【作者】 周丽君；

【导师】 张宇虹；

【作者基本信息】 大连医科大学 ， 影像医学与核医学（专业学位）， 2019， 硕士

【摘要】 目的:应用超声技术评价2型糖尿病(T2DM)患者心外膜脂肪(EAT)厚度与内皮功能,并评估二者间的相关性。方法:选取本院2017年12月~2018年9月收治的T2DM患者67例,均符合1999年世界卫生组织制定的T2DM诊断标准。排除标准包括高血压、冠心病、心包积液、周围动脉疾病、大动脉炎、伴有临床症状的出血性和缺血性中风、急慢性肝肾功能衰竭、血液病、自身免疫性疾病、急慢性感染和糖尿病急性并发症等。根据糖尿病病程长短分为2组:B组32例,病程≤10年;C组35例,病程>10年。另外,选取35例健康志愿者作为A组(对照组)。应用超声技术分别测量EAT厚度和右侧肱动脉血流介导的内皮依赖性血管舒张功能(FMD)。使用GE Vivid E9彩色超声诊断仪M5S-D探头测量EAT,频率为1.5~4.5MHz,同步记录心电图,受检者左侧卧位,取胸骨旁左室长轴切面,以主动脉根部为基准,使超声波中线垂直于右心室游离壁和主动脉瓣环,测量右室游离壁心肌外层和脏层心包膜之间的低回声区,于舒张末期(同步心电图R波的峰值)测量,记录3个心动周期,测量3次取平均值,所有操作均由同一人完成。内皮功能采用FMD来评估,在检测前4~6小时,嘱受试者停止剧烈运动,不能摄入可能影响FMD的物质,如咖啡因、高脂肪食物、维生素C等。于安静、温度适宜的房间内进行。使用GE Vivid E9彩色超声诊断仪11L-D探头,探头频率为7~11MHz。受试者取仰卧位,同步记录心电图,右上肢外展15°,于右肘上2~10cm范围内获得肱动脉纵切面最清晰的图像,冻结图像并标记位置。测量静息时舒张末期(同步心电图R波峰值)肱动脉内径为基础值(D0)。将血压计袖带置于右上臂,将袖带充气至收缩压以上至少50mm Hg并保持5分钟。在袖带放气之后的30秒至2分钟之间连续记录肱动脉的纵切面图像,同一位置测量肱动脉舒张末期内径(D1)。内径测量为动脉前后壁内膜层与内膜层之间的距离。FMD计算方式为(D1-D0)/D0×100%,结果为3次测量取平均值,整个过程由同一人完成。获取身高、体重、腹围、糖化血红蛋白(Hb A1C%)、总胆固醇(TC)、总甘油三酯(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)等相关临床和实验室指标。结果:A、B、C三组EAT比较,经方差分析,差异具有统计学意义(F=11.652,P=0.000),与A组相比,B、C组EAT均增高(P<0.05);A、B、C三组FMD比较,经方差分析,差异具有统计学意义(F=24.245,P=0.000),与A组相比,B、C组FMD均减低(P<0.05)。Pearson相关分析显示,FMD与糖尿病病程(r=-0.424,P=0.000)、BMI(r=-0.368,P=0.000)、Hb A1C(r=-0.305,P=0.011)、TC(r=-0.310,P=0.010)、TG(r=-0.614,P=0.000)、LDL(r=-0.474,P=0.000)、腰围(r=-0.503,P=0.000)及EAT(r=-0.558,P=0.000)均呈负相关关系。在多元线性回归分析中,TG、EAT、糖尿病病程是FMD的独立预测因子。结论:随着病程的增加,T2DM患者的EAT增加、内皮功能受损加重,EAT与内皮功能呈负相关关系。应用超声技术可以无创、简便、准确的评价T2DM患者EAT及与内皮功能的关系。更多还原

