目的 应用回声跟踪(E-Tracking)技术评价糖尿病肾病不同时期颈动脉弹性的变化及临床意义.方法 选择2型糖尿病(T2DM)患者93例和正常对照(NC)32例,按照尿白蛋白排泄率(UAER)将T2DM分为正常蛋白尿(DM1)、微量尿蛋白(DM2)和临床尿蛋白(DM3)三组,并采用彩色多普勒超声诊断仪测量颈动脉内膜-中层厚度(IMT)、收缩期颈动脉内径(Ds)、收缩期峰值流速(PSV)、阻力指数(RI)、压力-应变弹性系数(Ep)、硬化指数(β)、顺应性(AC)、单点脉搏波传导速度(PWVβ)和增大指数(AI)等参数.结果 (1)与NC组比较,T2DM患者IMT值均明显增高(P<0.05); (2)与NC组比较,T2DM患者β、Ep、AI和PWVβ值明显增高,AC降低(P<0.05),而与DM1和DM2两组比较,DM3组的β和PWVβ值均升高(P<0.05);(3)直线相关分析发现IMT与β、Ep、AI、PWVβ呈正相关(P<0.05),与AC呈负相关(P<0.05),Logistic回归分析显示UAER与β、PWVβ和IMT呈正相关性(P<0.05).结论 糖尿病早期肾病期患者的颈动脉弹性已经发生改变,测定颈动脉弹性的变化可以反映糖尿病微血管的病变程度.%Objective To detect the changes of carotid elasticity in patients with diabetic nephropathy in different periods by E-Tracking technique. Methods Ninety-three patients with type 2 diabetes(T2DM)and 32 normal controls (NC)were recruited in the study. According to urinary albumin excretion rate(UAER),the patients were divided into three groups : normoalbuminuria( DMI), minimal urine protein ( DM2 ) and clinical urine protein( DM3 ). Carotid vascular intima thickness(IMT) ,systolic carotid arterial lumen(Ds) ,peak systolic velocity(PSV)and resistance index(RI) ,elastic coefficient(Ep),hardening index(β) ,compliance(AC)and single pulse wave velocity(PWVβ)and increase index(AI)were measured using color Doppler ultrasound. Results 1. Compared with NC, IMT in T2DM patients was significantly higher(P＜0. 05). 2. Compared with NC,β,Ep,AI and PWVβ in T2DM patients increased and AC reduced significantly(P＜0.05). Moreover,βand PWVβ in DM3 group were higher than in DM1 and DM2 groups, respectively (P＜0. 05). 3. Linear correlation analysis showed that IMT positively related to the parameters of β, Ep, A I, PWVβ (P＜0.05)and negatively correlated to AC(P＜0. 05). Logistic regression analysis showed that UAER positively related to the parameters of PWVβand IMT(P＜0. 05). Conclusions Carotid artery elasticity has changed in diabetes patients with clinical stage kidney. Thus,carotid artery elasticity change could reflect the process of diabetes microvascular disease.
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