二维剪切波弹性成像评价2型糖尿病患者跟骨下脂肪垫改变

Two-dimensional shear wave ultrasound elastography for evaluation on changes of heel pad in patients with type 2 diabetes mellitus

目的观察二维剪切波弹性成像(2D-SWE)评价2型糖尿病(T2DM)患者跟骨下脂肪垫硬度改变的价值。方法将104例T2DM患者根据病程分为长病程组(n=54)和短病程组(n=50),另纳入38名健康志愿者作为对照组。采用2D-SWE技术测量受试者跟骨下脂肪垫弹性模量(E_(hp))及其大腔室弹性模量(E_(macro))、微腔室弹性模量(E_(micro)),比较组内左、右足各参数差异及组间双足参数差异。采用Pearson相关性分析评价E_(hp)与实验室指标的相关性;以多元线性逐步回归分析影响E_(hp)的独立因素。结果各组内左、右足各弹性参数差异均无统计学意义(P均>0.05)。长、短病程组E_(hp)、E_(macro)及E_(micro)均高于对照组(P均<0.05);长病程组各参数均高于短病程组(P均<0.05)。E_(hp)与空腹血糖(FBG)、糖化血红蛋白(HbA1c)均呈正相关(r=0.516、0.403,P均<0.001),与高密度脂蛋白胆固醇(HDL-C)呈负相关(r=-0.521,P<0.001)。FBG、HbA1c及HDL-C均为影响E_(hp)的独立因素(P均<0.05)。结论利用2D-SWE技术能够准确、客观地评价T2DM患者跟骨下脂肪垫异常改变。

Objective To observe the value of two-dimensional shear wave elastography(2D-SWE)for evaluating changes of heel pad in patients with type 2 diabetes mellitus(T2DM).Methods Totally 104 T2DM patients were enrolled and divided into long course group(n=54)and short course group(n=50)according to the course of T2DM,and 38 healthy volunteers were taken as controls(control group).2D-SWE technique was used to measure the elastic modulus of heel pad(E_(hp))and its macro chamber(E_(macro))and micro chamber(E_(micro)).Parameters of left and right foot were compared in each group,and bipedal parameters were compared among groups.Pearson correlation analysis was used to explore correlations of E_(hp)and laboratory indicators,and the independent impact factors of E_(hp)was analyzed using multiple linear stepwise regression.Results There was no significant difference between left and right foot elastic parameters in every group(all P>0.05).E_(hp),E_(macro)and E_(micro)of long course group and short course group were larger than those of control group(all P<0.05),and parameters in long course group were larger than those in short course group(all P<0.05).E_(hp)was positively correlated with fasting blood glucose(FBG)and glycosylated hemoglobin(HbA1c)(r=0.516,0.403,both P<0.001),but negatively correlated with high density lipoprotein-cholesterol(HDL-C)(r=-0.521,P<0.001).FBG,HbA1c and HDL-C were all independent impact factors of E_(hp)(all P<0.05).Conclusion 2D-SWE technique could be used to accurately and objectively evaluate abnormal changes of heel pad in patients with T2DM.