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中华医学超声杂志（电子版） ›› 2024, Vol. 21 ›› Issue (07) : 709 -717. doi: 10.3877/cma.j.issn.1672-6448.2024.07.012

心血管超声影像学

超声矢量血流成像对2型糖尿病患者颈动脉壁剪切应力的研究
曹雯佳1, 刘学兵1, 罗安果1, 钟释敏1, 邓岚1, 王玉琳1, 李赵欢1,†()   
  1. 1. 610072　成都，四川省医学科学院·四川省人民医院（电子科技大学附属医院）心血管超声及心功能科　超声心脏电生理学与生物力学四川省重点实验室
  • 收稿日期:2023-12-12 出版日期:2024-07-01
  • 通信作者: 李赵欢
  • 基金资助:
    四川省科技厅重点研发计划(2022YFS0247); 四川省留学回国人员科技活动项目择优资助项目

Evaluation of wall shear stress of the carotid artery by ultrasound vector flow imaging in patients with type 2 diabetes mellitus

Wenjia Cao1, Xuebing Liu1, Anguo Luo1, Shimin Zhong1, Lan Deng1, Yulin Wang1, Zhaohuan Li1,†()   

  1. 1. Department of Cardiovasular Ultrasound and Non-invasive Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610027, China
  • Received:2023-12-12 Published:2024-07-01
  • Corresponding author: Zhaohuan Li
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引用本文：

曹雯佳, 刘学兵, 罗安果, 钟释敏, 邓岚, 王玉琳, 李赵欢. 超声矢量血流成像对2型糖尿病患者颈动脉壁剪切应力的研究[J]. 中华医学超声杂志（电子版）, 2024, 21(07): 709-717.

Wenjia Cao, Xuebing Liu, Anguo Luo, Shimin Zhong, Lan Deng, Yulin Wang, Zhaohuan Li. Evaluation of wall shear stress of the carotid artery by ultrasound vector flow imaging in patients with type 2 diabetes mellitus[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2024, 21(07): 709-717.

目的

探究2型糖尿病（T2DM）患者颈总动脉（CCA）壁剪切应力（WSS）的特征，以及WSS检测T2DM患者发生心血管疾病（CVD）的应用价值。

方法

选取2020年11月至2021年2月于四川省人民医院接受治疗的49例T2DM患者作为DM组及19例健康志愿者作为对照组，并根据DM组患者有无高血压（HPT）分为DM+HPT组（26例）和DM+非HPT组（23例），根据是否伴有CVD分为DM+CVD组（15例）和DM+非CVD组（34例）。所有受试者均行常规颈动脉超声检查，并应用超声矢量血流（V-Flow）成像技术检测CCA中段、近分叉处及分叉处的最大壁剪切应力（WSSmax）和平均壁剪切应力（WSSmean）。DM组和对照组之间比较采用t检验；亚组之间超声参数的比较采用单因素方差分析，其中两两比较采用SNK检验；采用受试者操作特征（ROC）曲线分析T2DM患者合并CVD的超声诊断参数。

结果

与对照组相比，DM组患者CCA中段及近分叉处的WSSmean降低[中段：（0.81±0.23）Pa vs （1.02±0.21）Pa；近分叉处：（0.73±0.21）Pa vs （0.90±0.16）Pa]，差异具有统计学意义（t=-3.451、-3.127，P=0.001、0.003）。在亚组分析中，DM+非HPT组CCA中段和近分叉处的WSSmean仍小于对照组[中段：（0.87±0.24）Pa vs （1.02±0.21）Pa；近分叉处：（0.78±0.18）Pa vs （0.90±0.16）Pa]，差异具有统计学意义（P均<0.05）。DM+CVD组CCA中段及近分叉处WSSmean明显小于DM+非CVD组[中段：（0.71±0.18）Pa vs （0.85±0.23）Pa；近分叉处：（0.62±0.20）Pa vs （0.78±0.20）Pa]，差异具有统计学意义（P均<0.05）。ROC曲线分析显示CCA近分叉处的WSSmean对T2DM患者发生CVD具有诊断价值（曲线下面积为0.699，P<0.05）。

