剪切波弹性成像测量高原与平原人群正常皮肤弹性的研究

Normal skin elasticity of populations living on plateaus and plains under shear wave elastography

目的应用剪切波弹性成像(SWE)研究高原、平原常住人群正常皮肤弹性。方法招募113名高原地区(高原组)和92名平原地区(平原组)健康志愿者,分别用横切面和纵切面测量腹壁、胸壁、右侧前臂、右手中指、右侧脸颊5个部位皮肤弹性值(包括剪切模量、剪切波速度)。比较组间、组内弹性值差异,选取弹性值差异有统计学意义的参数,行诊断性试验,并绘制ROC曲线。结果高原组各部位皮肤弹性值高于平原组(P<0.05);2组各部位皮肤横切面、纵切面弹性值差异均有统计学意义(P<0.05);各部位皮肤横切面弹性值诊断高原地区皮肤的ROC曲线AUC大于纵切面;不防晒者右侧脸颊皮肤弹性值高于防晒者(P<0.001);高原组各部位皮肤横切面弹性值为右手中指>胸壁>右侧前臂,右手中指>胸壁>右侧脸颊,右手中指>胸壁>腹壁,平原组各部位皮肤横切面弹性值为右手中指>右侧前臂>右侧脸颊,右手中指>右侧前臂>腹壁,胸壁>右侧前臂>右侧脸颊,胸壁>右侧前臂>腹壁(均P<0.05),余不同部位弹性值比较差异均无统计学意义(均P>0.05)。结论高原日光照射会使皮肤弹性值增加,同一人群,日光暴露时间越长的部位皮肤弹性值越大,临近骨面的皮肤弹性值更大,防晒措施能减缓皮肤弹性值增加,皮肤具有各向异性,横切面弹性值诊断效能大于纵切面。

Objective To investigate the normal skin elasticity of populations living on plateaus and plains by using shear wave elastography(SWE).Methods A total of 113 healthy volunteers from plateaus and 92 healthy volunteers from plains were enrolled as plateau group and plain group in the investigation.The skin elasticity values(including shear modulus and shear wave velocity)of abdominal wall,chest wall,right forearm,right middle finger and right cheek were measured in transverse and longitudinal sections respectively.The differences in elastic value between the two groups were compared and the parameters with statistically significant differences in elastic value were selected to conduct diagnostic tests and draw ROC curves.Results The skin elasticity of the plateau group was significantly higher than that of the plain group(P<0.05).There were statistically differences in the elastic values of the transverse and longitudinal sections between the two groups(P<0.05).The AUC of ROC curve of the cross-sectional elastic value was greater than that of the longitudinal sectional elastic value in the populations living in the plateau area.The skin elasticity value of the right cheek of the residents using sunscreens was significantly higher than that of those using no sunscreens(P<0.05).In the plateau group,there were three rankings of different parts selected for detection in terms of the skin cross-sectional elastic value:the right middle finger>the chest wall>the right forearm,the right middle finger>the chest wall>the right cheek and the right middle finger>the chest wall>the abdominal wall.In the plain group,there were four different rankings:the right middle finger>the right forearm>the right cheek,the right middle finger>the right forearm>the abdominal wall,the chest wall>the right forearm>the right cheek,and the chest wall>the right forearm>the abdominal wall(P<0.05 for all).There was no significant difference in the elastic values of other different parts(P>0.05).Conclusion Sunlight exposure in plateaus can increase the skin elastic value.For the same group of population,the longer one is exposed to sunlight,the higher the skin elastic value is.The skin elastic value near the bone is higher.Sunscreen can slow down the increase of skin elasticity.Since skin is featured with anisotropy,the diagnostic efficiency of cross-sectional elasticity is greater than that of longitudinal sectional elasticity.