本文選題：超聲射頻技術(shù)　切入點(diǎn)：實(shí)時(shí)剪切波彈性成像　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：一、目的:使用超聲射頻技術(shù)及實(shí)時(shí)剪切波彈性成像評(píng)估2型糖尿病患者的頸動(dòng)脈內(nèi)皮功能,并結(jié)合病程、糖化血紅蛋白、空腹血清C肽和血脂,探討以上指標(biāo)與動(dòng)脈內(nèi)中膜厚度及彈性指標(biāo)的關(guān)聯(lián)。二、方法:1、納入及排除標(biāo)準(zhǔn):選擇我院41～64歲的2型糖尿病患者29例,所有患者均符合1999年WHO診斷標(biāo)準(zhǔn),頸部血管常規(guī)超聲檢查均無異常,對(duì)照組為相對(duì)應(yīng)年齡段的正常體檢者18例,兩組均要除外肥胖、嚴(yán)重營(yíng)養(yǎng)不良、嚴(yán)重肝腎功能不全、冠心病、腦卒中等心腦血管疾病、其他內(nèi)分泌疾病、風(fēng)濕免疫病、血液病、惡性腫瘤等疾病。2、實(shí)驗(yàn)方法:對(duì)病例組常規(guī)空腹采血,測(cè)定血脂、血清C肽,采取指尖采血法測(cè)定糖化血紅蛋白。將病例組根據(jù)有無高血壓分為糖尿病血壓正常組和糖尿病合并高血壓組,另將病例組根據(jù)視網(wǎng)膜病變分期分為無視網(wǎng)膜病變組、視網(wǎng)膜病變I期組、視網(wǎng)膜病變II期組、視網(wǎng)膜病變Ⅲ期組,同時(shí)選擇相對(duì)應(yīng)年齡段的正常體檢者18例作為對(duì)照組,對(duì)病例組和對(duì)照組分別進(jìn)行超聲射頻信號(hào)血管內(nèi)中膜分析(QIMT)、血管硬度定量分析(QAS)和實(shí)時(shí)剪切波彈性成像(SWE)檢查,獲取IMT(內(nèi)-中膜厚度)、CC(順應(yīng)性)、DC(擴(kuò)張性)、α(僵硬度參數(shù))、β(僵硬度參數(shù))、PWV(脈搏波傳導(dǎo)速度)、MEmean(楊氏模量平均值的均數(shù))、MEmin(楊氏模量最小值的均數(shù))、MEmax(楊氏模量最大值的均數(shù))。三、結(jié)果:1、與對(duì)照組相比較,病例組收縮壓、IMT與彈性指標(biāo)PWV、α、β、MEman、MEmin、MEmax均增大,DC減小,差異均有統(tǒng)計(jì)學(xué)意義(p0.05),兩組之間舒張壓和CC的差異無統(tǒng)計(jì)學(xué)意義(p0.05)。2、與糖尿病血壓正常組比較,糖尿病合并高血壓組病程較長(zhǎng),并發(fā)癥數(shù)目較多,彈性指標(biāo)MEmax增大,差異均有統(tǒng)計(jì)學(xué)意義(p0.05),兩組之間其他指標(biāo)的差異無統(tǒng)計(jì)學(xué)意義(p0.05)。3、無視網(wǎng)膜病變組和視網(wǎng)膜病變Ⅰ期、Ⅱ期、Ⅲ期組之間所有指標(biāo)差異均無統(tǒng)計(jì)學(xué)意義(p0.05)。4、MEmean與年齡、脂蛋白(a)呈正相關(guān),MEmax脂蛋白(a)呈正相關(guān),MEmin與年齡、脂蛋白(a)呈正相關(guān),IMT與收縮壓呈正相關(guān),差異均有統(tǒng)計(jì)學(xué)意義(p0.05)。5、MEmean與PWV、α、β呈正相關(guān);MEmax與PWV、α、β呈正相關(guān),與DC呈負(fù)相關(guān),差異均有統(tǒng)計(jì)學(xué)意義(p0.05)。6、以MEmean作為因變量建立的多因素線性回歸模型中,利用逐步法,最終年齡、脂蛋白(a)和α進(jìn)入該模型,年齡、脂蛋白(a)和α是和MEmean獨(dú)立相關(guān)的變量,標(biāo)準(zhǔn)回歸系數(shù)分別為0.531、0.231和0.251。7、以MEmax作為因變量建立的多因素線性回歸模型中,利用逐步法,最終HbA1c、脂蛋白(a)和PWV進(jìn)入該模型,HbA1c、脂蛋白(a)和PWV是和MEmax獨(dú)立相關(guān)的變量,標(biāo)準(zhǔn)回歸系數(shù)分別為0.390、0.227和0.402。8、PWV、α、β、MEmean、MEmax、MEmin診斷動(dòng)脈硬化的AUC及其對(duì)應(yīng)的95%可信區(qū)間分別為 0.786(0.648～0.925)、0.734(0.587～0.881)、0.738(0.591～0.884)、0.818(0.697～0.939)、0.852(0.745～0.959)、0.770(0.632-0.908),上述指標(biāo)間AUC的比較差異均無統(tǒng)計(jì)學(xué)意義(p0.05)。四、結(jié)論:1、實(shí)時(shí)剪切波彈性成像作為一項(xiàng)新興的超聲彈性成像技術(shù),與傳統(tǒng)的超聲射頻技術(shù)相關(guān)性良好,實(shí)時(shí)剪切波彈性成像與超聲射頻技術(shù)均能夠評(píng)估動(dòng)脈彈性改變,均具有良好的診斷效能且兩者具有等效性。2、糖尿病患者血管功能的改變?cè)缬谘芙Y(jié)構(gòu)的改變,超聲射頻技術(shù)與實(shí)時(shí)剪切波彈性成像均能夠診斷糖尿病患者早期的大血管病變。3、糖尿病和高血壓有著共同的發(fā)病機(jī)制和病理基礎(chǔ),高血糖、高血壓和高血脂能夠進(jìn)一步加重糖尿病患者的動(dòng)脈粥樣硬化,糖尿病患者需積極控制這些危險(xiǎn)因素。4、糖尿病患者血糖總體控制水平和胰島β細(xì)胞功能與糖尿病微血管病變密切相關(guān),強(qiáng)化血糖控制有助于降低微血管病變進(jìn)一步發(fā)展的風(fēng)險(xiǎn),糖尿病患者大血管病變與微血管病變存在一定聯(lián)系,伴有微血管病變者動(dòng)脈粥樣硬化較嚴(yán)重。5、在所有的血脂指標(biāo)中,脂蛋白(a)作為一種相對(duì)獨(dú)立的血漿脂蛋白,與動(dòng)脈粥樣硬化關(guān)系密切,在引起動(dòng)脈粥樣硬化和血栓形成的眾多環(huán)節(jié)發(fā)揮重要作用,這個(gè)指標(biāo)值得臨床充分重視。
