormone secreted by adipose tissue, acts mainly in the arcuate hypothalamus nucleus as a satiety signal, but given its closed connections with inflammatory and endothelial systems, a probable regulatory role in blood pressure (BP) control by interaction with nitric oxide (NO) and C-reactive protein (CRP) has also been described. The cold pressor test (CPT) is a simple test that indirectly determines endothelial dysfunction. In this work, biochemical indicators (CRP, leptin, and NO) and hemodynamic indicators (systolic and diastolic BP) were performed and evaluated in patients with hypertension, patients with type 2, and control subjects during a single CPT for assessment of endothelial dysfunction. A total of 43 subjects aged 25 to 60 years were divided into three groups: 15 healthy volunteers, 13 patients with hypertension, and 15 patients with type 2 diabetes were included in the study. A complete clinical history was obtained from each subject and a complete physical examination, including an electrocardiogram, was carried out. During the 30-minute assay, 0.9% saline solution was infused intravenously. CPT was performed to assess the cardiovascular reactivity at 15 minutes. The cardiovascular variables (systolic and diastolic BP) were measured at 0, 16, and 30 minutes. In addition, serum variables were extracted at the beginning and at the end of the experiment and statistical analysis was performed. CPT caused in all subjects a significant increase in BP and pulse. There were no significant differences in CRP or leptin in all groups, although we observed significant differences for NO (P < 0.05). Sensibility and specificity for all biochemical variables resulted in nonsignificant statistical or clinical importance as markers of endothelial dysfunction; however, a positive association was found when leptin and NO were evaluated together (sensibility, 0.2; specificity, 0.8). CRP, leptin, and NO did not show any direct or significant association with the hemodynamic variables in this study, although a relationship was observed in NO according to group and among biochemical variables when studied together.     

2型糖尿病患者葡萄糖耐量试验后胰高糖素样肽1水平变化

目的：探讨2型糖尿病(T2DM)患者葡萄糖耐量试验(OGTT,口服葡萄糖75 g)后胰高糖素样肽1(GLP-1)水平与血糖、胰岛β细胞功能、胰岛素抵抗的关系。方法 T2DM 患者35例及健康对照组30例均禁食12小时以上后行 OGTT,采集0(即空腹)、0.5、2小时血样,分别测定血浆葡萄糖、胰岛素、GLP-1浓度、糖化血红蛋白(HbA1 c)水平。结果 T2DM 患者的0、0.5、2小时血糖、空腹胰岛素及 HbA1 c 明显高于对照组(P <0.05),而T2DM 患者0.5小时胰岛素及2小时 GLP-1水平明显低于对照组(P <0.05),餐后2小时胰岛素水平及0、0.5小时GLP-1水平与对照组比较差异无统计学意义(P >0.05)。结论餐后 GLP-1水平的上升与进餐刺激有关;T2DM 患者口服葡萄糖后 GLP-1的分泌水平可能与血糖水平、胰岛功能、胰岛素抵抗相关。     

Obstetric duplex sonography in patients with lupus anticoagulant syndrome

The lupus anticoagulant (LAC) syndrome has recently been described as a potential cause of many cases of preeclampsia. This syndrome is associated with a maternal history of repeated first trimester abortions and second and third trimester demise in utero. Umbilical arterial duplex Doppler systolic/diastolic (S/D) ratios and uterine artery S/D ratios for 28 patients whose pregnancies were complicated by lupus anticoagulant syndrome are presented. Five of the six patients who subsequently delivered fetuses small for gestational age (SGA) demonstrated abnormal umbilical arterial S/D ratios, whereas only two of these patients demonstrated abnormally elevated uterine S/D ratios. Twenty three of 28 patients were treated with aspirin and prednisone throughout gestation; no cases of fetal demise in utero were noted.     

