超声射频技术及实时剪切波弹性成像对中老年2型糖尿病患者颈动脉功能的评价

发布时间：2018-03-19 10:30

  本文选题：超声射频技术　切入点：实时剪切波弹性成像　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：一、目的:使用超声射频技术及实时剪切波弹性成像评估2型糖尿病患者的颈动脉内皮功能,并结合病程、糖化血红蛋白、空腹血清C肽和血脂,探讨以上指标与动脉内中膜厚度及弹性指标的关联。二、方法:1、纳入及排除标准:选择我院41～64岁的2型糖尿病患者29例,所有患者均符合1999年WHO诊断标准,颈部血管常规超声检查均无异常,对照组为相对应年龄段的正常体检者18例,两组均要除外肥胖、严重营养不良、严重肝肾功能不全、冠心病、脑卒中等心脑血管疾病、其他内分泌疾病、风湿免疫病、血液病、恶性肿瘤等疾病。2、实验方法:对病例组常规空腹采血,测定血脂、血清C肽,采取指尖采血法测定糖化血红蛋白。将病例组根据有无高血压分为糖尿病血压正常组和糖尿病合并高血压组,另将病例组根据视网膜病变分期分为无视网膜病变组、视网膜病变I期组、视网膜病变II期组、视网膜病变Ⅲ期组,同时选择相对应年龄段的正常体检者18例作为对照组,对病例组和对照组分别进行超声射频信号血管内中膜分析(QIMT)、血管硬度定量分析(QAS)和实时剪切波弹性成像(SWE)检查,获取IMT(内-中膜厚度)、CC(顺应性)、DC(扩张性)、α(僵硬度参数)、β(僵硬度参数)、PWV(脉搏波传导速度)、MEmean(杨氏模量平均值的均数)、MEmin(杨氏模量最小值的均数)、MEmax(杨氏模量最大值的均数)。三、结果:1、与对照组相比较,病例组收缩压、IMT与弹性指标PWV、α、β、MEman、MEmin、MEmax均增大,DC减小,差异均有统计学意义(p0.05),两组之间舒张压和CC的差异无统计学意义(p0.05)。2、与糖尿病血压正常组比较,糖尿病合并高血压组病程较长,并发症数目较多,弹性指标MEmax增大,差异均有统计学意义(p0.05),两组之间其他指标的差异无统计学意义(p0.05)。3、无视网膜病变组和视网膜病变Ⅰ期、Ⅱ期、Ⅲ期组之间所有指标差异均无统计学意义(p0.05)。4、MEmean与年龄、脂蛋白(a)呈正相关,MEmax脂蛋白(a)呈正相关,MEmin与年龄、脂蛋白(a)呈正相关,IMT与收缩压呈正相关,差异均有统计学意义(p0.05)。5、MEmean与PWV、α、β呈正相关;MEmax与PWV、α、β呈正相关,与DC呈负相关,差异均有统计学意义(p0.05)。6、以MEmean作为因变量建立的多因素线性回归模型中,利用逐步法,最终年龄、脂蛋白(a)和α进入该模型,年龄、脂蛋白(a)和α是和MEmean独立相关的变量,标准回归系数分别为0.531、0.231和0.251。7、以MEmax作为因变量建立的多因素线性回归模型中,利用逐步法,最终HbA1c、脂蛋白(a)和PWV进入该模型,HbA1c、脂蛋白(a)和PWV是和MEmax独立相关的变量,标准回归系数分别为0.390、0.227和0.402。8、PWV、α、β、MEmean、MEmax、MEmin诊断动脉硬化的AUC及其对应的95%可信区间分别为 0.786(0.648～0.925)、0.734(0.587～0.881)、0.738(0.591～0.884)、0.818(0.697～0.939)、0.852(0.745～0.959)、0.770(0.632-0.908),上述指标间AUC的比较差异均无统计学意义(p0.05)。四、结论:1、实时剪切波弹性成像作为一项新兴的超声弹性成像技术,与传统的超声射频技术相关性良好,实时剪切波弹性成像与超声射频技术均能够评估动脉弹性改变,均具有良好的诊断效能且两者具有等效性。2、糖尿病患者血管功能的改变早于血管结构的改变,超声射频技术与实时剪切波弹性成像均能够诊断糖尿病患者早期的大血管病变。3、糖尿病和高血压有着共同的发病机制和病理基础,高血糖、高血压和高血脂能够进一步加重糖尿病患者的动脉粥样硬化,糖尿病患者需积极控制这些危险因素。4、糖尿病患者血糖总体控制水平和胰岛β细胞功能与糖尿病微血管病变密切相关,强化血糖控制有助于降低微血管病变进一步发展的风险,糖尿病患者大血管病变与微血管病变存在一定联系,伴有微血管病变者动脉粥样硬化较严重。5、在所有的血脂指标中,脂蛋白(a)作为一种相对独立的血浆脂蛋白,与动脉粥样硬化关系密切,在引起动脉粥样硬化和血栓形成的众多环节发挥重要作用,这个指标值得临床充分重视。
[Abstract]:One objective: To evaluate carotid artery endothelial function in patients with type 2 diabetes mellitus using ultrasound radiofrequency technology and real-time shear wave elastography, and combined with the duration, HbA1c, fasting serum C peptide and blood lipid, investigate the relationship between the above indexes and the intima-media thickness and elasticity index. Two methods: 1, inclusion and exclusion criteria: 29 patients with type 2 diabetes in our hospital 41~64 cases, all patients met the diagnostic criteria of WHO in 1999, neck vascular routine ultrasound examination showed no abnormality in control group, 18 cases of corresponding age normal subjects, two groups except for obesity, severe malnutrition, severe liver and kidney dysfunction, coronary heart disease. Cerebrovascular disease, endocrine disease, rheumatic disease, blood disease, malignant tumor and other diseases.2, experimental methods: Determination of blood lipid of the patients, routine fasting blood serum C peptide, determination of sugar by fingerstick Hemoglobin. The patients were divided into hypertension according to hypertension group, diabetes group and diabetes with normal blood pressure, the other patients according to retinopathy stages divided into retinopathy group, I retinopathy group, retinopathy II retinopathy group, III group, and select the corresponding age of normal physical examination in 18 cases as the control group, the case group and control group were the quality intima-media thickness (QIMT), quantitative analysis of vascular hardness (QAS) and real-time shear wave elastography (SWE) examination, obtain IMT (intima-media thickness), CC (compliance), DC (expansion (alpha), stiffness parameters (stiffness parameters), beta), PWV (Mai Bobo velocity (mean MEmean), Young's modulus average), MEmin (mean modulus minimum), MEmax (average number of Young's modulus