超声造影对糖尿病视网膜病变患者颈动脉斑块稳定性的评估价值研究

Evaluation of carotid plaque stability by contrast-enhanced ultrasound in patient with diabetic retinopathy

目的探讨超声造影评估2型糖尿病视网膜病变患者颈动脉斑块稳定性的价值.方法选取2018年9月至2019年3月在陕西省人民医院就诊的2型糖尿病合并糖尿病视网膜病变且颈动脉超声检查发现颈动脉斑块者69例,根据视网膜病变情况将其分为2型糖尿病合并视网膜病变增殖前期(NPDR)组(40例)和增殖期(PDR)组(29例),另选取2型糖尿病眼科检查无糖尿病视网膜病变同时行颈动脉超声检查发现颈动脉斑块者[2型糖尿病无视网膜病变(NDR)组]32例.所有患者均行超声造影检查.记录颈动脉内中膜厚度(IMT)、颈动脉责任斑块厚度、颈动脉责任斑块超声造影评分.结果3组均以低回声斑块为主,PDR组颈动脉IMT大于NDR组和NPDR组[(1.10±0.15)mm比(0.96±0.14)、(0.99±0.12)mm],差异均有统计学意义(均P<0.05).3组责任斑块厚度比较差异无统计学意义(P>0.05).NDR组和NPDR组患者颈动脉责任斑块超声造影评分以1分为主,而PDR组颈动脉责任斑块超声造影评分以3分为主.结论糖尿病合并视网膜病变患者及不合并者颈动脉斑块均以低回声为主.糖尿病视网膜病变增殖期IMT增厚,斑块内新生血管较多,斑块不稳定.

Objective To explore the value of contrast-enhanced ultrasound in the evaluation of carotid plaque stability in patients with type 2 diabetes and diabetic retinopathy.Methods From September 2018 to March 2019,69 patients with type 2 diabetes and diabetic retinopathy,including 40 cases of non-proliferative diabetic retinopathy(NPDR group)and 29 cases of proliferative diabetic retinopathy(PDR group),and 32 type 2 diabetic patients without retinopathy(NDR group)were found carotid plaque by ultrasound examination in Shaanxi Provincial People’s Hospital.Contrast-enhanced ultrasound was performed in all patients.Carotid intima-media thickness(IMT),culprit plaque thickness and contrast-enhanced ultrasound score of culprit plaque were analyzed.Results Most patients showed hypoechoic plaques.Carotid IMT was greater with PDR than with NDR and NPDR[(1.10±0.15)mm vs(0.96±0.14),(0.99±0.12)mm](both P<0.05).There was no significant difference in the thickness of culprit plaque among the 3 groups(P>0.05).The ultrasound contrast score of culprit plaque was mostly 1 in NDR,NPDR and 3 in PDR.Conclusions Carotid plaques are mainly hypoechoic in diabetic patients with or without retinopathy.IMT increases in PDR patients,causing angiogenesis that may increase the vulnerability of plaques.