本文選題：糖尿病　切入點(diǎn)：跟腱　出處：《吉林大學(xué)》2017年碩士論文

【摘要】：目的:糖尿病患者下肢容易發(fā)生病變,其中跟腱的病變影響糖尿病患者后期的生活質(zhì)量,早期發(fā)現(xiàn)糖尿病跟腱的病變是不容易的,超聲彈性成像創(chuàng)新性地從彈性的角度檢測病變的程度,糖尿病跟腱的彈性成像結(jié)果與組織學(xué)檢查有良好的對(duì)應(yīng)性,對(duì)糖尿病跟腱的早期異常改變具有量化、快速、無創(chuàng)、低廉的診斷優(yōu)勢。方法:回顧性分析2016年1月至2016年11月在吉林大學(xué)第二醫(yī)院各科的T2DM住院部患者63名(男32名,女31名)。血糖正常住院部患者29名(男10名,女19名)。入選標(biāo)準(zhǔn)為下肢無明顯主觀癥狀并排除影響跟腱彈性的其他疾病(如風(fēng)濕性關(guān)節(jié)炎、脊椎關(guān)節(jié)病變、血膽脂醇高、跟腱滑膜炎、跟腱末梢病、跟腱后滑囊炎等,或糖尿病足病史、跟腱外傷史、下肢截肢史、特殊運(yùn)動(dòng)功能鍛煉史等),另外年齡相仿(50-55)歲。按照糖尿病病程將T2DM組劃分為4組,1-5年為組別1,6-10年為組別2,11-15年為組別3,16年以上為組別4。應(yīng)用Mindray Resona 7超聲診斷儀,測量跟腱二維超聲圖像、跟腱遠(yuǎn)端三分之一處楊氏模量以及跟腱的最大厚徑,結(jié)合研究對(duì)象的性別、患糖尿病病程等指標(biāo)進(jìn)行評(píng)估。數(shù)據(jù)處理時(shí)采用了IBM SPSS22.0的統(tǒng)計(jì)軟件。把符合正態(tài)分布的計(jì)量數(shù)據(jù)用均數(shù)±標(biāo)準(zhǔn)差的方式描述,把非正態(tài)分布的計(jì)量數(shù)據(jù)用中位數(shù)(P25,P75)的方式描述。正態(tài)分布且方差齊的數(shù)據(jù)組之間的比較用LSD檢驗(yàn),不符合方差齊性檢驗(yàn)的數(shù)據(jù)組之間的兩兩比較采用Dunnett-t檢驗(yàn),相關(guān)性分析采用pearson相關(guān)系數(shù)計(jì)算。非正態(tài)分布的數(shù)據(jù)采用非參數(shù)檢驗(yàn)法比較差異,用spearman相關(guān)系數(shù)進(jìn)行相關(guān)性分析。p0.05有統(tǒng)計(jì)學(xué)意義。結(jié)果:1.對(duì)照組左、右側(cè)的跟腱厚度分別為(0.576±0.165)cm、(0.582±0.188)cm,雙側(cè)跟腱厚度無顯著差異(p0.05),對(duì)照組的跟腱也可以出現(xiàn)異常二維超聲特征:高-低回聲區(qū)、跟腱纖維走行呈波浪狀、跟腱邊緣不規(guī)整。2.T2DM組左、右側(cè)跟腱厚度分別為(0.651±0.010)cm、(0.678±0.014)cm,雙側(cè)無統(tǒng)計(jì)學(xué)差異(p0.05)。T2DM組更容易出現(xiàn)高回聲區(qū)和波浪狀的纖維走行的異常二維超聲特征(p0.05)。3.不同性別的跟腱厚度或楊氏模量均沒有統(tǒng)計(jì)學(xué)差異(p0.05)。4.T2DM組比對(duì)照組的跟腱厚度增大(p0.05),但是T2DM的四個(gè)病程組的跟腱厚度的統(tǒng)計(jì)學(xué)差異不顯著(p0.05)。5.對(duì)照組左、右側(cè)跟腱楊氏模量分別為41.85(30.53,50.68)k Pa、45.53(35.96,60.81)k Pa,雙側(cè)無統(tǒng)計(jì)學(xué)差異(p0.05)。6.組別1的左、右側(cè)跟腱楊氏模量分別為(70.56±22.86)k Pa、(66.74±22.75)k Pa;組別2的左、右側(cè)跟腱楊氏模量分別為65.87(55.45,97.58)k Pa、(70.30±26.70)k Pa;組別3的左、右側(cè)跟腱楊氏模量分別為(87.135±25.82)k Pa、(75.42±20.89)k Pa;組別4的左、右側(cè)跟腱楊氏模量分別為(77.52±31.32)k Pa、69.79(56.46,77.10)k Pa;對(duì)比組別1、2、3、4的跟腱楊氏模量,除了組別1與組別3的右側(cè)跟腱有統(tǒng)計(jì)學(xué)差異(p0.05),其余各組統(tǒng)計(jì)學(xué)差異不顯著(p0.05)。7.T2DM組比對(duì)照組跟腱的楊氏模量大(p0.05),T2DM組雙側(cè)跟腱楊氏模量與病程長度為中度相關(guān)性,左側(cè)r=0.45,p=0.01;右側(cè)r=0.50,p=0.01。結(jié)論:1.常規(guī)超聲作為跟腱檢查常用手段,其二維征象在跟腱病變?cè)\斷中有著無可替代的地位。2.下肢無癥狀T2DM患者跟腱較正常人群跟腱厚度及硬度增大,且隨著病程延長,跟腱硬度增加。3.超聲彈性成像作為非侵入手段,可以定量測量跟腱的硬度,結(jié)合臨床及其它輔助檢查,在一定程度上可以提示跟腱病變程度,從而預(yù)防未來跟腱斷裂事件的發(fā)生。
[Abstract]:Objective: lower extremity diabetic patients prone to disease, quality of life of patients with late diabetes disease affecting the early detection of diabetic Achilles tendon, Achilles tendon lesion is not easy, ultrasound elastography innovatively from the elastic angle detecting lesions with tendon elasticity imaging results in the diabetes and the histological examination has a good correspondence. Early on the abnormal changes of diabetes Achilles tendon with quantitative, rapid, noninvasive, inexpensive