Kikuchi Minoru, Hirokawa Naoki, Hagiwara Seiya, Nakayama Hidetaka, Taneda Shinji, Manda Naoki, Sakata Kouichi
Department of Radiology, Sapporo Medical University, Sapporo, Japan; Department of Diabetes Center, Manda Memorial Hospital, Sapporo, Japan.
Department of Radiology, Sapporo Medical University, Sapporo, Japan.
Ultrasound Med Biol. 2017 Oct;43(10):2284-2294. doi: 10.1016/j.ultrasmedbio.2017.06.011. Epub 2017 Jul 25.
We examined the feasibility of ultrasound diagnosis of insulin-derived localized amyloidosis (IDLA). In addition to ultrasound detectability and findings, the insulin absorption rate, insulin dosage and hemoglobin A1c (HbA1c) levels before and after shifting the insulin injection site were investigated for 22 cases of IDLA. The detectability of IDLA on ultrasound was 100%; 59.1% was palpable lumps and 40.9% was not palpable. The palpable type had lower echo intensity and were harder than the non-palpable type. Blood flow decreased in IDLA, especially in the palpable type. IDLA, especially the palpable type, had a low insulin absorption rate. HbA1c level and insulin dosage decreased after shifting the injection site. The palpable type had more insulin reduction than the non-palpable type. Characteristic ultrasound images of IDLA were acquired. As the non-palpable type could be identified by ultrasound, its diagnosis encourages changing the insulin injection site; hence, ultrasound diagnosis of IDLA can enhance insulin treatment.
我们研究了超声诊断胰岛素源性局限性淀粉样变（IDLA）的可行性。除了超声可检测性及表现外，还对22例IDLA患者在更换胰岛素注射部位前后的胰岛素吸收率、胰岛素剂量及糖化血红蛋白（HbA1c）水平进行了研究。IDLA在超声检查中的可检测率为100%；其中59.1%为可触及肿块，40.9%为不可触及。可触及型的回声强度较低，且比不可触及型更硬。IDLA中的血流减少，尤其是可触及型。IDLA，尤其是可触及型，胰岛素吸收率较低。更换注射部位后，HbA1c水平和胰岛素剂量降低。可触及型比不可触及型的胰岛素减少更多。获得了IDLA的特征性超声图像。由于不可触及型可通过超声识别，其诊断有助于鼓励更换胰岛素注射部位；因此，IDLA的超声诊断可改善胰岛素治疗。