应用彩色多普勒超声探测早期糖尿病视网膜病变血流动力学的变化

目的：探讨2型糖尿病早期糖尿病视网膜病变发生发展过程中的视网膜血流动力学变化。方法：随机抽取无眼部症状的2型糖尿病患者应用彩色多普勒超声监测其视网膜中央动脉的血流参数,分析其收缩期流速、舒张期流速和阻力指数的变化,所有患者进行眼底荧光造影检查进行分期。结果：T2DM组的878只眼中,46只眼为DR1期,CRA的血流速度降低,RI增高,其余为NDR。但其中63只眼CRA的流速降低,但RI无明显增高,86只眼仅表现为流速稍低。结论：DR早期彩色多普勒超声可发现在DR发现前视网膜血流动力学的异常变化,提示视网膜血流灌注不良在DR的发生和发展过程中起作用。     

微量蛋白尿的2型糖尿病患者下肢血流动力学的变化

INTRODUCTION It has been proved recently that obesity, microalbuminuria (MAU) and low- insulin resistance are independent risk factors and increase the mortality of cardiovascular diseases in type 2 diabetic patients. In order to study the relationship between microalbuminria and early larger artery lesions in type 2 diabetic patients,we analyzed the relationship between urine albumin excretory rate and arterial hemodynamic change in lower limbs.     

高频超声结合增强型能量多普勒成像评价Ⅱ型糖尿病患者指尖微血管变化的应用研究

目的寻找Ⅱ型糖尿病患者并发末梢微血管病变的早期证据，为临床提供有效的观察方法和指标。方法应用高频超声结合增强型能量多普勒显像（e-Flow）观察30例Ⅱ型糖尿病患者右手中指末节指腹和甲床内微血管床的分布特征、走行和数量，并计算指腹动脉和甲床动脉的收缩期峰值速度（PSV）、舒张期峰值速度（EDV）以及血管阻力（RI）参数。观察结果与32例年龄、性别相匹配的健康成人对照。结果①正常人中指末节指腹的血管供应丰富，e-Flow清晰显示手指的两支掌侧固有动脉及发出的分支，呈网状分布于整个指腹。血管形态勾勒清晰，走行正常，可追踪全程；甲床内微血管呈纵行分布，末梢可见横行吻合支，血管网清晰，血供丰富。②糖尿病患者中指的末节指腹血管网显示欠丰富，仅可显示一或两支固有动脉分支或仅见零星点条状血流，血管走行迂曲断续，与正常人差异有统计学意义（P〈0．05）；甲床内微血管，尤其是远端血管显示不良，仅见零星点条状血流，与正常人差异有统计学意义（P〈0．05）；糖尿病合并症者的指端微血管异常较单纯糖尿病患者为甚。③与正常人比较，糖尿病患者的指腹动脉、甲床动脉PSV、EDV测值稍减低（P〈0．05～0．09），RI相应升高（P〈0．05）。结论E-Flow结合传统彩色多普勒血流成像技术可敏感、准确地反映糖尿病患者的指端微血管分布减少，血管阻力增高，为临床早期诊断糖尿病微血管病变和评价治疗效果提供了新手段。     

Optimizing insulin secretagogue therapy in patients with type 2 diabetes: a randomized double-blind study with repaglinide

OBJECTIVE: Repaglinide, a novel antidiabetic agent that has a rapid onset and short duration of action, was developed for mealtime dosing. The purpose of this pharmacodynamic study was to validate a prandial regimen of repaglinide by comparing meal-related dosing with a regimen in which the same total daily dose was divided into only two doses at morning and evening meals. RESEARCH DESIGN AND METHODS: The study was a double-blind, randomized, parallel-group trial in 19 antidiabetic agent-naive subjects with type 2 diabetes (mean age 58 years, known duration of diabetes 3.5 years, HbA(1c) 7.3%, and BMI 32 kg/m(2)). Patients were randomly assigned to receive repaglinide either before each of the three main meals or before breakfast and before the evening meal. Patients in both groups received the same total daily dose of repaglinide. Twenty-four hour profiles of blood glucose, plasma insulin, and plasma C-peptide concentrations were measured at baseline and after 4 weeks of treatment. RESULTS: Repaglinide increased postprandial insulin levels and markedly reduced postprandial glucose levels relative to baseline in both groups. Significant reductions were also recorded in fasting blood glucose and HbA(1c) levels. The repaglinide regimen, in which a dose was taken before each main meal, was more effective in improving glycemic control (including postprandial glucose and HbA(1c) levels) than the same total dose of repaglinide divided into morning and evening mealtime doses. CONCLUSIONS: These data support the strategy of mealtime dosing with repaglinide. The improvements in glycemic control observed in these patients are encouraging. In addition to classic parameters of glycemic control, improvements in postprandial glucose excursions may prove to be important because postprandial hyperglycemia has been suggested to be an independent risk factor for cardiovascular disease in diabetes.     

