极速脉搏波技术评估亚临床甲状腺功能减退对2型糖尿病患者早期颈动脉弹性功能的影响  

Effects of Subclinical Hypothyroidism on Early Carotid Elasticity in Type 2 Diabetes via Ultrafast Pulse Wave Velocity Technology

作　　者：王玥 葛丽丽 WANG Yue;GE Lili(Department of Ultrasound,the First Affiliated Hospital of Jinzhou Medical University,Jinzhou 121000,China)

机构地区：[1]锦州医科大学附属第一医院超声科,辽宁锦州121000

出　　处：《中国医学影像学杂志》2023年第12期1250-1255,1267,共7页Chinese Journal of Medical Imaging

基　　金：辽宁省自然科学基金(20170540381)。

摘　　要：目的应用极速脉搏波技术评估亚临床甲状腺功能减退(SCH)对2型糖尿病(T2DM)患者早期颈动脉弹性功能的影响。资料与方法前瞻性纳入2020年12月—2021年6月锦州医科大学附属第一医院的90例T2DM患者(根据甲状腺功能分为甲状腺功能正常组63例和SCH组27例)与155例同期于体检中心检查的健康成年人(正常对照组),比较各组临床及实验室指标、颈总动脉内-中膜厚度(IMT)、收缩期开始时脉搏波传导速度(PWV-BS)以及收缩末期时脉搏波传导速度(PWV-ES),分析PWV与临床指标的相关性、PWV的影响因素及其诊断T2DM合并SCH患者发生颈动脉弹性变化的敏感度、特异度。结果SCH组PWV-BS[(7.36±0.85)m/s比(6.24±1.51)m/s]及PWV-ES[(10.11±0.97)m/s比(8.36±1.31)m/s]高于甲状腺功能正常组(P<0.05);PWV-BS、PWV-ES与T2DM患者的临床实验室指标相关性良好(P<0.05):PWV-BS、PWV-ES均与年龄(r=0.355、0.305)、吸烟(r=0.281、0.263)、促甲状腺激素(r=0.402、0.579)、体重指数(r=0.318、0.037)、空腹血糖(r=0.497、0.432)、收缩压(r=0.628、0.361)、舒张压(r=0.495、0.378)、总胆固醇(r=0.350、0.242)、甘油三酯(r=0.265、0.281)及IMT(r=0.698、0.614)呈正相关(P均<0.05),与高密度脂蛋白胆固醇(r=-0.378、-0.413)呈负相关(P均<0.05);多元线性逐步回归分析显示,PWV-BS、PWV-ES的共同影响因素包括促甲状腺激素、空腹血糖、高密度脂蛋白胆固醇及IMT(P均<0.05);PWV-ES预测T2DM患者颈动脉弹性变化的敏感度和特异度优于PWV-BS(96.3%比88.9%,61.9%比52.4%,P均<0.05);PWV-BS、PWV-ES的最佳阈值分别为6.36 m/s、8.72 m/s。结论极速脉搏波技术可以检测出T2DM合并SCH患者在颈动脉粥样硬化前血管弹性已经受损,PWV-ES和PWV-BS可作为预测指标指导临床早期干预动脉硬化的发展。Purpose To evaluate the effect of subclinical hypothyroidism(SCH)on the early carotid elastic function in type 2 diabetes mellitus(T2DM)via ultrafast pulse wave velocity technology.Materials and Methods A total of 90 patients with T2DM in the First Affiliated Hospital of Jinzhou Medical University from December 2020 and June 2021 were prospectively collected and were divided into normal thyroid group(n=63)and SCH group(n=27)according to the thyroid function,and 155 healthy adults(healthy control group)from physical examination center in the same period were also collected.Statistical analysis were performed on clinical and laboratory indicators,intima-media thickness(IMT),pulse wave velocity of beginning of systolic(PWV-BS)and pulse wave velocity of end of systolic(PWV-ES).The correlation between PWV and clinical indicators,the influencing factors of PWV and the sensitivity and specificity of PWV in T2DM with SCH were further analyzed.Results PWV-BS[(7.36±0.85)m/s vs.(6.24±1.51)m/s]and PWV-ES levels[(10.11±0.97)m/s vs.(8.36±1.31)m/s]of SCH group were significantly higher than those of the normal thyroid group(all P<0.05).Pearson correlation analysis showed that PWV-BS and PWV-ES were well correlated with the clinical laboratory indicators in T2DM(P<0.05):PWV-BS and PWV-ES were all positively correlated with age(r=0.355,0.305),smoking(r=0.281,0.263),thyroid stimulating hormone(r=0.402,0.579),body mass index(r=0.318,0.037),fasting blood glucose(r=0.497,0.432),systolic blood pressure(r=0.628,0.361),diastolic blood pressure(r=0.495,0.378),total cholesterol(r=0.350,0.242),triglyceride(r=0.265,0.281)and IMT(r=0.698,0.614),while negatively correlated with high density lipoprotein cholesterol(r=-0.378,-0.413)(all P<0.05).Multivariate linear stepwise regression analysis showed that common influencing factors of PWV-BS and PWV-ES included thyroid stimulating hormone,fasting blood glucose,high density lipoprotein cholesterol and IMT(all P<0.05).The receiver operator characteristic curve showed that PWV-ES was superior t

关 键 词：糖尿病 2型 超声检查 甲状腺功能减退症 颈动脉 弹性 脉搏波分析 

分 类 号：R581.2[医药卫生—内分泌] R587.1[医药卫生—内科学] R445.1[医药卫生—临床医学] R322.121