探讨组织多普勒成像技术评估2型糖尿病（T2DM）患者股动脉远端血流阻断下股动脉壁弹性的价值。

2012年12月至2014年2月绍兴第二医院收治T2DM患者64例，其中34例股动脉内膜中层厚度（IMT）<1.0 mm，30例股动脉IMT≥1.0 mm，同时选取同期30名健康体检者作为健康对照组。高频超声观察股动脉结构并测量股动脉IMT，应用脉冲多普勒（PW）技术测量股动脉血流频谱。使用血压机阻断股动脉远端血流后，应用PW及组织速度成像（TVI）技术测得股动脉后壁组织运动曲线，测量第一、二峰持续时间。采用t检验分别比较T2DM股动脉IMT<1.0 mm组患者、T2DM股动脉IMT≥1.0 mm组患者与健康对照组受试者IMT差异；采用秩和检验分别比较3组受试者股动脉远端血流阻断下股动脉后壁组织运动曲线第一、二峰持续时间差异。

健康对照组受试者、T2DM股动脉IMT<1.0 mm组患者、T2DM股动脉IMT≥1.0 mm组患者IMT分别为（0.80±0.09）、（0.82±0.08）、（1.26±0.19）mm。T2DM股动脉IMT<1.0 mm组患者与健康对照组受试者IMT差异无统计学意义（t=1.67，P=0.10），T2DM股动脉IMT≥1.0 mm组患者IMT大于健康对照组受试者，且差异有统计学意义（t=16.88，P=0.00）。3组受试者股动脉远端血流阻断前股动脉血流频谱均为一高二低三相波型，股动脉远端血流阻断后股动脉血流频谱也均为二高二低四相波型。股动脉远端血流阻断下，健康对照组受试者、T2DM股动脉IMT<1.0 mm组患者、T2DM股动脉IMT≥1.0 mm组患者股动脉后壁组织运动曲线第一峰持续时间分别为（220.77±59.07）、（250.96±42.62）、（246.55±52.41）ms，3组间差异无统计学意义（u=3.258，P=0.196）；第二峰持续时间分别为（209.18±42.99）、（272.27±39.98）、（344.71±43.96）ms，3组间差异有统计学意义（u=74.150，P=0.000）。

股动脉后壁组织运动曲线第二峰持续时间可作为T2DM患者股动脉壁IMT改变前评价股动脉弹性的一个有效指标。

To study the value of tissue Doppler imaging in evaluating the elasticity of femoral arterial wall in patients with type 2 diabetes mellitus with the distal femoral artery blood flow blocked.

From December 2012 to February 2014, 64 patients with T2DM were treated in Shaoxing Second Hospital. Among them, the femoral artery intima media thicknesses (IMT) of 34 patients were <1.0 mm and those of 30 patients were≥1.0 mm. At the same time, 30 healthy persons were selected as healthy control. High frequency ultrasound was used to observe the structure of femoral artery and measure IMT of femoral artery. Pulsed-wave Doppler (PW) technique was used to measure the blood flow spectrum of the femoral artery. After the blood flow of the distal femoral artery was blocked, PW and tissue velocity imaging (TVI) technique were used to measure the motion curve of the posterior wall of the femoral artery, and the first and second peak duration was measured. T test was used to compare the IMT difference between T2DM group with femoral artery IMT<1.0 mm, T2DM group with femoral artery IMT≥1.0 mm and healthy control group. Rank sum test was used to compare the difference between the first and second peak duration of the posterior wall of the femoral artery in the three groups.

The IMT of healthy control group, T2DM group with femoral artery IMT<1.0 mm and T2DM group with femoral artery IMT≥1.0 mm were (0.80±0.09), (0.82±0.08) and (1.26±0.19) mm , respectively. There was no significant difference in IMT between the T2DM group with femoral artery IMT<1.0 mm and healthy control group (t=1.67, P=0.10). The IMT in T2DM group with femoral artery IMT≥1.0 mm were higher than those in healthy control group, and the difference was statistically significant (t=16.88, P=0.00). The femoral artery blood flow spectrum in 3 groups of subjects were three-phase wave type with a peak and two troughs before the blood flow of the distal femoral artery blocked, which were four-phase wave type with two peaks and two troughs after the blood flow of the distal femoral artery blocked. After the blood flow of the distal femoral artery blocked, the duration of the first peak of the posterior wall of the femoral artery in healthy control group, T2DM group with femoral artery IMT<1.0 mm and T2DM group with femoral artery IMT≥1.0 mm were (220.77±59.07), (250.96±42.62) and (246.55±52.41) ms, respectively. There was no significant difference between the three groups (u=3.258, P=0.196). The duration of the second peak were (209.18±42.99), (272.27±39.98) and (344.71±43.96) ms, respectively. The difference between the 3 groups were statistically significant (u=74.150, P=0.000).

The second wave duration of the femoral artery posterior wall motion curve can be used as an effective index for the evaluation of the femoral artery elasticity before the IMT changes of the femoral artery wall.