2型糖尿病患者颈总动脉壁剪应力分布的研究  

Spatial distribution of wall shear stress in the common carotid artery of type 2 diabetes mellitus patients

作　　者：黄志芳[1] 陈明[1] 张宇辉[1] 董云[1] 魏颖[1] 丁方[1] 刘秋云[2] 

机构地区：[1]同济大学附属东方医院心脏中心,上海200120 [2]上海市浦东新区公利医院

出　　处：《中华超声影像学杂志》2014年第5期393-397,共5页Chinese Journal of Ultrasonography

基　　金：浦东新区科技发展基金创新资金（PKJ2010-Y16）;上海市浦东新区心血管疾病学科群项目（PWZxkq2010-01）

摘　　要：目的 采用血流剪应力可视化定量分析技术分析2型糖尿病患者颈总动脉壁剪应力（WSS）的空间分布规律.方法 选择21例男性2型糖尿病患者作为糖尿病组,21例男性健康体检者作为对照组.所有入选的研究对象排除高血压、高脂血症及吸烟史.对所有研究对象进行颈总动脉彩色多普勒超声检测,并记录内中膜厚度、斑块数量、大小及颈总动脉彩色多普勒血流动态图.采用WSS可视化定量分析技术计算颈总动脉WSS,并绘制相应的WSS空间分布图.结果 对照组颈总动脉WSS的变化范围在4～14 dyne/cm^2之间,糖尿病组颈总动脉WSS的变化范围在2～8 dyne/cm^2之间.糖尿病组颈总动脉WSS平均值[（3.14±0.79） dyne/cm^2]显著低于对照组[（6.96±1.17） dyne/cm^2],差异具有统计学意义（t=9.380,P=0.000）.6例2型糖尿病患者一侧颈总动脉均出现一个斑块,其中,产生斑块侧的颈总动脉WSS平均值显著低于对侧无斑块生成的颈总动脉（t=7.324,P=0.000）,且所有研究对象颈总动脉的内中膜厚度与WSS呈明显负相关性（r=-0.76,P＜0.01）.结论 与正常人群相比,2型糖尿病患者更容易发生颈动脉粥样硬化并与其WSS的降低相关联.WSS的血流动力学改变可能是促使2型糖尿病患者动脉粥样硬化患病率和严重性增加的一个额外的因素.Objective To investigate the wall shear stress（WSS） in the common carotid artery of type 2 diabetes mellitus（DM） patients,and analyzed the spatial distribution of WSS by using quantitative visualization of blood flow shear stress analysis software.Methods Eighteen male type 2 DM subjects were enrolled as DM group and 18 age-matched healthy subjects were selected as control group.None of the participants was hypertensive,hyperlipidemic or a cigarette smoker.Intimal-medial thickness （IMT）,number and size of plaques in the common carotid artery were evaluated by high-resolution echo-Doppler.Color Doppler flow images of common carotid arteries in the two groups were extracted from DICOM files.WSS in the common carotid arteries was calculated by shear stress visualization quantitative analysis software,and the corresponding spatial distribution maps of WSS were designed.Results WSS of the common carotid arteries in the control group were ranged from 4 to 14 dyne/cm^2.WSS of the common carotid arteries in the DM group were ranged from 2 to 8 dyne/cm^2.Compared to mean WSS value [（6.96 ± 1.17）dyne/cm^2] of common carotid arteries in the control group,mean WSS value [（3.14 ± 0.79）dyne/cm^2] of common carotid arteries in the DM group was significantly lower （t =9.380,P =0.000）.Six diabetic participants had a plaque in one carotid artery and no lesions in the contralateral carotid.Among these subjects,mean WSS was significantly lower in the side with lesion （t =7.324,P =0.000）.Therefore,IMT of common carotid arteries in participants was significantly inversely related to WSS （r =-0.76,P 〈0.01）.Conclusions The common carotid arteries of DM patients are more prone to atherosclerosis which is associated with reduction of WSS.The hemodynamic profile might represent an additional factor contributing to the increased prevalence and severity of carotid atherosclerosis in diabetic patients compared with general population.

关 键 词：超声检查 糖尿病 2型 颈总动脉 壁剪应力 

分 类 号：R445.1[医药卫生—影像医学与核医学]