【Abstract】 Objective: To evaluate the thickness of epicardial adipose tissue(EAT)of the patients with type 2 diabetes mellitus(T2DM)by ultrasonography and its correlation with endothelial function.Methods: 67 patients with T2 DM admitted to our hospital from December 2017 to September 2018 were enrolled and all met the diagnostic criteria of T2 DM established by WHO in 1999.Exclusion criteria included hypertension,coronary heart disease,pericardial effusion,peripheral artery disease,arteritis,hemorrhagic and ischemic stroke with clinical symptoms,acute and chronic liver and kidney failure,hematological diseases,autoimmune diseases,acute and chronic infections and acute complications of diabetes.According to the duration of diabetes mellitus,the patients were divided into two groups: group B(32 cases),with a course of less than or equal 10years;group C(35 cases),with a course of more than 10 years.In addition,35 healthy volunteers were enrolled as group A(control group).The thickness of EAT and endothelium-dependent flow-mediated vasodilation(FMD)of right brachial artery were measured by ultrasonography.EAT was measured by GE Vivid E9 color ultrasound diagnostic instrument with M5S-D probe of 1.5~4.5MHz frequency.ECG was recorded synchronously.The left lateral decubitus position of the subjects was recorded.The long axis section of the leftventricle near the sternum was obtained and the aortic root was taken as the baseline.The middle line of the ultrasound was perpendicular to the free wall of the right ventricle and the aortic annulus.The hypoechoic area between the outer myocardium of the right ventricle free wall and the pericardium of the visceral layer was measured during the end-diastolic period(peak value of R wave of synchronous electrocardiogram).Three cardiac cycles were recorded and the mean values were measured three times.All procedures were performed by the same operator.Endothelial function was assessed by FMD in a quiet room with appropriate temperate.The subjects should stop exercising vigorously and refrain from taking substances that may affect FMD,such as caffeine,high-fat foods,vitamin C,etc.GE Vivid E9 color ultrasound diagnostic instrument was used with the 11L-D probe of7~11MHz frequency.The subjects took supine position and electrocardiogram was recorded synchronously with the right upper limb extended 15 degrees.The best image of the longitudinal section of the brachial artery from 2 cm to 10 cm above the right elbow was obtained.Then the image was frozen and the position was marked.The end-diastolic(peak R wave of synchronous electrocardiogram)brachial artery diameter was measured as baseline(D0)at rest.The cuff was placed on the right upper arm and was inflated at least 50 mm Hg above systolic pressure for 5 minutes.Longitudinal images of brachial artery were continuously recorded between 30 seconds to 2 minutes after the cuff ventilation.End-diastolic diameter(D1)of brachial artery was measured at the same position.The internal diameter was measured as the distance between the intima-to-intima between the anterior and posterior wall of the artery.The FMD was calculated by the formula:(D1-D0)/D0 × 100%.The results were averaged for three measurements.The whole procedure was performed by the same operator.The related clinical and laboratory indexes such as height,weight,abdominal circumference,hemoglobin A1C(Hb A1C%),total cholesterol(TC),total triglyceride(TG),low density lipoprotein(LDL),high density lipoprotein(HDL)were obtained.Results: Compared with group A,group B and group C,the difference was statistically significant by ANOVA(F=11.652,P=0.000).Compared with group A,EATof group B and C increased(P<0.05).Compared with group A,group B and group C,the difference of FMD was statistically significant by ANOVA(F=24.245,P=0.000).Compared with group A,FMD of group B and C decreased(P<0.05).Pearson correlation analysis showed that FMD was negatively correlated with duration of diabetes(r=-0.424,P=0.000),BMI(r=-0.368,P=0.000),Hb A1C(r=-0.305,P=0.011),TC(r=-0.310,P=0.010),TG(r=-0.614,P=0.000),LDL(r=-0.474,P=0.000),waist circumference(r=-0.503,P=0.000)and EAT(r=-0.558,P=0.000).In multiple linear regression analysis,TG,EAT,the duration of diabetes were independent predictors of FMD.Conclusion: With increase of the duration of diabetes,the epicardial fat tissue thickness increased and the endothelial function decreased with a negative correlation.The thickness of EAT and the endothelial function in the T2 DM patients can be evaluated by ultrasonography non-invasively and conveniently.更多还原