运动负荷试验对2型糖尿病患者左室舒张功能变化的早期评估作用

背景彩色多普勒超声可检出2型糖尿病患者的早期心肌病变,运动负荷试验配合彩色多普勒超声检查对于该病变的检出又能起到什么作用呢?目的比较分析运动负荷试验加彩色多普勒超声检查与单纯彩色多普勒超声检查对2型糖尿病患者左室舒张功能降低的早期评估作用.设计病例-对照及自身,前后对照观察.单位一所市级医院电诊科和内分泌科.对象选择2004-03/12沈阳市红十字会医院内分泌科住院的2型糖尿病患者36例,男25例,女11例.纳入的糖尿病患者均无心血管疾病并发症,且自愿参加.正常对照组32例,为同期本院体检健康自愿者,男20例,女12例.方法应用美高仪平板运动试验仪给予两组运动负荷.运动前(静息状态下)及运动负荷结束后即刻应用Vivid 4彩色多普勒超声诊断仪检测E峰峰值流速、A峰峰值流速、E峰峰值流速/A峰峰值流速比值、等容舒张期时间.主要观察指标两组运动负荷前后心功能指标比较.结果34例糖尿病患者完成了运动负荷试验,1例出现频发室性期前收缩,另1例出现心前区疼痛中止试验.对照组32例均完成试验.①患者组运动前E峰峰值流速/A峰峰值流速比值明显低于对照组运动前(0.90±0.25,1.40±0.30,P＜0.05);等容舒张期时间明显大于对照组运动前[(112.07±20.16),(98.45±8.55)ms,P＜0.05].②患者组运动负荷后E峰峰值流速/A峰峰值流速比值明显低于对照组运动后(0.62±0.12,1.28±0.87,P＜0.01);等容舒张期时间明显大于对照组运动后[(138.10±19.21),(97.37±9.61)ms,P＜0.01].结论彩色多普勒超声检查可早期监测和评估2型糖尿病患者的心功能变化;运动负荷试验并彩色多普勒超声检查,因加了运动负荷的诱发作用,可使结论更准确客观,更有早期的价值.     

2型糖尿病患者凝血变化的试验分析

目的　观察 2型糖尿病患者凝血指标的变化及其临床意义。方法　利用双抗体夹心ELISA法检测 6 5例 2型糖尿病患者 (其中 33例合并血管病变 )及 38名健康对照者血浆血管性假性血友病因子抗原 (vWF :Ag)、凝血酶调节蛋白 (TM)、凝血酶原片段 (F1+ 2 )、血小板选择素 (P selectin)水平。结果　糖尿病组血浆vWF :Ag (14 7.3± 2 9.5 ) %、TM (2 9.9± 11.3) μg/L、F1+ 2 (0 .78± 0 .19)nmol/L、P selectin (16 .9± 3.2 ) μg/L水平均显著高于健康对照组 ,差异有显著意义 (P <0 .0 5～ 0 .0 1) ;有血管病变的患者血浆vWF :Ag (16 1.6± 34.2 ) %、TM (32 .9± 13.2 ) μg/L、F1+ 2 (0 .96± 0 .2 5 )nmol/L、P selectin(19.2± 3.4 ) μg/L水平均显著高于无血管病变组 ,差异有显著意义 (P <0 .0 5～ 0 .0 1) ;相关分析显示 ,F1+ 2 、P selectin与vWF :Ag显著正相关 (r分别为 0 .4 2 3、0 .397,P均 <0 .0 1) ,F1+ 2 、P selectin与TM亦显著正相关 (r分别为 0 .4 5 8、0 .4 11,P均 <0 .0 1)。结论　 2型糖尿病患者均存在血管内皮损伤 ,并由此引起血小板活化和血液的高凝状态 ;血浆vWF :Ag、TM、F1+ 2 、P selectin水平在一定程度上可反映 2型糖尿病患者血管病变的情况。