结论

T2DM患者CCA中段和近分叉处的WSSmean低于正常人，在合并CVD患者中降低更明显,近分叉处的WSSmean在检测T2DM患者发生CVD方面具有潜在临床应用价值。

关键词: 颈动脉, 壁剪切应力, 2型糖尿病, 矢量血流成像, 心血管疾病
Objective

To investigate the characteristics of common carotid artery (CCA) wall shear stress (WSS) in patients with type 2 diabetes mellitus (T2DM) and the application value of WSS in detecting cardiovascular disease (CVD) in such patients.

Methods

A total of 49 T2DM patients treated at Sichuan People's Hospital from November 2020 to February 2021 were selected as a DM group and 19 healthy volunteers as a control group. Patients in the DM group were further divided into a DM+HPT group and a DM+non-HPT group according to whether they had hypertension (HPT) or not, and a DM+CVD group and a DM+non-CVD group according to whether they had CVD or not. All subjects underwent conventional carotid ultrasound examination, and ultrasound vector flow imaging (V-Flow) was applied to examine the maximum wall shear stress (WSSmax) and mean wall shear stress (WSSmean) at the bifurcation, proximal bifurcation, and middle region of the CCA. The comparison between the DM group and control group was performed by the t test. The comparison of ultrasonic parameters between subgroups was performed by one-way ANOVA, and the SNK test was used for pairwise comparisons. The ultrasonic diagnostic parameters of T2DM patients with CVD were analyzed by using the receiver operating characteristic (ROC) curve.

Results

Compared with the control group, the WSSmean in the middle region and proximal bifurcation of the CCA was decreased in the DM group [middle region: (0.81±0.23) Pa vs (1.02±0.21) Pa; proximal bifurcation: (0.73±0.21) Pa vs (0.90±0.16) Pa; P<0.05 for both]. In subgroup analysis, WSSmean in the middle region and proximal bifurcation of the CCA in the DM+non-HPT group was still lower than that of the control group [middle region: (0.87±0.24) Pa vs (1.02±0.21) Pa; proximal bifurcation: (0.78±0.18) Pa vs (0.90±0.16) Pa; P<0.05 for both]. WSSmean in the middle region and proximal bifurcation of the CCA in the DM+CVD group was significantly lower than that of the DM+non-CVD group [middle region: (0.71±0.18) Pa vs (0.85±0.23) Pa; proximal bifurcation: (0.62±0.20) Pa vs (0.78±0.20) Pa; P<0.05 for both]. ROC curve analysis showed that WSSmean at the proximal bifurcation of the CCA was a validated diagnostic parameter for CVD in T2DM patients (area under the curve: 0.699, P<0.05).

Conclusion

WSSmean in the middle region and proximal bifurcation of the CCA in T2DM patients is lower than that of healthy people, and the decrease is more obvious in patients with CVD. WSSmean in the proximal bifurcation is a valuable parameter for detecting the occurrence of CVD in T2DM patients.

