【作者】 田静；

【导师】 何雨；

【作者基本信息】 吉林大学 ， 影像医学与核医学（专业学位）， 2020， 硕士

【摘要】 目的:应用速度向量成像(velocity vector imaging,VVI)无创评估糖尿病患者颈总动脉弹性,结合糖尿病时血管内皮功能变化,探讨颈总动脉弹性改变评估血管内皮功能的可行性,比较糖尿病时大血管内皮功能与微血管内皮功能的变化情况,寻找早期发现和防治糖尿病血管病变的新的、精准的客观指标。方法:选取32名2型糖尿病患者,分为单纯糖尿病组(uncomplicated diabetes mellitus,uDM)和微血管并发症组(complicated diabetes mellitus,cDM),各16名,另选取18名健康受试者作为正常对照组(Control)。应用肱动脉血流介导的血管舒张功能(flow-mediated vasodilation,FMD)检测各组血管内皮功能。应用颈总动脉超声测量内中膜厚度(intima-media thickness,IMT)。应用VVI评价颈总动脉弹性,采集所有检测者颈总动脉短轴及长轴图像,测量并记录各组近侧壁和远侧壁收缩期峰值位移、峰值速度、峰值应变、峰值应变率(Dmax、Vmax、Smax、SRmax)及对应达峰时间(T-Dmax、T-Vmax、T-Smax、T-SRmax)、面积变化分数(fractional area change,FAC)及总纵向位移(total longitudinal displacement,t-LOD),比较组间及组内差异;分析颈总动脉长、短轴VVI测值间的相关性,并进行VVI数据的可重复性分析。结合糖尿病患者尿微量白蛋白(microalbuminuria,MAU)数值,将糖尿病患者VVI测值与FMD、MAU和IMT分别进行相关性比较,同时对FMD和MAU进行相关性分析。结果:FMD比较结果:cDM组FMD明显低于Control组和uDM组(P<0.01),但Control组和uDM组之间未见明显差异(P>0.05)。MAU比较结果:cDM组MAU较uDM组明显增多(P<0.05)。IMT比较结果:cDM组的IMT明显高于Control组(P<0.05),而cDM组与uDM及uDM组与Control组之间均未见明显差异(P>0.05)。VVI测值比较结果:(1)组间比较:随病变严重程度加深,颈总动脉短轴及长轴Dmax、Vmax、Smax、SRmax、FAC及t-LOD逐渐减小,对应达峰时间逐渐延长,三组间存在显著性差异(P<0.05)。(2)组内比较:颈总动脉短轴各组组内近侧壁与远侧壁相比,Dmax、Vmax、Smax、SRmax及对应达峰时间差异均无明显差异(P>0.05);颈总动脉长轴各组组内近侧壁Dmax、Vmax、Smax、SRmax及t-LOD值明显低于远侧壁(P<0.05),对应达峰时间较远侧壁明显延长(P<0.05)。(3)颈总动脉短轴FAC与长轴远侧壁t-LOD呈高度正相关(r=0.921,P<0.001)。(4)颈总动脉短轴及长轴VVI测值可重复性良好(ICC>0.75)。相关性分析结果:(1)颈总动脉短轴及长轴全部VVI变量与FMD均呈中度相关(0.5≤|r|<0.8,P<0.001);颈总动脉短轴约一半VVI变量与MAU呈低度相关(0.3≤|r|<0.5,P<0.05)、长轴大部分VVI变量与MAU呈中度或低度相关(0.3≤|r|<0.8,P<0.05);颈总动脉短轴和长轴仅少部分VVI变量与IMT呈低度相关(0.3≤|r|<0.5,P<0.05)。(2)FMD与MAU呈低度负相关(r=-0.459,P<0.05)。结论:1.随糖尿病病情加重,颈总动脉硬度出现明显变化。2.糖尿病时颈总动脉硬度变化较血管内皮功能和颈总动脉结构变化更敏感。3.糖尿病时颈总动脉硬度变化与血管内皮功能变化明显相关,可用于评估大血管内皮功能。4.颈总动脉硬度与颈总动脉结构变化相关性不明显。5.糖尿病大血管内皮功能与微血管内皮功能之间存在一定相关性。更多还原

