血管回声追踪技术评价2型糖尿病患者股动脉弹性的价值

Assessment of femoral artery elasticity in type 2 diabetes mellitus by echo-tracking technique

目的探讨血管回声追踪（ET）技术评价2型糖尿病患者股动脉弹性的价值。方法采集30例正常人和54例2型糖尿病患者股动脉的二维超声图像，测量双侧股动脉内膜-中层厚度（IMT），血管内径（D）；应用脉冲多普勒技术（Pw）测量收缩期流速（Vs）、舒张早期反向流速（Vr）、舒张末期正向流速（Vd）、阻力指数（RI）、搏动指数（PI）；应用ET技术检测弹性指标：僵硬度指数（β）、血管压力-应变弹性系数（Ep）、顺应性（AC）、增大指数（AI）、脉搏波传导速度（PWVβ）。结果按照IMT是否〈1．0mm分组后显示：糖尿病IMT〈1．0mm组及糖尿病IMT≥1．0mm组的股动脉血流动力学参数RI、PI、Vr及弹性指标p、Ep、PWVp均较对照组显著增高（P〈O．05），AC值显著降低（P〈0．05）；糖尿病IMT≥1．0mm组的股动脉血流动力学参数RI、PI与IMT〈1．0mm组比较差异无统计学意义，但弹性指标β、Ep、PWVβ较糖尿病IMT〈1．0mm组显著增高（P〈0．05）。结论糖尿病患者存在动脉硬化，且在血管粥样硬化的形态学改变出现之前，血管壁弹性功能已降低，且影响血流动力学，造成外周组织血液供应不良。

Objective To investigate the elasticity and hemodynamics of femoral artery in patients with type 2 diabetes mellitus （T2DM）. Methods Subjects recruited in this study were divided into three groups, healthy control （ n = 30）, T2DM patients with femoral arterial intima-media thickness（IMT） 〈1.0 mm （ n = 32） and IMT≥1. 0 mm （ n = 22）. The IMT and diameter were measured by two dimensional ultrasound. The blood velocity in early and late systolic stages and early diastolic reverse blood velocity, resistance index and pulsatile index were measured by pulse Doppler. The stiffness parameter, pressurestrain elasticity modulus, arterial compliance, argumentation index and one-point pulse wave velocity were measured by echo-tracking technique. Results The early diastolic reverse blood velocity,resistance index, pulsatile index, stiffness parameter, pressure-strain elasticity modulus and one-point pulse wave velocity were significantly elevated in T2DM patients compared with healthy control （P 〈 0.05）, the arterial compliance was significantly lower in T2DM subjects. Stiffness parameter, pressure-strain elasticity modulus and one-point pulse wave velocity were more pronounced in the patients with IMT≥1. 0 mm than those with IMT 〈 1.0 mm （ P 〈 0.05）. Conclusions There is atherosclerosis in femoral arteries in patients with T2DM. A decrease in arterial elasticity occurs prior to the morphological changes in vascular atherosclerosis, the arterial elasticity abnormality causes insufficient blood supply to peripheral tissues.