diagnostic advantage. Methods: a retrospective analysis from January 2016 to November 2016 for 63 patients in each hospital second hospital of Jilin University, T2DM (32 male, 31 female). The blood glucose level in normal inpatient 29 patients (10 male, 19 female name). Inclusion criteria for the lower extremity without obvious subjective symptoms and exclude other diseases affecting the Achilles tendon elasticity (such as rheumatoid arthritis, spinal joint disease, hypercholesterolemia, and tendon synovitis, tendon endings Disease, Achilles tendon bursitis, or diabetic foot disease, Achilles tendon injury history, the history of lower extremity amputation, special functional exercise history, age) and (50-55). According to the duration of diabetes T2DM were divided into 4 groups, 1-5 years 1,6-10 years 2,11-15 years group group group 3,16 years to stop the 4. groups using Mindray Resona 7 ultrasound diagnostic instrument, measurement of tendon two-dimensional ultrasound images, 1/3 distal Achilles tendon modulus and the maximum thickness of Achilles tendon, combined with the study of gender, duration of diabetes risk index were evaluated. Data processing using the statistical software IBM SPSS22.0. To meet the measurement data of normal distribution described by the mean and standard deviation of the method, the non measurement data of normal distribution with the median (P25, P75) is described. The way of data between the groups of normal distribution and homogeneity compared with the LSD test, does not meet the homogeneity of variance. The 22 test data between groups were compared using Dunnett-t test, correlation analysis using Pearson correlation coefficients were calculated. The non normal distribution of data using non parametric test to compare the differences of Spearman correlation coefficient of correlation analysis of.P0.05 was statistically significant. Results: 1. of the control group left, respectively right Achilles tendon thickness (0.576 + 0.165 cm), (0.582 + 0.188) cm, there was no significant difference between the bilateral Achilles tendon thickness (P0.05), the control group of the Achilles tendon can also appear abnormal ultrasound features: high - low echo area, tendon fibers wavy, irregular edge of Achilles tendon group.2.T2DM left and right Achilles tendon thickness respectively (0.651 + 0.010) cm, (0.678 + 0.014) cm, there was no significant difference in bilateral.T2DM group (P0.05) are more likely to have abnormal ultrasound features of high echo area and wavy fibers (P0.05) of the Achilles tendon thickness or young's modulus.3. of different gender were not unified 璁″宸紓(p0.05).4.T2DM緇勬瘮瀵圭収緇勭殑璺熻叡鍘氬害澧炲ぇ(p0.05),浣嗘槸T2DM鐨勫洓涓梾紼嬬粍鐨勮窡鑵卞帤搴︾殑緇熻瀛﹀樊寮備笉鏄捐憲(p0.05).5.瀵圭収緇勫乏,鍙充晶璺熻叡鏉ㄦ皬妯￠噺鍒嗗埆涓，

本文編號(hào)：1687502