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。

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（WSS_max）和平均壁剪切应力（WSS_mean）。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。

与对照组相比，DM组患者CCA中段及近分叉处的WSS_mean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WSS_mean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WSS_mean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WSS_mean对T2DM患者发生CVD具有诊断价值（曲线下面积为0.699，P<0.05）。

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

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.

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 (WSS_max) and mean wall shear stress (WSS_mean) 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.

Compared with the control group, the WSS_mean 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, WSS_mean 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]. WSS_mean 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 WSS_mean 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).

WSS_mean 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. WSS_mean in the proximal bifurcation is a valuable parameter for detecting the occurrence of CVD in T2DM patients.