无症状2型糖尿病患者跟腱超声弹性成像对临床研究价值的初步探讨

发布时间：2018-03-30 20:18

  本文选题：糖尿病　切入点：跟腱　出处：《吉林大学》2017年硕士论文

【摘要】：目的:糖尿病患者下肢容易发生病变,其中跟腱的病变影响糖尿病患者后期的生活质量,早期发现糖尿病跟腱的病变是不容易的,超声弹性成像创新性地从弹性的角度检测病变的程度,糖尿病跟腱的弹性成像结果与组织学检查有良好的对应性,对糖尿病跟腱的早期异常改变具有量化、快速、无创、低廉的诊断优势。方法:回顾性分析2016年1月至2016年11月在吉林大学第二医院各科的T2DM住院部患者63名(男32名,女31名)。血糖正常住院部患者29名(男10名,女19名)。入选标准为下肢无明显主观症状并排除影响跟腱弹性的其他疾病(如风湿性关节炎、脊椎关节病变、血胆脂醇高、跟腱滑膜炎、跟腱末梢病、跟腱后滑囊炎等,或糖尿病足病史、跟腱外伤史、下肢截肢史、特殊运动功能锻炼史等),另外年龄相仿(50-55)岁。按照糖尿病病程将T2DM组划分为4组,1-5年为组别1,6-10年为组别2,11-15年为组别3,16年以上为组别4。应用Mindray Resona 7超声诊断仪,测量跟腱二维超声图像、跟腱远端三分之一处杨氏模量以及跟腱的最大厚径,结合研究对象的性别、患糖尿病病程等指标进行评估。数据处理时采用了IBM SPSS22.0的统计软件。把符合正态分布的计量数据用均数±标准差的方式描述,把非正态分布的计量数据用中位数(P25,P75)的方式描述。正态分布且方差齐的数据组之间的比较用LSD检验,不符合方差齐性检验的数据组之间的两两比较采用Dunnett-t检验,相关性分析采用pearson相关系数计算。非正态分布的数据采用非参数检验法比较差异,用spearman相关系数进行相关性分析。p0.05有统计学意义。结果:1.对照组左、右侧的跟腱厚度分别为(0.576±0.165)cm、(0.582±0.188)cm,双侧跟腱厚度无显著差异(p0.05),对照组的跟腱也可以出现异常二维超声特征:高-低回声区、跟腱纤维走行呈波浪状、跟腱边缘不规整。2.T2DM组左、右侧跟腱厚度分别为(0.651±0.010)cm、(0.678±0.014)cm,双侧无统计学差异(p0.05)。T2DM组更容易出现高回声区和波浪状的纤维走行的异常二维超声特征(p0.05)。3.不同性别的跟腱厚度或杨氏模量均没有统计学差异(p0.05)。4.T2DM组比对照组的跟腱厚度增大(p0.05),但是T2DM的四个病程组的跟腱厚度的统计学差异不显著(p0.05)。5.对照组左、右侧跟腱杨氏模量分别为41.85(30.53,50.68)k Pa、45.53(35.96,60.81)k Pa,双侧无统计学差异(p0.05)。6.组别1的左、右侧跟腱杨氏模量分别为(70.56±22.86)k Pa、(66.74±22.75)k Pa;组别2的左、右侧跟腱杨氏模量分别为65.87(55.45,97.58)k Pa、(70.30±26.70)k Pa;组别3的左、右侧跟腱杨氏模量分别为(87.135±25.82)k Pa、(75.42±20.89)k Pa;组别4的左、右侧跟腱杨氏模量分别为(77.52±31.32)k Pa、69.79(56.46,77.10)k Pa;对比组别1、2、3、4的跟腱杨氏模量,除了组别1与组别3的右侧跟腱有统计学差异(p0.05),其余各组统计学差异不显著(p0.05)。7.T2DM组比对照组跟腱的杨氏模量大(p0.05),T2DM组双侧跟腱杨氏模量与病程长度为中度相关性,左侧r=0.45,p=0.01;右侧r=0.50,p=0.01。结论:1.常规超声作为跟腱检查常用手段,其二维征象在跟腱病变诊断中有着无可替代的地位。2.下肢无症状T2DM患者跟腱较正常人群跟腱厚度及硬度增大,且随着病程延长,跟腱硬度增加。3.超声弹性成像作为非侵入手段,可以定量测量跟腱的硬度,结合临床及其它辅助检查,在一定程度上可以提示跟腱病变程度,从而预防未来跟腱断裂事件的发生。
[Abstract]:Objective: lower extremity diabetic patients prone to disease, quality of life of patients with late diabetes disease affecting the early detection of diabetic Achilles tendon, Achilles tendon lesion is not easy, ultrasound elastography innovatively from the elastic angle detecting lesions with tendon elasticity imaging results in the diabetes and the histological examination has a good correspondence. Early on the abnormal changes of diabetes Achilles tendon with quantitative, rapid, noninvasive, inexpensive diagnostic advantage. Methods: a retrospective analysis from January 2016 to November 2016 for 63 patients in each hospital second hospital of Jilin University, T2DM (32 male, 31 female). The blood glucose level in normal inpatient 29 patients (10 male, 19 female name). Inclusion