Key words: Carotid artery, Wall shear stress, Type 2 diabetes mellitus, Vector flow imaging, Cardiovascular diseases
图1 颈总动脉（CCA）不同节段壁剪切力（WSS）取样点放置位置与测量方法。图a：测量CCA中段WSS；图b：测量CCA分叉处WSS；图c：测量CCA近分叉处WSS
表1 DM组和对照组一般临床资料比较
资料 DM组（n=49） 对照组（n=19） 统计值 P值
年龄（岁） 63.47±11.87 57.42±12.36 t=-1.863 0.067
男性[例（%）] 25（51.0） 11（57.9） χ2=0.260 0.610
BMI（kg/m2，±s） 25.17±3.24 22.88±2.83 t=-2.519 0.014
收缩压（mmHg，±s） 141±21 122±13 t=-3.228 <0.001
舒张压（mmHg，±s） 79±11 72±7 t=-2.674 0.010
心率（次/min，±s） 85±14 79±9 t=-1.853 0.071
TG（mmol/L，±s） 2.06±1.18 1.34±0.58 t=-1.940 0.058
TC（mmol/L，±s） 4.83±1.21 4.49±1.01 t=-.837 0.406
LDL-C（mmol/L，±s） 2.63±0.92 2.51±0.70 t=-.388 0.700
HDL-C（mmol/L，±s） 1.17±0.35 1.33±0.39 t=1.242 0.220
FPG（mmol/L，±s） 10.41±4.46 5.13±0.47 t=-7.972 <0.001
HbA1c（%，±s） 9.64±2.70 5.20±0.50 t=-10.170 <0.001
吸烟史[例（%）] 16（32.7） 1（5.3） χ2=5.478 0.019
图2 颈总动脉不同节段壁剪切应力（WSS）测量结果。图a~c：1例糖尿病组受试者测量结果；图d~e：1例对照组受试者测量结果；图a、d为颈总动脉分叉处测量结果，图b、e为颈总动脉近分叉处测量结果，图c、f为颈总动脉中段测量结果
表2 DM组和对照组颈总动脉不同节段的超声参数比较（ ±s）
参数 DM组（n=49） 对照组（n=19） t值 P值
WSSmax（Pa）        
颈总动脉中段 2.38±0.47 2.63±0.40 -2.041 0.045
颈总动脉近分叉处 2.14±0.47a 2.21±0.34a -0.607 0.546
颈总动脉分叉处 1.69±0.60ab 1.62±0.22ab 0.473 0.638
F值 22.379 44.015    
P值 <0.001 <0.001    
WSSmean（Pa）        
颈总动脉中段 0.81±0.23 1.02±0.21 -3.451 0.001
颈总动脉近分叉处 0.73±0.21 0.90±0.16 -3.127 0.003
颈总动脉分叉处 0.53±0.18ab 0.55±0.11ab -0.482 0.631
F值 23.551 39.714    
P值 <0.001 <0.001    
CD（cm）        
颈总动脉中段 0.64±0.08 0.59±0.05 2.218 0.030
颈总动脉近分叉处 0.67±0.09 0.63±0.05 2.459 0.017
颈总动脉分叉处 0.74±0.14ab 0.77±0.08ab -1.125 0.265
F值 10.456 40.999    
P值 <0.001 <0.001    
Vp（cm/s）        
颈总动脉中段 0.61±0.13 0.68±0.12 -2.123 0.038
颈总动脉近分叉处 0.49±0.14a 0.51±0.09a -0.644 0.522
颈总动脉分叉处 0.43±0.13a 0.42±0.09ab 0.779 0.439
F值 17.847 29.728    
P值 <0.001 <0.001    
IMTmean（mm）        
颈总动脉中段 0.85±0.14 0.73±0.12 3.085 0.003
颈总动脉近分叉处 0.99±0.17 0.88±0.11 2.489 0.015
t值 -4.105 -5.183    
P值 <0.001 0.001    
IMTsd（mm）        
颈总动脉中段 0.08±0.05 0.05±0.02 3.843 <0.001
颈总动脉近分叉处 0.09±0.04 0.07±0.02 2.548 0.013
t值 -1.237 -2.422    
P值 0.197 0.018    
表3 DM+HPT、DM+非HPT组及对照组颈总动脉不同节段的超声参数比较
