剪切波弹性成像所测胰腺硬度与2型糖尿病微血管病变的关系

Correlation between pancreatic hardness measured by shear wave elastography and microvascular lesions in type 2 diabetes mellitus

目的应用剪切波弹性成像(SWE)检测2型糖尿病(T2DM)患者胰腺硬度,并分析其与微血管病变的关系。方法选取我院收治的T2DM患者200例(T2DM组)和同期健康体检者200例(对照组),均应用二维超声观察胰腺大小、形态及内部回声;SWE检测胰头、胰体和胰尾组织杨氏模量平均值(Emean)。根据临床诊断微血管病变发生情况将T2DM组患者分为合并微血管病变组(86例)和未合并微血管病变组(114例),比较T2DM组与对照组、合并微血管病变组与未合并微血管病变组上述参数的差异,比较不同临床特征(年龄、性别、T2DM病程)T2DM患者SWE参数的差异。采用多因素Logistic回归分析T2DM患者胰腺SWE参数的独立影响因素;绘制受试者工作特征(ROC)曲线分析SWE对T2DM患者发生微血管病变的诊断效能。结果T2DM组胰腺回声增强占比高于对照组,胰头、胰体、胰尾厚径和Emean均大于对照组,差异均有统计学意义(均P<0.05)。合并微血管病变组胰体Emean大于未合并微血管病变组,差异有统计学意义(P<0.05);其余参数比较差异均无统计学意义。男性、年龄≥60岁的T2DM患者胰体Emean均分别大于女性、年龄<60岁患者,差异均有统计学意义(均P<0.05);T2DM患者胰体Emean随着病程的增加逐渐增大(P<0.001)。多因素Logistic回归分析显示,性别、年龄、T2DM病程、微血管病变均为T2DM患者胰体Emean的独立影响因素。ROC曲线分析显示,胰体Emean诊断T2DM患者发生微血管病变的曲线下面积为0.792,灵敏度为82.55%,特异度为71.93%。结论应用SWE可准确检出T2DM患者胰腺硬度增大,当合并微血管病变时胰体Emean增大明显,有一定的临床价值。

Objective To measure the pancreatic hardness in patients with type 2 diabetes mellitus(T2DM)by shear wave elastography(SWE),and to analyze its relationship with microvascular lesions.Methods A total of 200 patients with T2DM(T2DM group)and 200 healthy subjects(control group)in our hospital were enrolled.The pancreatic size,morphology and internal echo were observed by two-dimensional ultrasound.The mean Young’s modulus(Emean)of pancreatic head,body and tail tissues were detected by SWE.According to the clinical diagnosis of microvascular lesions,patients in T2DM group were divided into microvascular lesion group(n=86)and non-microvascular lesion group(n=114).The differences of the above parameters between T2DM group and control group,as well as between microvascular lesion and non-microvascular lesion groups were compared.Differences of SWE parameters in T2DM patients with different characteristics(age,gender,duration of T2DM)were analyzed.Multivariable Logistic regression was performed to analyze the independent influencing factors of SWE parameters in T2DM patients.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy SWE in the diagnosis of microvascular lesions in T2DM patients.Results The proportion of pancreatic hyperecho in T2DM group was higher than that in control group,the diameters and Emean of pancreatic head,body and tail were higher than those in control group,with statistically significant differences(all P<0.05).Emean of pancreatic body in microvascular lesion group was higher than that in non-microvascular lesion group(P<0.05),while the differences in the other parameters between the two groups were not statistically significant.Emean of pancreatic body in male,aged≥60 years and T2DM patients with microvascular lesion was higher than that in female,aged<60 years and T2DM patients without microvascular lesion,respectively,with statistically significant differences(all P<0.05).Emean of pancreatic body was gradually increased with the duration of T2DM(P<0.001).Multivariate Logistic regression analysis showed that gender,age,duration of T2DM and microvascular lesions were independent influencing factors for Emean of pancreatic body in T2DM patients.ROC curve analysis showed that the area under ROC curve,sensitivity and specificity of Emean of pancreatic body in the diagnosis of microvascular lesions were 0.792,82.55%and 71.93%,respectively.Conclusion SWE can accurately detect the increase of Emean in the head,body and tail of the pancreas in patients with T2DM.When patients combined with microvascular lesion,the increase of Emean in the body of pancreas is more obvious,which has certain clinical value.