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Variation of Microcirculatory and Mechanical Properties in Muscles and Tendons of Lower Extremity in Subjects with Diabetes Mellitus
diabetes mellitus,diabetic musculoskeletal complications,microcirculation,muscle and tendon stiffness,glycemic control,
|Publication Year :||2018|
|Abstract:||研究背景：糖尿病為全球盛行之代謝性疾病，且易導致併發症包括血管系統病變等，近年來研究發現糖尿病併發症也出現在骨骼肌肉系統，且過去文獻提出可能的機制為微循環變異導致組織的缺氧所致。但就糖尿病之骨骼肌肉系統於運動過程中是否會有微循環的改變，卻缺乏完整的了解，因此無法了解糖尿病造成患者的肌肉與肌腱功能缺失之機制並給予適當的建議。研究目的：本研究目的在於收集糖尿病患者與非糖尿病受試者，其下肢肌肉與肌腱微循環特徵與機械特性，並與糖尿病臨床檢查如血糖控制，進行相關性分析。設計：本研究為橫斷式研究。實驗對象：本研究共90位患有糖尿病之受試者與31位非糖尿病控制組，其平均年齡分別為61.8歲與58.6歲，並排除會影響微循環之相關疾病。方法：本研究所量測之微循環特徵包含氧氣飽和度與總血紅素含量，使用近場遠紅外線光譜與紅光雷射檢測受試者於靜態之下肢肌肉（包含股直肌與內側腓腸肌）與肌腱（髕骨肌腱與阿基里斯腱）微循環特徵，以及肌肉等長收縮過程中之肌肉與肌腱微循環變化，並使用超音波剪力波彈性成像儀檢測肌肉與肌腱剛性。統計分析：本研究使用Mann-Whitney U test進行統計分析，比較糖尿病患者與非糖尿病受試者之（1）靜態下肌肉與肌腱之微循環、剛性、（2）肌肉等長收縮過程中微循環變化量、變化速度、（3）肌力與肌耐力是否有顯著差異。第二部分則使用斯皮爾曼等級相關係數（Spearman correlation coefficient）分析肌肉與肌腱之微循環、糖尿病受試者之年紀與疾病史、運動表現及糖尿病患者臨床檢查之相關性。結果：髕骨肌腱與阿基里氏腱靜態下的微循環數值皆高於控制組，其中髕骨肌腱與阿基里氏肌腱氧氣飽和度之p值為0.002與0.003，總血紅素含量則為0.001與0.01。股直肌與內側腓腸肌靜態下微循環基準值則發現糖尿病組之氧氣飽和度皆低於控制組（p值皆小於0.001）。在肌肉等長收縮過程中，股直肌與內側腓腸肌之氧氣飽和度最低值皆是糖尿病組顯著低於控制組（p=0.001與p<0.001），內側腓腸肌氧氣飽和度的變化總量與變化速率糖尿病組則顯著高於控制組（p=0.001與p<0.001）。股四頭肌腱之機械特性為糖尿病組顯著高於控制組（p=0.041），而內側腓腸肌機械特性則是控制組高於糖尿病組（p=0.033）。相關性分析大多數的結果為無顯著相關性，僅部分結果得到低強度相關性。結論：糖尿病患者之肌肉於靜態之氧氣飽和度低於控制組，指出其肌肉之氧氣供應較不足，因此在運動過程中氧氣的供應不平衡而導致肌肉縮收時容易缺氧，且此現象在靠近下肢末端的內側腓腸肌較顯著。糖尿病患者之下肢肌腱微循環特徵與肌腱病變之血管新生特徵相似，因此可能暗示糖尿病患者之肌腱處於肌腱病變之前期，或是有肌腱病變的高風險。根據本研究之結果，糖尿病患者之下肢肌肉與肌腱微循環受到糖尿病的影響，可能影響其運動表現，因此期望未來有相關研究探討此現象是否能透過特定運動介入進行改善。|
Background: Diabetes mellitus (DM) is recognized as a global epidemic and often causes numerous complications, some of which have been found, in recent years, to affect the musculoskeletal system. One of the possible mechanisms is hypoxia due to microvascular impairment. However, a clear understanding of microcirculation in the musculoskeletal system at rest and during isometric muscle contraction is still lacking. Purpose: The purpose of this study was (1) to investigate the variation in microcirculatory properties during resting phases and isometric muscle contraction and the mechanical properties of muscles and tendons in patients with DM and (2) to investigate the correlation between the variation in microcirculatory properties, mechanical properties, and clinical tests in patients with DM. Design: This study was a cross-sectional study. Participants: Ninety subjects were recruited for the DM group and 31 were recruited for the control group, with the average age of 61.8 years old and 58.6 years old, respectively. Conditions that may affect microcirculation were excluded. Methods: The microcirculation included total hemoglobin (THb) and oxygen saturation (StO2), which were measured using near-field infrared spectroscopy and red laser light for the muscles and tendons, respectively. Each subject was assessed for microcirculation in the rectus femoris (RF) and the patellar tendon (PT) during maximal isometric contraction of knee extension, as well as for microcirculation in the medial gastrocnemius (MG) and Achilles tendon (AT) during a one-leg heel raise. The mechanical properties of the muscles and tendons were assessed by shear wave elastography. The results of measurements were compared with routine clinical tests, such as blood glucose measurements. Statistical analysis: The Mann-Whitney U test was used to compare the differences in microcirculatory properties, mechanical properties and muscle performances between the DM and control groups. A Spearman correlation coefficient was used to analyze the correlation between variables. Results: The microcirculatory properties of tendons in a resting state were higher in the DM group, with p-values of 0.002 and 0.003 for the SaO2 of the PT and AT, respectively. The THb of the PT and AT were higher in the DM group as well, with p-values of 0.001 and 0.01, respectively. The baseline of SaO2 in the muscles was lower in the DM group, with p-values of <0.001 for the SaO2 of both muscles. During isometric muscle contraction, the lowest values of SaO2 in the RF and MG were lower in the DM group, with p-values of 0.001 and <0.001, respectively. The amount and rate of change of SaO2 in the MG were significantly higher in the DM group, with p-values of 0.001 and <0.001, respectively. The mechanical property of the quadriceps tendon in the resting state was significantly higher in the DM group (p = 0.041), and the mechanical property of the MG was lower in the DM group (p = 0.033). The relationship between microcirculatory properties, age and clinical test results presented little to fair strengths of correlation. Conclusion: According to the findings of this study, the microcirculation of muscles was lower in muscles at rest, indicating the oxygen supply for these muscles was impaired. Furthermore, the oxygen supply for muscles during exercise was impaired in the distal muscle, which may lead to the hypoxia of the muscle during contraction. This may indicate that the local regulation of microcirculation is impaired by DM, affecting the delivery of oxygen. The higher microcirculatory properties of tendons in patients with DM indicate the presence of tendinopathy or high risks of tendinopathy. Therefore, based on the findings of our study, further investigation of exercise intervention for these patients may be valuable, and more evidence is needed of the reversibility of microcirculatory properties in muscles and tendons in future studies.
|Appears in Collections:||物理治療學系所|
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