[Abstract]:One objective: To evaluate carotid artery endothelial function in patients with type 2 diabetes mellitus using ultrasound radiofrequency technology and real-time shear wave elastography, and combined with the duration, HbA1c, fasting serum C peptide and blood lipid, investigate the relationship between the above indexes and the intima-media thickness and elasticity index. Two methods: 1, inclusion and exclusion criteria: 29 patients with type 2 diabetes in our hospital 41~64 cases, all patients met the diagnostic criteria of WHO in 1999, neck vascular routine ultrasound examination showed no abnormality in control group, 18 cases of corresponding age normal subjects, two groups except for obesity, severe malnutrition, severe liver and kidney dysfunction, coronary heart disease. Cerebrovascular disease, endocrine disease, rheumatic disease, blood disease, malignant tumor and other diseases.2, experimental methods: Determination of blood lipid of the patients, routine fasting blood serum C peptide, determination of sugar by fingerstick Hemoglobin. The patients were divided into hypertension according to hypertension group, diabetes group and diabetes with normal blood pressure, the other patients according to retinopathy stages divided into retinopathy group, I retinopathy group, retinopathy II retinopathy group, III group, and select the corresponding age of normal physical examination in 18 cases as the control group, the case group and control group were the quality intima-media thickness (QIMT), quantitative analysis of vascular hardness (QAS) and real-time shear wave elastography (SWE) examination, obtain IMT (intima-media thickness), CC (compliance), DC (expansion (alpha), stiffness parameters (stiffness parameters), beta), PWV (Mai Bobo velocity (mean MEmean), Young's modulus average), MEmin (mean modulus minimum), MEmax (average number of Young's modulus maximum value). Results: three, compared with 1. The control group, The case group systolic blood pressure, IMT and elastic index of PWV, alpha, beta, MEman, MEmin, MEmax increased, DC decreased, the differences were statistically significant (P0.05), diastolic blood pressure and CC was no statistically significant difference between the two groups (.2, P0.05) compared with normal blood pressure diabetes group, diabetes mellitus and hypertension group of longer duration the number of complications, more elastic index MEmax increased, the differences were statistically significant (P0.05), there was no significant difference between the two groups in other indicators (P0.05).3, without retinopathy group and retinopathy in phase I, II, III group between all indexes showed no significant difference (.4, MEmean and P0.05) age, lipoprotein (a) was positively related to MEmax lipoprotein (a) MEmin was positively correlated with age, lipoprotein (a) was positively correlated with IMT positively correlated with systolic blood pressure, the