本文關(guān)鍵詞： 動脈硬化 組織多普勒 2型糖尿病 腎動脈 血管阻力　出處：《大連醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：糖尿病可引起大血管彈性降低、管壁僵硬已被廣泛證實，而糖尿病引起終末器官小血管病變的研究甚少。本研究旨在探究2型糖尿病患者腎動脈阻力與左室舒張功能之間的相關(guān)性。 方法：選取2012年7月至2013年10月在我院內(nèi)分泌科初次確診的2型糖尿病人80例，健康對照組40例。超聲診斷儀器采用Philips IU22，所有被檢者采取臥位或側(cè)臥位，彩色超聲多普勒模式下清晰顯示雙側(cè)腎各級動脈血流情況，利用頻譜多普勒測量腎中部葉間動脈的收縮期峰值流速Vs，舒張末期流速Vd，阻力指數(shù)RI=(Vs-Vd)/Vs，每側(cè)腎至少三次取樣求平均值作為最終參數(shù)；超聲心動圖常規(guī)測量左房內(nèi)徑LAD,室間隔厚度IVS，左室后壁厚度LVPW等，脈沖多普勒模式下在心尖四腔觀，測量二尖瓣口血流舒張早期最大流速(E)、二尖瓣口血流心房收縮期最大流速(A)，主動脈血流頻譜終點至二尖瓣血流頻譜始點的時間即等容舒張時間IRT，并計算E/A比值，接著應(yīng)用組織多普勒TDI，將2mm脈沖多普勒取樣框放置在二尖瓣環(huán)室間隔側(cè)得到舒張早期最大運動速度（E'）,并計算E/E’。生化常規(guī)指標為入院時的檢測結(jié)果。兩組間各類參數(shù)進行對比分析。 結(jié)果：1.腎動脈阻力指標：糖尿病組的腎動脈RI（0.66±0.05）高于健康對照組（0.54±0.08，P0.05），糖尿病組舒張末期流速Vd（9.79±5.17）低于健康對照組（14.99±8.19,P0.05），差異均有統(tǒng)計學(xué)意義。2.超聲心動圖參數(shù)：健康組與糖尿病組的心臟參數(shù)E’、E/E’比值、LVPW之間有統(tǒng)計學(xué)差異，(E’：11.4±1.5，9.7±1.6，P0.05；E/E’：9.6±2.3，10.3±3.0，P0.05，LVPW：8±1，，10±1，P0.05）。而代表收縮功能的LVEF%、FS%兩組間也沒有統(tǒng)計學(xué)差異。3.腎動脈RI與心臟參數(shù)的相關(guān)分析：RI與E/E’比值（r=0.31，P0.001）、LAD（r=0.36，P0.05）呈正相關(guān)，與E/A比值（r=-0.36，P0.05）呈負相關(guān),其中，與E/E’比值的相關(guān)性最強。4.E/E’比值與臨床生化指標的相關(guān)性：E/E’比值與年齡、糖尿病病程、收縮壓SBP、血肌酐、尿白蛋白排泄率都呈正相關(guān)，與腎小球濾過率估測值eGFR呈負相關(guān)。多元線性回歸分析后，糖尿病病程(β=0.322,p0.001)、尿白蛋白排泄率β=0.431,p0.001)是E/E'比值的獨立危險因素。 結(jié)論：2型糖尿病患者早期不僅出現(xiàn)腎小動脈阻力增加，還有左室舒張功能障礙，且隨著腎小動脈阻力升高，左室舒張功能逐漸減低。
[Abstract]:Objective: diabetes mellitus can cause the reduction of macrovascular elasticity, and the wall stiffness has been widely confirmed. However, there are few studies on the end organ microvascular lesions caused by diabetes. This study aims to explore the correlation between renal artery resistance and left ventricular diastolic function in type 2 diabetes mellitus. Methods: from July 2012 to October 2013, 80 patients with type 2 diabetes were selected. Philips IU22 was used as the ultrasonic diagnostic instrument. All the subjects were in the supine position or lateral position. The blood flow of bilateral renal arteries was clearly displayed in color Doppler mode. The peak systolic velocity (V _ s), the end-diastolic velocity (V _ d) and the resistance index (RI=(Vs-Vd)/Vs) of the interlobar artery were measured by spectral Doppler. The average value of each kidney was obtained at least three times as the final parameter. Left atrial diameter (lad), ventricular septal thickness (IVS) and left ventricular posterior wall thickness (LVPW) were measured by echocardiography. The peak flow velocity in early diastolic phase of mitral orifice and atrial systolic velocity in mitral orifice were measured. The end point of aortic flow spectrum to the beginning point of mitral flow spectrum was isovolumic relaxation time (IRTT). The ratio of E / A was calculated and then tissue Doppler TDI was used. A 2mm pulsed Doppler sampling frame was placed on the septal side of the mitral annulus to obtain the maximum early diastolic velocity. The biochemical routine indexes were measured at admission. The parameters of the two groups were compared and analyzed. Results 1.Renal artery resistance index: the renal artery RI(0.66 鹵0.05 in the diabetic group was higher than that in the healthy control group (0.54 鹵0.08, P 0.05). The end-diastolic velocity (Vd(9.79 鹵5.17) in the diabetic group was lower than that in the control group (14.99 鹵8.19) (P 0.05). Echocardiographic parameters: the heart parameters of healthy group and diabetes group were significantly different (P < 0.05). There was significant difference in the ratio of E / E / E 'between healthy group and diabetic group. There was significant difference between LVPW and EW: 11.4 鹵1.5. 9.7 鹵1.6 P0.05; E / E: 9. 6 鹵2. 3 + 10. 3 鹵3. 0 P0. 05% LVPWW: 8 鹵1 + 10 鹵1 + P0. 05%, and LVEF%, which represents contraction function. There was also no statistical difference between the two groups. The correlation between RI of renal artery and heart parameters was analyzed. The ratio of RI to E / E was 0.31% P 0.001 / 0.36. There was a positive correlation between P0.05) and a negative correlation with the ratio of E / A to 0.36 (P0.05). The correlation between E / E 'ratio and clinical biochemical index was the strongest. 4. The correlation between E / E' ratio and clinical biochemical indexes:% E / E 'ratio and age, course of diabetes, SBP, creatinine. Urinary albumin excretion rate was positively correlated and negatively correlated with glomerular filtration rate (eGFR). After multiple linear regression analysis, the course of diabetes mellitus (尾 -0.322 p 0.001). Urinary albumin excretion rate (尾 -0.431g, p 0.001) is an independent risk factor of E / E 'ratio. Conclusion in the early stage of type 2 diabetes mellitus, the resistance of renal arterioles and left ventricular diastolic dysfunction were increased, and the left ventricular diastolic function decreased gradually with the increase of resistance of renal arterioles.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R587.1;R445.1

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