参数 DM+HPT组（n=26） DM+非HPT组（n=23） 对照组（n=19） F值 P值
WSSmax（Pa）          
颈总动脉中段 2.37±0.50 2.41±0.44 2.63±0.40 2.091 0.132
颈总动脉近分叉处 2.12±0.56 2.17±0.37 2.21±0.34 0.251 0.779
颈总动脉分叉处 1.82±0.77 1.55±0.27 1.62±0.22 1.800 0.173
WSSmean（Pa）          
颈总动脉中段 0.77±0.21a 0.87±0.24a 1.02±0.21 7.540 0.001
颈总动脉近分叉处 0.69±0.24a 0.78±0.18a 0.90±0.16 6.080 0.004
颈总动脉分叉处 0.56±0.20 0.50±0.16 0.55±0.11 1.020 0.366
CD（cm）          
颈总动脉中段 0.67±0.08ab 0.61±0.08 0.59±0.05 6.474 0.003
颈总动脉近分叉处 0.69±0.08a 0.65±0.09 0.63±0.05 4.108 0.021
颈总动脉分叉处 0.71±0.15 0.78±0.14 0.77±0.08 1.794 0.174
Vp（cm/s）          
颈总动脉中段 0.60±0.12 0.62±0.15 0.68±0.12 2.380 0.101
颈总动脉近分叉处 0.49±0.14 0.50±0.14 0.51±0.09 0.222 0.802
颈总动脉分叉处 0.47±0.16 0.43±0.10 0.42±0.09 0.912 0.407
IMTmean（mm）          
颈总动脉中段 0.88±0.14a 0.83±0.16a 0.73±0.12 5.716 0.005
颈总动脉近分叉处 1.01±0.19a 0.97±0.16 0.88±0.11 3.485 0.036
IMTsd（mm）          
颈总动脉中段 0.08±0.05a 0.08±0.04a 0.05±0.02 3.860 0.026
颈总动脉近分叉处 0.10±0.05 0.09±0.05 0.07±0.02 2.063 0.135
表4 DM+CVD、DM+非CVD组及对照组颈总动脉不同节段的超声参数比较
参数 DM+CVD组（n=15） DM+非CVD组（n=34） 对照组（n=19） F值 P值
WSSmax（Pa）          
颈总动脉中段 2.31±0.50 2.41±0.44 2.63±0.40 2.302 0.108
颈总动脉近分叉处 1.96±0.46 2.22±0.46 2.21±0.34 2.072 0.134
颈总动脉分叉处 1.95±0.94 1.58±0.32 1.62±0.22 2.853 0.065
WSSmean（Pa）          
颈总动脉中段 0.71±0.18ab 0.85±0.23a 1.02±0.21 8.305 0.001
颈总动脉近分叉处 0.62±0.20ab 0.78±0.20a 0.90±0.16 8.953 <0.001
颈总动脉分叉处 0.57±0.22 0.51±0.16 0.55±0.11 0.732 0.485
CD（cm）          
颈总动脉中段 0.67±0.08ab 0.62±0.08 0.59±0.05 4.754 0.012
颈总动脉近分叉处 0.70±0.09a 0.66±0.08 0.63±0.05 3.380 0.040
颈总动脉分叉处 0.67±0.15 0.77±0.13 0.77±0.08 3.397 0.040
Vp（cm/s）          
颈总动脉中段 0.60±0.15 0.61±0.12 0.68±0.12 2.289 0.110
颈总动脉近分叉处 0.50±0.18 0.48±0.12 0.51±0.09 0.372 0.691
颈总动脉分叉处 0.48±0.18 0.43±0.11 0.42±0.09 0.859 0.428
IMTmean（mm）          
颈总动脉中段 0.86±0.11a 0.85±0.16a 0.73±0.12 4.696 0.012
颈总动脉近分叉处 1.03±0.16a 0.97±0.17 0.88±0.11 4.002 0.023
IMTsd（mm）          
颈总动脉中段 0.08±0.05a 0.07±0.05a 0.05±0.02 4.102 0.021
颈总动脉近分叉处 0.10±0.06 0.09±0.04 0.07±0.02 2.226 0.116
图3 平均壁剪切应力诊断2型糖尿病合并心血管疾病患者的受试者操作特征曲线
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