脉搏波传导速度定量检测糖尿病合并脂肪肝病人颈动脉弹性功能的价值

Application value of the pulse wave velocity in the quantitative detection of carotid elastic function in patients with diabetes mellitus complicated with fatty liver

目的:探究脉搏波传导速度对定量检测糖尿病合并脂肪肝病人颈动脉弹性功能的应用价值。方法:选取60例2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)病人,按脂肪肝严重程度分为:轻度脂肪肝组(A组)、中度脂肪肝组(B组)及重度脂肪肝组(C组),各20例。采用极速脉搏波技术(ultrafast pulse wave velocity,UFPWV),定量测定所有病人内中膜厚度(intima-medium thickness,IMT)、收缩期开始时的脉搏波传导速度(pulsewave velocity at the beginning of systole,PWVBS)和收缩期结束时的脉搏波传导速度(pulse wave velocity at the ending of systole,PWVES),并与同期20例单纯2型糖尿病病人(T2DM组)进行比较。统计各组UFPWV测量结果,并比较各组颈动脉弹性功能,采用Spearman相关系数分析IMT、PWVBS及PWVES与T2DM合并NAFLD病人脂肪肝分度的相关性。结果:T2DM合并NAFLD组IMT、PWVBS、PWVES值均高于T2DM组(P <0. 01)。IMT、PWVBS、PWVES值,C组高于A组和B组,且B组高于A组(P <0. 01)。Spearman相关性分析显示,脂肪肝分度与IMT、PWVBS及PWVES呈正相关关系(r=0. 608、0. 668、0. 765,P <0. 01)。ROC曲线分析显示:PWVBS及PWVES诊断颈动脉硬化的曲线下面积(AUC)分别为0. 868(95%CI:0. 809~0. 926)、0. 844(95%CI:0. 781~0. 906),诊断效能较高(AUC> 0. 5)。结论:糖尿病合并脂肪肝病人的颈动脉弹性较单纯糖尿病病人降低,UFPWV技术能快速测量并直接精确计算颈动脉IMT、PWVBS和PWVES,其结果客观,可重复性高,易于操作,值得在临床评价血管弹性功能中广泛应用。

Objective:To explore the application value of the pulse wave velocity in the quantitative detection of carotid elasticity in patients with diabetes mellitus complicated with fatty liver.Methods:Sixty patients with type 2 diabetes mellitus(T2DM)combined with nonalcoholic fatty liver disease(NAFLD)were divided into the mild fatty liver group(group A),moderate fatty liver group(group B)and severe fatty liver group(group C)according to the severity of fatty liver(20 cases in each group).The intima-medium thickness(IMT)and pulse wave velocity at the beginning of systole(PWVBS)and pulse wave velocity at the ending of systole(PWVES)at the end of the systole were quantitatively measured using ultrafast pulse wave velocity(UFPWV),and compared with 20 patients with T2DM(T2DM group)during the same period.The results of UFPWV measurement in four groups were compared.The carotid artery elasticity function was compared among four groups.The correlations of IMT,PWVBS and PWVES with fatty liver grading in patients with T2DM combined with NAFLD were analyzed using Spearman correlation coefficient.Results:The IMT,PWVBS and PWVES values in patients with T2DM complicated with NAFLD were higher than those in T2DM group,and the differences of which was statistically significant(P<0.01).The values of IMT,PWVBS and PWVES in group C were significantly higher than those in group A and group B,and which in group B was higher than that in group A(P<0.01).The results of Spearman correlation analysis showed that the fatty liver index was positively correlated with the IMT,PWVBS and PWVES(r=0.608,0.668,0.765,P<0.01).The results of ROC curve analysis showed that the areas under the curve(AUC)of PWVBS and PWVES in diagnosing carotid arteriosclerosis were 0.868(95%CI:0.809-0.926)and 0.844(95%CI:0.781-0.906),respectively,and the diagnostic efficacy of which was high(AUC>0.5).Conclusions:The carotid artery elasticity in patients with diabetes mellitus complicated with fatty liver is lower than that in patients with diabetes mellitus.The UFPWV technology can quickly measure and accurately calculate the IMT,PWVBS and PWVES of carotid,the result of which is objective,highly reproducible and easy to operate,which is worthy of clinical evaluation.