二维剪切波弹性成像评价2型糖尿病患者跟骨下脂肪垫改变

目的 观察二维剪切波弹性成像（2D-SWE）评价2型糖尿病（T2DM）患者跟骨下脂肪垫硬度改变的价值。方法 将104例T2DM患者根据病程分为长病程组（n=54）和短病程组（n=50），另纳入38名健康志愿者作为对照组。采用2D-SWE技术测量受试者跟骨下脂肪垫弹性模量（E_hp）及其大腔室弹性模量（E_macro）、微腔室弹性模量（E_micro），比较组内左、右足各参数差异及组间双足参数差异。采用Pearson相关性分析评价E_hp与实验室指标的相关性；以多元线性逐步回归分析影响E_hp的独立因素。结果 各组内左、右足各弹性参数差异均无统计学意义（P均>0.05）。长、短病程组E_hp、E_macro及E_micro均高于对照组（P均<0.05）；长病程组各参数均高于短病程组（P均<0.05）。E_hp与空腹血糖（FBG）、糖化血红蛋白（HbA1c）均呈正相关（r=0.516、0.403，P均<0.001），与高密度脂蛋白胆固醇（HDL-C）呈负相关（r=－0.521，P<0.001）。FBG、HbA1c及HDL-C均为影响E_hp的独立因素（P均<0.05）。结论 利用2D-SWE技术能够准确、客观地评价T2DM患者跟骨下脂肪垫异常改变。

Two-dimensional shear wave ultrasound elastography for evaluation on changes of heel pad in patients with type 2 diabetes mellitus

Objective To observe the value of two-dimensional shear wave elastography (2D-SWE) for evaluating changes of heel pad in patients with type 2 diabetes mellitus (T2DM). Methods Totally 104 T2DM patients were enrolled and divided into long course group (n=54) and short course group (n=50) according to the course of T2DM, and 38 healthy volunteers were taken as controls (control group). 2D-SWE technique was used to measure the elastic modulus of heel pad (E_hp) and its macro chamber (E_macro) and micro chamber (E_micro). Parameters of left and right foot were compared in each group, and bipedal parameters were compared among groups. Pearson correlation analysis was used to explore correlations of E_hp and laboratory indicators, and the independent impact factors of E_hp was analyzed using multiple linear stepwise regression.Results There was no significant difference between left and right foot elastic parameters in every group (all P>0.05). E_hp, E_macro and E_micro of long course group and short course group were larger than those of control group (all P<0.05), and parameters in long course group were larger than those in short course group (all P<0.05). E_hp was positively correlated with fasting blood glucose (FBG) and glycosylated hemoglobin (HbA1c) (r=0.516, 0.403, both P<0.001), but negatively correlated with high density lipoprotein-cholesterol (HDL-C) (r=-0.521, P<0.001). FBG, HbA1c and HDL-C were all independent impact factors of E_hp (all P<0.05). Conclusion 2D-SWE technique could be used to accurately and objectively evaluate abnormal changes of heel pad in patients with T2DM.