criteria for the lower extremity without obvious subjective symptoms and exclude other diseases affecting the Achilles tendon elasticity (such as rheumatoid arthritis, spinal joint disease, hypercholesterolemia, and tendon synovitis, tendon endings Disease, Achilles tendon bursitis, or diabetic foot disease, Achilles tendon injury history, the history of lower extremity amputation, special functional exercise history, age) and (50-55). According to the duration of diabetes T2DM were divided into 4 groups, 1-5 years 1,6-10 years 2,11-15 years group group group 3,16 years to stop the 4. groups using Mindray Resona 7 ultrasound diagnostic instrument, measurement of tendon two-dimensional ultrasound images, 1/3 distal Achilles tendon modulus and the maximum thickness of Achilles tendon, combined with the study of gender, duration of diabetes risk index were evaluated. Data processing using the statistical software IBM SPSS22.0. To meet the measurement data of normal distribution described by the mean and standard deviation of the method, the non measurement data of normal distribution with the median (P25, P75) is described. The way of data between the groups of normal distribution and homogeneity compared with the LSD test, does not meet the homogeneity of variance. The 22 test data between groups were compared using Dunnett-t test, correlation analysis using Pearson correlation coefficients were calculated. The non normal distribution of data using non parametric test to compare the differences of Spearman correlation coefficient of correlation analysis of.P0.05 was statistically significant. Results: 1. of the control group left, respectively right Achilles tendon thickness (0.576 + 0.165 cm), (0.582 + 0.188) cm, there was no significant difference between the bilateral Achilles tendon thickness (P0.05), the control group of the Achilles tendon can also appear abnormal ultrasound features: high - low echo area, tendon fibers wavy, irregular edge of Achilles tendon group.2.T2DM left and right Achilles tendon thickness respectively (0.651 + 0.010) cm, (0.678 + 0.014) cm, there was no significant difference in bilateral.T2DM group (P0.05) are more likely to have abnormal ultrasound features of high echo area and wavy fibers (P0.05) of the Achilles tendon thickness or young's modulus.3. of different gender were not unified 璁″�﹀樊寮�(p0.05).4.T2DM缁勬瘮瀵圭収缁勭殑璺熻叡鍘氬害澧炲ぇ(p0.05),浣嗘槸T2DM鐨勫洓涓�鐥呯▼缁勭殑璺熻叡鍘氬害鐨勭粺璁″�﹀樊寮備笉鏄捐憲(p0.05).5.瀵圭収缁勫乏,鍙充晶璺熻叡鏉ㄦ皬妯￠噺鍒嗗埆涓，

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