超声评估2型糖尿病患者颈动脉弹性传递指数与颈动脉内膜-中层厚度的相关性

Correlation between carotid elasticity transmission index and carotid intima-media thickness in patients with type 2 diabetes mellitus assessed with ultrasonic testing

目的应用超声检测评估2型糖尿病患者颈动脉弹性传递指数(CETI)与颈动脉内膜-中层厚度(CIMT)的相关性。方法选择38例2型糖尿病患者和24例健康对照组,应用经颅多普勒超声和颈动脉超声检查,检测在侧大脑中动脉(MCA)、基底动脉(BA)、颈内动脉(ICA)、颈总动脉(CCA)的血流速度及CIMT,计算搏动指数(PI)。拟定MCA、ICA、BA的CETI分别为:CETI_1=P_(MCA)/PI_(CCA)、CETI_2=PI_(ICA)/PI_(CCA)、CETI_3=PI_(BA)/PI_(CCA)。分析左侧CETI与CIMT的相关性以及影响CETI、CIMT的危险因素。结果①与健康对照组相比,糖尿病组PI_(MCA)、PI_(ICA)、PI_(BA)、PI_(CCA)的值均增大,CETI_1～CETI_3值均降低,差异有统计学意义,均P<0.01。②CETI_1、CETI_2、CETI_3与CIMT呈负相关,相关系数分别为r_1=-0.733、r_2=-0.681及r_3=-0.706(均P<0.001);PI_(CCA)、PI_(ICA)、PI_(MCA)、PI_(BA)与CIMT呈正相关(r_(CCA)=0.490,r_(ICA)=0.465,r_(MCA)=0.382,r_(BA)=0.484;均P<0.01)。③低密度脂蛋白-胆固醇与CETI_1、CETI_2、CETI_3、CIMT多元相关系数R分别为0.620、0.525、0.559、0.801,均P<0.01。结论 2型糖尿病患者的CETI随着CIMT的增大而减小,说明CCA粥样硬化的进展速度较颅内动脉快,推测糖尿病患者颅内动脉的弹性储备的下降是受到颅外动脉弹性储备下降的影响;并且低密度脂蛋白-胆固醇是2型糖尿病患者CIMT、CETI变化的独立影响因素。

Objective To assess the correlation between the carotid elasticity transmission index （CETI） and carotid intima-media thickness in patients with type 2 diabetes mellitus with ultrasonic testing. Methods Thirty-eight patients with type 2 diabetes mellitus and 24 healthy controls were selected. Transcranial Doppler ultrasound and carotid artery ultrasound were used to detect the blood flow velocity and carotid intima-media thickness （CIMT） of the left middle cerebral artery （MCA）, basilar artery （BA）, internal carotid artery （ICA） , and common carotid artery （CCA）. Their pulsatility index （PI） was calculated. The proposed CETI of MCA, ICA, and BA were： CETI1 = PIMCA/PICCA, CETI2 = PIICA/PICCA, and CETI3 = PIBA/PICCA, respectively. The correlation between the left CETI and CIMT, as well as the risk factors for affecting CIMT and CETI were analyzed. Results ①Compared with the healthy control group, the values of PIMCA, PIICA, PIBA, and PICCA were increased, and the values of CETI1 to CETI3 were decreased in the diabetes mellitus group, the differences were statistically significant （ all P 〈 0.01 ）. ②CETI1 , CETI2 , CETI3 were negatively correlated with CIMT, and the correlation coefficients were r1 = -0. 733; r2 = -0. 681; r3 = -0. 706, respectively （Pall 〈0. 01 ）. PICCA, PIICA, PIMCA, and PIBA were positively correlated with CIMT （ rCCA = 0. 490, rICA = 0. 465, rMCA = 0. 382, rBA = 0. 484） （ P 〈 0. 01 all）. ③The low-density lipoprotein-cholesterol （LDL-C） and CETI1, CETI2, CETI3, and CIMT multiple correlation coefficient R were 0. 620, 0. 525, 0. 559, and 0. 801, respectively （P 〈 0. 01 all）. Conclusions CETI decreases with the increase of CIMT in patients with type 2 diabetes mellitus, and it is indicated that the development speed of atherosclerosis of common carotid is faster than that of the intraeranial artery. It is speculaled that the decreased elastic reserves of the intracrania arteries in patients with diabetes mellitus are impacted by the deereased elastic reserves of the extracranial arteries; LDL-C is an independent factor affecting the changes of CIMT and CETI in patients with type 2 diabetes mellitus.