【Abstract】 Purpose: To explore the feasibility of the common carotid artery(CCA)stiffness measured by velocity vector imaging(VVI)in evaluating the vascular endothelial function in people with diabetes mellitus(DM),also the relationship between macrovascular and microvascular endothelial function,and look for new and accurate indicators for early detection and prevention of diabetes microvascular complications.Methods: A total of 32 patients with T2 DM was enrolled,and they were divided into 3 groups: uncomplicated DM(uDM,n=16),complicated DM,(cDM,n=16),and matched subjects without DM(Control,n=18).Flow-mediated vasodilation(FMD)was used to detect vascular endothelial function in each group.Intima-media thickness(IMT)was measured by ultrasound in CCA.VVI was used to evaluate the carotid artery stiffness,images of radial and axial movement of CCA were collected.peak systolic displacement、velocity 、strain、strain rate(maximum displacement、velocity、strain、strain rate,Dmax,Vmax,Smax,SRmax)and corresponding peak time(T-Dmax、T-Vmax、T-Smax、T-SRmax),fractional area change(FAC)and total longitudinal displacement(t-LOD)were measured、recorded and compared.The correlation of VVI between the radial and axial axes of CCA was analyzed and assess the repeatability of VVI.In combination with urinary microalbumin(MAU)in uDM and cDM,the correlation between the VVI、FMD、MAU and IMT was compared,also the correlation between FMD and MAU.Results: FMD results: FMD in cDM was significantly lower than Control and uDM(P < 0.01),while no significant difference between the Control and uDM(P> 0.05).results: MAU in cDM significantly higher than uDM(P<0.05).IMT results: IMT in cDM was significantly higher than Control(P<0.05),while there was no significant difference between cDM and uDM、uDM and group(P>0.05).VVI results:(1)inter-group comparison: Dmax,Vmax,Smax,SRmax,FAC and t-LOD in radial and axial movement of CCA decreased and the corresponding peak time increased significantly in three groups as the condition advanced(P<0.05).(2)intra-group comparison: no significant difference in Dmax,Vmax,Smax,SRmax and corresponding peak time between the near and far wall of each group on radial movement of CCA(P>0.05).Dmax,Vmax,Smax,SRmax and t-LOD of the far wall of axial movement of CCA in each group were significantly lower than those of the near wall(P<0.05),and the corresponding peak time was significantly longer than that of the far wall(P<0.05).(3)the radial movement of CCA was highly and positively correlated with the axial movement(r=0.921,P<0.001).(4)VVI in radial and axial movement of CCA had very good repeatability(ICC>0.75).Results of correlation analysis:(1)VVI in radial and axial movement of CCA were moderately correlated with FMD(0.5≤|r|<0.8,P<0.001);about half of the VVI variables in the radial axis of CCA were weakly correlated with MAU(0.3≤|r|<0.5,P<0.05)、most of the VVI variables in the axial axis of CCA were moderately or weakly correlated with MAU(0.3≤|r|<0.8,P<0.05);only a few VVI variables were weakly correlated with IMT(0.3≤|r|<0.5,P<0.05)in both axial and radial axis of CCA.(2)FMD and MAU were weakly and negatively correlated(r=-0.459,P<0.05).Conclusions: 1.The stiffness of CCA changed significantly with the progression of diabetes.2.Changes in CCA stiffness are more sensitive than those in FMD and IMT in DM.3.The stiffness changes in CCA are significantly correlated with changes in vascular endothelial function in DM,which can be used to evaluate the endothelial function of large artery.4.There was no strong correlation between the changes in stiffness and structure of CCA.5.Certain correlation between macro-and micro-vascular endothelial function in DM.更多还原