maximum value). Results: three, compared with 1. The control group, The case group systolic blood pressure, IMT and elastic index of PWV, alpha, beta, MEman, MEmin, MEmax increased, DC decreased, the differences were statistically significant (P0.05), diastolic blood pressure and CC was no statistically significant difference between the two groups (.2, P0.05) compared with normal blood pressure diabetes group, diabetes mellitus and hypertension group of longer duration the number of complications, more elastic index MEmax increased, the differences were statistically significant (P0.05), there was no significant difference between the two groups in other indicators (P0.05).3, without retinopathy group and retinopathy in phase I, II, III group between all indexes showed no significant difference (.4, MEmean and P0.05) age, lipoprotein (a) was positively related to MEmax lipoprotein (a) MEmin was positively correlated with age, lipoprotein (a) was positively correlated with IMT positively correlated with systolic blood pressure, the differences were statistically significant (P0.05).5, MEmean and PWV, alpha beta, MEmax and PWV were positively correlated; alpha, beta. Cheng Zhengxiang Off, and negatively correlated with DC, the differences were statistically significant (.6, P0.05) with MEmean as the dependent variables to establish multiple linear regression model, using the stepwise method, the final age, lipoprotein (a) and alpha into the model, age, lipoprotein (a) and alpha is related and independent MEmean variable, standard regression coefficients were 0.531,0.231 and 0.251.7, with MEmax as the dependent variables to establish multiple linear regression model, using the stepwise method, the final HbA1c, lipoprotein (a) and PWV in the model, HbA1c, lipoprotein (a) and PWV and MEmax is independently related variables, the standard regression coefficient was for 0.390,0.227 and 0.402.8, PWV, alpha, beta, MEmean, MEmax, 95% confidence interval AUC and the corresponding MEmin in the diagnosis of arteriosclerosis was 0.786 (0.648 ~ 0.925), 0.734 (0.587 ~ 0.881), 0.738 (0.591 ~ 0.884), 0.818 (0.697 ~ 0.939), 0.852 (0.745 ~ 0.959). 0.770 (0.632-0.908), the The difference between the standard AUC had no statistical significance (P0.05). Conclusion: four, 1, real-time shear wave elastography is a new ultrasonic elastography, and good ultrasonic RF technology of traditional correlation, real-time shear wave elastography and ultrasonic technology were able to assess changes in arterial elasticity, have good the diagnostic efficiency of which is equivalent to.2, the change of vascular function in patients with diabetes mellitus earlier than the change of vascular structure, ultrasonic frequency technology and real-time shear wave elastography were able to diagnosis of diabetic macrovascular disease in patients with early.3, diabetes and hypertension with pathogenesis and pathologic basis of common, high blood sugar, high blood pressure and high blood lipids can further aggravate atherosclerosis in diabetes patients, patients with diabetes need to control the risk factors of diabetes in the.4, the overall control level and beta Cell function and diabetic microangiopathy is closely related to strengthen the risk control of blood sugar helps reduce microvascular disease further development, there exists certain relationship between macroangiopathy and microangiopathy in diabetic patients with microvascular disease, atherosclerosis is more serious in.5, all the indexes of blood lipid, lipoprotein (a) as a relative independent of the plasma lipoprotein, and atherosclerosis are closely related, play an important role in many aspects caused by atherosclerosis and thrombosis, the index it is worthy of clinical importance.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2;R445.1
，

本文编号：1633882