differences were statistically significant (P0.05).5, MEmean and PWV, alpha beta, MEmax and PWV were positively correlated; alpha, beta. Cheng Zhengxiang Off, and negatively correlated with DC, the differences were statistically significant (.6, P0.05) with MEmean as the dependent variables to establish multiple linear regression model, using the stepwise method, the final age, lipoprotein (a) and alpha into the model, age, lipoprotein (a) and alpha is related and independent MEmean variable, standard regression coefficients were 0.531,0.231 and 0.251.7, with MEmax as the dependent variables to establish multiple linear regression model, using the stepwise method, the final HbA1c, lipoprotein (a) and PWV in the model, HbA1c, lipoprotein (a) and PWV and MEmax is independently related variables, the standard regression coefficient was for 0.390,0.227 and 0.402.8, PWV, alpha, beta, MEmean, MEmax, 95% confidence interval AUC and the corresponding MEmin in the diagnosis of arteriosclerosis was 0.786 (0.648 ~ 0.925), 0.734 (0.587 ~ 0.881), 0.738 (0.591 ~ 0.884), 0.818 (0.697 ~ 0.939), 0.852 (0.745 ~ 0.959). 0.770 (0.632-0.908), the The difference between the standard AUC had no statistical significance (P0.05). Conclusion: four, 1, real-time shear wave elastography is a new ultrasonic elastography, and good ultrasonic RF technology of traditional correlation, real-time shear wave elastography and ultrasonic technology were able to assess changes in arterial elasticity, have good the diagnostic efficiency of which is equivalent to.2, the change of vascular function in patients with diabetes mellitus earlier than the change of vascular structure, ultrasonic frequency technology and real-time shear wave elastography were able to diagnosis of diabetic macrovascular disease in patients with early.3, diabetes and hypertension with pathogenesis and pathologic basis of common, high blood sugar, high blood pressure and high blood lipids can further aggravate atherosclerosis in diabetes patients, patients with diabetes need to control the risk factors of diabetes in the.4, the overall control level and beta Cell function and diabetic microangiopathy is closely related to strengthen the risk control of blood sugar helps reduce microvascular disease further development, there exists certain relationship between macroangiopathy and microangiopathy in diabetic patients with microvascular disease, atherosclerosis is more serious in.5, all the indexes of blood lipid, lipoprotein (a) as a relative independent of the plasma lipoprotein, and atherosclerosis are closely related, play an important role in many aspects caused by atherosclerosis and thrombosis, the index it is worthy of clinical importance.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R587.2;R445.1
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本文編號(hào)：1633882