超声应变率成像评价2型糖尿病患者腹主动脉弹性的研究

目的 应用超声应变率成像(SRI)测定糖尿病患者腹主动脉的位移(d)、应变(ST)、应变率(SR)等参数,观察糖尿病患者腹主动脉弹性的变化情况,为早期诊断和治疗糖尿病患者腹主动脉病变提供依据.方法 选择糖尿病腹主动脉内膜正常组、内膜增厚组、单发斑块组各30例,另选30名体检正常健康者作为健康对照组.应用SRI技术将取样容积分别置于膈下3 cm腹主动脉的前壁及后壁上,获取同步的d、ST和SR曲线,分别测量每个位点的最大d、最大ST以及收缩期、舒张早期和舒张晚期的应变率峰值(SRs、Sre、Sra),并计算腹主动脉测量位点的脉搏波传导速度(PWV).结果 2型糖尿病组中内膜正常组腹主动脉后壁d、ST、PWV分别为(0.80±0.39)mm、(1.71±0.98)%、(9.19±1.52)m/s,内膜增厚组后壁d、ST、PWV分别为(0.78±0.76)mm、(1.53±0.94)%、(9.61±2.78)m/s,单发斑块组后壁d、ST、PWV分别为(0.53±0.43)mm、(1.21±1.01)%、(9.76±2.38)m/s,健康对照组的后壁d、ST、PWV分别为(0.97±0.26)mm、(2.54±1.06)%、(6.53±1.87)m/s,4组比较差异有统计学意义(χ2=17.34或F=13.20、14.02,P均＜0.01).其中内膜正常组与健康对照组比较,PWV差异有统计学意义(Z=3.01,P＜0.05);内膜增厚组与健康对照组比较,d、ST、PWV差异有统计学意义(Z=2.29、4.77、5.71,P均＜0.05);单发斑块组与健康对照组比较,d、ST、PWV差异有统计学意义(Z=4.04、3.41、3.90,P均＜0.05).2型糖尿病组3组后壁d、ST与健康对照组后壁比较均有所下降,PWV明显增大.2型糖尿病内膜正常组后壁SRs、Sre、Sra的绝对值分别为(0.44±0.39)s-1、(0.27±0.29)s-1、(0.22±0.14)s-1,内膜增厚组后壁SRs、Sre、Sra的绝对值分别为(0.31±0.26)s-1、(0.21±0.12)s-1、(0.24±0.37)s-1,单发斑块组后壁绝对值分别为(0.27±0.25)s-1、(0.21±0.16)s-1、(0.22±0.31)s-1,健康对照组后壁的分别为(1.26±0.41)s-1、(1.10±0.19)s-1、(1.01±0.28)s-1,4组比较差异有统计学意义(χ2=52.66、61.32或F=184.70,P均＜0.01).内膜正常组与健康对照组比较,差异有统计学意义(Z=5.13、6.90、6.03,P均＜0.05);内膜增厚组与健康对照组比较,差异有统计学意义(Z=5.77、6.37、5.21,P均＜0.05);单发斑块组与健康对照组比较,差异有统计学意义(Z=5.90、5.21、6.07,P均＜0.05).3组SRs、Sre、Sra的绝对值与健康对照组比较均明显减低,其中SRs绝对值以单发斑块组减低最大.结论超声应变率成像可作为评价糖尿病患者腹主动脉弹性早期改变的新方法.

Research on abdominal aortic elasticity in patients with type 2 diabetes mellitus by strain rate imaging

Objective To evaluate the displacement(d),strain(ST),strain rate(SR)and observe their changes of abdominal aortic elasticity in patients with type 2 diabetes by strain rate imaging(SRI).Methods A total of 90 patients with type 2 diabetes mellitus and 30 control subjects were enrolled.The patients were divided into three groups:group of normal intima,group of thickened intima and group of single plaque of the abdominal aorta.The values of d,ST,SR of the anterior and posterior wall of abdominal aorta were measured and PWV was calculated.Results The data of d,ST,PWV of posterior wall were(0.80±0.39)mm,(1.71±0.98)%,and(9.19±1.52)m/s in group of normal intima;(0.78±0.76) mm,(1.53±0.94)%,and(9.61±2.78)m/s in group of thickened intima;(0.53±0.43)mm,(1.21±1.01)%,and(9.76±2.38)mm/s in group of single plaque of the abdominal aorta;(0.97±0.26)mm,(2.54±1.06)%,and(6.53±1.87)m/s in control group,respectively.There were significant difference among the 4 groups(χ2=17.34 or F=13.20,14.02,all P<0.01).PWV was significantly higher in group of normal intima than that in control group(Z=3.01,P<0.05).The value of d,ST were significantly lower in group of thickened intima than those in control group,while PWV just represented the opposite tendency(Z=2.29,4.77,5.71,all P<0.05).The similar results were found between the group of single plaque of the abdominal aorta and the control group(Z=4.04,3.41,3.90,all P<0.05).The value of d,ST were significantly lower in the three groups of type 2 diabetes mellitus than those in control group,but PWV just represented the opposite tendency.The absolute value of SRs,SRe,SRa were(0.44±0.39)s-1,(0.27±0.29)s-1and(0.22±0.14)s-1 in group of normal intima;(0.31±0.26)s-1,(0.21±0.12)s-1and(0.24±0.37)s-1 in group of thickened intima;(0.27±0.25)s-1,(0.21±0.16)s-1 and(0.22±0.31)s-in group of single plaque of the abdominal aorta;(1.26±0.41)s-1,(1.10±0.19)s-1and(1.01±0.28)s-1 in control group,respectively.There were significant difference among the 4 groups((χ2=52.66,61.32 or F=184.70,all P<0.01).SRs,SRe,SRa were lower in group of normal intima than those in control group(Z=5.13,6.90,6.03,all P<0.05).These variables were lower in group of thickened intima than those in control group(Z=5.77,6.37,5.21,all P<0.05).And they were also lower in group of single plaque of the abdominal aorta than those in control group(Z=5.90,5.21,6.07,all P<0.05).SRs,SRe,SRa of type 2 diabetes patients decreased obviously compared with the control group,especially the absolute value of SRs in group of single plaque of the abdominal aorta.Conclusion SRI can provide a new method to evaluate the early changes of abdominal aorta in type 2 diabetes patients.