彩色多普勒超声参数值变化对糖尿病肾病患者下肢动脉形态及血液流变学变化的评估价值

Value of color Doppler flow imaging parameters in the evaluation of the changes in lower limb artery and hemorheology in patients with diabetic nephropathy

目的:探讨彩色多普勒超声检测在糖尿病肾病男性患者下肢动脉硬化中的应用价值。方法:选择2004-06/2006-06选择解放军沈阳军区总医院和沈阳军区第201医院收治糖尿病肾病男性患者64例,以70名正常男性体检者作为正常对照组。采用泰索尼2DW型彩色多普勒超声仪,探头频率5～12MHz,进行下肢血管超声检查,以二维超声显示并测量两组股动脉、腘动脉、胫前动脉、胫后动脉、足背动脉的内-中膜厚度,测量血管内径,观察其是否有硬化斑块形成(内-中膜厚度>1.2mm为斑块形成);再以彩色多普勒观察血管腔内的血流充盈情况,以脉冲多普勒获取血流动力学参数(峰值血流速度、搏动指数、阻力指数)。结果:134名受试者均进入结果分析。①糖尿病肾病组血管狭窄,动脉内膜增厚,局部可见大小不等的硬化斑块形成,斑块所致管腔不同程度的狭窄,甚至闭塞。血流通过明显狭窄处显示血流变细,形态不规则,流速增快,频谱增宽、充填,失去正常三相波形态;闭塞的血管壁增厚,内腔消失,无彩色血流显示,血流频谱引不出,狭窄远端的血管血流信号减弱,流速减低,为单相低速波型。②斑块的发生率:糖尿病肾病组胫前、胫后动脉和足背动脉高于正常对照组(31.3%,43.8%,59.4%;15.7%,11.4%,14.3%;P<0.05,0.01),股、腘动脉与对照组比差异无显著性(P>0.05)。③狭窄的发生率:糖尿病肾病组高于正常对照组(P<0.05)。糖尿病肾病组膝以下动脉(含胫前、胫后动脉和足背动脉)狭窄发生率高于正常对照组(48.4%,10.0%,P<0.01)。④糖尿病肾病组患者膝以下动脉内径变细,内-中膜厚度较正常对照组增厚(P<0.05);峰值血流速度、下肢血管搏动指数和阻力指数值高于对照组(P<0.05)。结论:糖尿病肾病下肢动脉的彩色多普勒超声检查,可对动脉管壁、内-中膜厚度、斑块形成、狭窄程度、血流动力学等进行全面评估,在动脉粥样硬化病变早期就可以做出诊断,对糖尿病肾病患者下肢动脉硬化的诊断、预防、治疗方式的选择、预后判断及疗效观察等方面均具有重要价值。

AIM： To probe into the applying value of color Doppler flow imaging （CDFi） in the diagnosis of lower limb arteriosclerosis of diabetic nephropathy patients. METHODS： Sixty-four male patients with diabetic nephropathy between June 2004 and June 2006 were selected from the 201 Hospital of Chinese PLA of Shenyang Military Area, and 70 normal males were taken as the normal control group. Sonos 2DW ultrasonic systems equipped with a 5-12 MHz liner-array transducer were adopted. Vascular ultrasound was Conducted in the lower limbs, and 2D ultrasonic was used for Visualization and detection of the intima-media thickness （IMT） in femoral artery, popUteal artery, anterior tibial artery, posterior tibial artery and dorsal pedal artery. Vascular internal diameter was determined to detect the atheroscierotic plaques （there were plaques as the IMT 〉 1.2 mm）. Color Doppler was adopted to observe the turgor of blood flow in lumen of blood vessels. Parameters of haemodynamics were gained with pulse Doppler （peak value blood flow velocity, pulsatility index and resistant index）. RESULTS： A total of 134 subjects were involved in the analysis of results. （1） Angiostegnosis, thickened endarterium and partial artherosclerotic plaque of different sizes were found in patients with diabetic nephropathy. Plague induced different degree of stenosis even block in the lumina. The blood flow was significantly weakened in the stenosis with irregular morphous, accelerated flow, widened spectra and fillings, whereas normal triphasic wave was not found. Blocked vessel wall was thickened with inner cavity disappeared. Achromatic color blood flow showed that the spectra of blood flow failed, and the signal of blood flow in distal stenosis was weakened with lower flow of peak systolic velocity. （2）T he incidence of plague： The incidence in anterior tibial artery, posterior tibial artery and dorsal pedal artery in patients with diabetic nephropathy were obviously higher than those in the normal control group （31.3% ,43.8%,59.4%; 15.7%, 11.4%, 14.3%;P 〈 0.05,0.01）, and there were no significant differences in the femoral and popliteal arteries in comparison with the normal control group （P 〉 0.05）. （3） Stenosal incidence： it was higher in the diabetic nephropathy group than that in the normal control group （P 〈 0.05）. The incidences in arteries below the knees （anterior tibial artery, posterior tibial artery and dorsal pedal artery） in patients with diabetic nephropathy were higher than those in the normal control group （48.4%,10.0%, P〈 0.01）. （4） The inner diameters of arteries below the knees turned slimmer in patients with diabetic nephropathy, and the IMT was thicker than that in the normal control group （P 〈 0.05）; The incidence of stenosis of the arteries under the knee in the patients group was much higher than that in the control group. The results indicates that the diameters of arteries under the knee decreased and the RI, PI and the velocity of the lower limb artery increased in patients. The IMT of the arteries were thicker than that in the control group. And the blood flow velocity of peak value, pulsatility index and resistant index were higher those in the normal control group （P 〈 0.05）. CONCLUSION： CDFI inspection of the lower limbs of patients with diabetic nephropathy can comprehensively evaluate the thickness of vessel wall and IMT, formation of plague, stenosis as well as in hemodynamics, and it contributes to early diagnosis of atheromatosis. CDFI has important clinical values in the early diagnosis, prevention and therapeutic effect as well as prognosis of lower limb arteriosclerosis of diabetic nephropathy.