剪切波弹性成像联合极速脉搏波技术评估颈动脉弹性对糖尿病性视网膜病变的预测价值  

Predictive value of carotid artery elasticity evaluated by shear wave elastography combined with ultrafast pulse wave imaging for diabetic retinopathy

作　　者：王珏[1] 陈赛君[1] 贲志飞[1] 詹锦勇 徐开颖 Jue Wang;Saijun Chen;Zhifei Ben;Jinyong Zhan;Kaiying Xu(Department of Ultrasound,Ningbo No.2 Hospital,Ningbo 315000,China)

机构地区：[1]宁波市第二医院超声科,315000

出　　处：《中华医学超声杂志（电子版）》2023年第6期636-641,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：宁波市科技计划项目(202003N4225);浙江省医药卫生计划项目(2023KY1089)。

摘　　要：目的探讨剪切波弹性成像(SWE)和极速脉搏波速度(UFPWV)评估颈动脉弹性对糖尿病性视网膜病变(DR)的预测价值。方法选取2019年1月至2020年8月在宁波市第二医院内分泌科住院并符合世界卫生组织(WHO)制定的2型糖尿病诊断标准的糖尿病患者共86例。根据糖尿病视网膜病变的相关诊断标准将研究对象分为糖尿病性视网膜病变组(DR组)39例,非糖尿病视网膜病变组(NDR组)47例,所有患者均进行颈动脉SWE及UFPWV检查。采用独立样本t检验比较2组间SWE检查的弹性模量值最大值(Emax)、平均值(Emean)、最小值(Emin)及UFPWV的收缩起始时脉搏波传导速度(PWV-BS)、收缩结束时脉搏波传导速度(PWV-ES)之间的差异,绘制ROC曲线比较SWE、UFPWV中诊断效能最高的参数以及两者联合预测DR的诊断效能。结果2组间颈动脉前壁Emax、Emean、Emin值差异均有统计学意义(P均<0.01),Emax、Emean、Emin的ROC曲线下面积分别为0.705、0.726、0.703,以Emean≥55.25 kPa为截断值,其诊断的敏感度为61.5%,特异度为74.5%。而2组间颈动脉后壁的各参数差异均无统计学意义(P均>0.05)。DR组的PWV-BS和PWV-ES均明显高于NDR组,差异均有统计学意义(P均<0.01),且PWV-BS较PWV-ES差异更显著。PWV-BS诊断DR的ROC曲线下面积为0.744,以PWV-BS≥8.935 m/s为截断值,其诊断的敏感度为74.4%,特异度为61.7%。前壁Emean与PWV-BS两者联合的ROC曲线下面积为0.809,大于单独应用前壁Emean或PWV-BS,两者联合的敏感度、特异度、阴性预测值、阳性预测值分别为82.3%、62.7%、64.0%、80.6%。结论SWE与UFPWV均能评估颈动脉管壁硬度,两者联合对DR的预测效能更高,可为临床诊断提供无创、定量的早期影像学指标。Objective To investigate the predictive value of carotid artery elasticity measured by shear wave elastography(SWE)and ultrafast pulse wave velocity(UFPWV)for diabetic retinopathy(DR).Methods A total of 86 patients with type 2 diabetes who met the WHO diagnostic criteria and were treated at the Department of Endocrinology of Ningbo No.2 Hospital from January 2019 to August 2020 were collected.According to the diagnostic criteria for DR,the patients were divided into a DR group(39 patients)and a non-DR(NDR)group(47 patients).All patients underwent carotid SWE and UFPWV examination.The independent t test was used to compare the differences in the Emax,Emean,and Emin of SWE,and the pulse wave velocity-the beginning of systolic(PWV-BS)and pulse wave velocity-the end of systolic(PWV-ES)of UFPWV between the two groups.Receiver operating characteristic(ROC)curve analysis was performed to investigate the diagnostic efficacy of SWE and UFPWV parameters and their combination in predicting DR.Results The differences in Emax,Emean,and Emin of the carotid artery anterior wall were significantly different between the two groups(P<0.01 for all),the area under the ROC curve of Emax,Emean,and Emin was 0.705,0.726,and 0.703,respectively;with Emean≥55.25 kPa as the cut-off value,the sensitivity and specificity for DR diagnosis were 61.5%and 74.5%,respectively.The PWV-BS and PWV-ES in the DR group were significantly higher than those in the NDR group(P<0.01 for both),and the increase of PWV-BS was more obvious than PWV-ES.With PWV-BS≥8.935 m/s as the cut-off value,the sensitivity was 74.4%and the specificity was 61.7%.The area under the ROC curve of Emean of the anterior wall combined with PWV-BS for DR diagnosis was 0.809,which was larger than that of Emean of the anterior wall or PWV-BS alone,and the sensitivity,specificity,positive predictive value,and negative predictive value of the combination were 82.3%,62.7%,64.0%,and 80.6%,respectively.Conclusions Both SWE and UFPWV can evaluate the stiffness of the carotid artery wall.

关 键 词：剪切波弹性成像 脉搏波成像 糖尿病视网膜病变 颈动脉 

分 类 号：R445.1[医药卫生—影像医学与核医学] R587.1[医药卫生—诊断学]