Utility of Contrast-Enhanced Ultrasound for the Assessment of Skeletal Muscle Perfusion in Diabetes Mellitus: A Meta-Analysis
Utility of Contrast-Enhanced Ultrasound for the Assessment of Skeletal Muscle Perfusion in Diabetes Mellitus: A Meta-Analysis
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DOI：
10.12659/msm.915252
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发表时间：
2019-06-18
影响因子：
3.1
通讯作者：
Li, You-shan
中科院分区：
文献类型：
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作者：
Chen, Lin-lin;Zhai, Jun-xiu;Li, You-shan
背景：本研究评估了超声造影评估糖尿病骨骼肌灌注的有效性。材料/方法：在电子数据库（Embase、Google Scholar、Ovid 和 PubMed）中搜索所需文章，并根据预先确定的资格标准选择研究。采用均数差或标准化均数差（SMD）的荟萃分析来评估糖尿病患者与健康个体之间或糖尿病患者与健康个体在胰岛素操作或体育锻炼后的灌注指数基础值和终值之间超声造影测量的肌肉灌注指数之间的差异显着性。 结果：共纳入15项研究，其中糖尿病患者279例，健康个体230例。研究中糖尿病患者的年龄为 55.8 岁（95% CI：49.6 岁、61.9 岁），这些患者的患病时间为 11.4 年（95% CI：7.7 岁、15.1 岁）。糖尿病患者组中男性比例为66%（95% CI：49%、84%），体重指数为29.4 kg/m（2）（95% CI：26.5 kg/m（2）、32.3 kg/m2），糖化血红蛋白为7.3%（95% CI：6.7%、7.9%），空腹血糖为149 kg/m(2)（95% CI：118 kg/m2，179 kg/m(2)）。糖尿病患者激发后达到峰值强度的时间显着高于健康个体（SMD 1.18 [95% CI：0.60，1.76]；P < 0.00001）。在糖尿病患者中，注射胰岛素并没有改善超声造影测量的肌肉灌注指数，但运动改善了肌肉灌注，但在统计上不显着（基础值和运动后值之间的 SMD（1.03 [95% CI：-0.14，2.20]；P = 0.08）。在健康个体中，除了注射胰岛素外，血脂与血容量和血流量显着减少有关。结论：我们的综述显示使用对比增强超声检查表明糖尿病与肌肉灌注改变有关，其中胰岛素介导的代谢变化发挥了重要作用。
Background: This study evaluated the effectiveness of contrast-enhanced ultrasonography for the assessment of skeletal muscle perfusion in diabetes mellites.Material/Methods: Electronic databases (Embase, Google Scholar, Ovid, and PubMed) were searched for required articles, and studies were selected by following pre-determined eligibility criteria. Meta-analyses of mean differences or standardized mean differences (SMD) were performed to evaluate the significance of difference in contrast-enhanced ultrasonography measured muscle perfusion indices between patients with diabetes and healthy individuals or between basal and final values of perfusion indices after insulin manipulation or physical exercise in patients with diabetes or healthy individuals.Results: There were 15 studies included, with 279 patients with diabetes and 230 healthy individuals in total. The age of the study patients with diabetes mellitus was 55.8 years (95% CI: 49.6 years, 61.9 years) and these patients had disease for 11.4 years (95% CI: 7.7 years, 15.1 years). The percentage of males in group of patients with diabetes was 66% (95% CI: 49%, 84%), body mass index was 29.4 kg/m(2) (95% CI: 26.5 kg/m(2), 32.3 kg/m2), hemoglobin A1c was 7.3% (95% CI: 6.7%, 7.9%), and fasting plasma glucose was 149 kg/m(2) (95% CI: 118 kg/m2, 179 kg/m(2)). Time to peak intensity after provocation was significantly higher in patients with diabetes than in healthy individuals (SMD 1.18 [95% CI: 0.60, 1.76]; P< 0.00001). In patients with diabetes, insulin administration did not improve contrast-enhanced ultrasonography measured muscle perfusion indices but exercise improved muscle perfusion but at a level that was statistically non-significant (SMD between basal and post-exercise values (1.03 [95% CI: -0.14, 2.20]; P= 0.08). In healthy individuals, lipids in addition to insulin administration was associated with significantly reduced blood volume and blood flow.Conclusions: Our review showed that the use of contrast-enhanced ultrasonography showed that diabetes mellitus was associated with altered muscle perfusion in which insulin-mediated metabolic changes played an important role.