Quantitative model for assessment of lower-extremity perfusion in patients with diabetes
Quantitative model for assessment of lower-extremity perfusion in patients with diabetes
复制标题
评估糖尿病患者下肢血流灌注的定量模型
DOI：
10.1002/mp.16214
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发表时间：
2023-01-16
期刊：
影响因子：
3.8
通讯作者：
Yan，Zhencheng
中科院分区：
文献类型：
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作者：
Zhang，Qian;Liu，Xiaoxiao;Yan，Zhencheng
研究背景虽然糖尿病与动脉粥样硬化性血管疾病的病理生理机制不同，但目前糖尿病下肢血管疾病的筛查方法主要基于动脉粥样硬化性血管疾病的评估方法。因此，微血管灌注的评估对于早期发现糖尿病下肢缺血非常重要。目的本横断面研究旨在开发评估下肢灌注的定量模型。方法我们招募了 57 名参与者（14 名健康参与者和 43 名糖尿病患者，其中 16 名患有下肢动脉疾病 [LEAD]）。所有参与者均接受了锝‐99 m 塞他米比 (99mTc‐MIBI) 闪烁扫描和踝臂指数 (ABI) 检查。我们得出了两个关键的灌注动力学指标，称为活动灌注指数（API）和基础灌注指数（BPI）。该研究已在 ClinicalTrials.gov 上注册（URL：https://www.ClinicalTrials.gov，NCT02752100）。结果我们的下肢灌注评估（LEPA）模型中估计的肢体灌注值与实际测量数据显示出极好的一致性。与对照组相比，糖尿病患者的下肢灌注减少（BPI：106.21 ± 11.99 vs. 141.56 ± 17.38，p < 0.05；API：12.34 ± 3.27 vs. 14.56 ± 3.12，p < 0.05）。使用我们的模型，可以在大约 96.30% 的糖尿病患者中及早检测到下肢灌注减少。患有 LEAD 的患者比未患有 LEAD 的糖尿病患者表现出更严重的下肢灌注减少（BPI：47.85 ± 20.30 对比 106.21 ± 11.99，p < 0.05；API：7.06 ± 1.70 对比 12.34 ± 3.27，p < 0.05）。使用 API 和 BPI 进行判别分析可以成功筛查所有患有 LEAD 的糖尿病患者，敏感性为 100%，特异性为 80.77%。结论我们建立了 LEPA 模型，可以成功评估糖尿病患者下肢微血管灌注。该模型对于糖尿病患者早期LEAD的识别具有重要的应用价值。
BackgroundAlthough diabetic and atherosclerotic vascular diseases have different pathophysiological mechanisms, the screening methods currently used for diabetic lower‐extremity vascular diseases are mainly based on the evaluation methods used for atherosclerotic vascular diseases. Thus, assessment of microvascular perfusion is of great importance in early detection of lower‐extremity ischemia in diabetes.PurposeThis cross‐sectional study aimed to develop a quantitative model for evaluating lower‐extremity perfusion.MethodsWe recruited 57 participants (14 healthy participants and 43 diabetes patients, of which 16 had lower‐extremity arterial disease [LEAD]). All participants underwent technetium‐99 m sestamibi (99mTc‐MIBI) scintigraphy and ankle‐brachial index (ABI) examination. We derived two key perfusion kinetics indices named activity perfusion index (API) and basal perfusion index (BPI). This study was registered in ClinicalTrials.gov (URL: https://www.ClinicalTrials.gov, NCT02752100).ResultsThe estimated limb perfusion values in our lower‐extremity perfusion assessment (LEPA) model showed excellent consistency with the actual measured data. Diabetes patients showed reduced lower‐extremity perfusion in comparison with the control group (BPI: 106.21 ± 11.99 vs. 141.56 ± 17.38,p< 0.05; API: 12.34 ± 3.27 vs. 14.56 ± 3.12,p< 0.05). Using our model, the reductions in lower‐extremity perfusion could be detected early in approximately 96.30% of diabetes patients. Patients with LEAD showed more severe reductions in lower‐extremity perfusion than diabetes patients without LEAD (BPI: 47.85 ± 20.30 vs. 106.21 ± 11.99,p< 0.05; API: 7.06 ± 1.70 vs. 12.34 ± 3.27,p< 0.05). Discriminant analysis using API and BPI could successfully screen all diabetes patients with LEAD with a sensitivity of 100% and specificity of 80.77%.ConclusionsWe established a LEPA model that could successfully assess lower‐extremity microvascular perfusion in diabetes patients. This model has important application value for the recognition of early‐stage LEAD in patients with diabetes.