| 摘要: |
| 摘 要 目的 应用剪切波弹性成像（SWE）技术检测2型糖尿病视网膜病变（DR）患者视神经硬度，探讨其临床应用价值。方法 选取我院收治的2型糖尿病患者95例，根据眼底病变程度分为糖尿病非视网膜病变（NDR）组30例、非增殖期糖尿病视网膜病变（NPDR）35例和增殖期糖尿病视网膜病变（PDR）组30例，另选健康成人30例作为对照组。应用彩色多普勒测量视网膜中央动脉（CRA）、睫状后短动脉（PCA）收缩期峰值流速（PSV）、舒张末期流速（EDV）和阻力指数（RI）；应用SWE测量视神经和相邻视神经眶内脂肪组织杨氏模量值（Emean）；比较各组上述参数的差异。应用Spearman相关分析法分析各临床资料与视神经和眶内脂肪组织Emean的相关性；绘制受试者工作特征（ROC）曲线分析视神经和眶内脂肪组织的Emean诊断DR的效能。结果 各组视神经和眶内脂肪组织Emean比较差异均有统计学意义（均P＜0.001）。DR各组视神经和眶内脂肪组织Emean均高于对照组，差异均有统计学意义（均P＜0.001）；视神经和眶内脂肪组织Emean随着DR程度加重而增大。各组CRA、PCA的PSV、EDV比较差异有统计学意义（均P < 0.001）；CRA、PCA的RI会随着DR病情进展程度加重而增加，各组CRA、PCA的RI比较有显著差异（P < 0.001）；相关性分析显示，视神经和眶内脂肪组织Emean与BMI、年龄、甘油三酯和空腹血糖均呈正相关，与高密度脂蛋白呈负相关。ROC曲线分析显示，视神经和眶内脂肪组织Emean诊断DR的曲线下面积（AUC）分别为0.971（95%可信区间：0.956~0.981）和0.969（95%可信区间：0.954~0.980），二者联合诊断DR的曲线下面积（AUC）为0.976（95%可信区间：0.963~0.986）。结论 糖尿病患者未发生视网膜病变时，其视神经和眶内脂肪组织硬度及球后血管血流动力学已发生改变，且随着DR患者病变程度加重而增大。应用SWE技术检测DR患者视神经硬度可为临床及早诊治提供重要依据。
关键词：视神经；剪切波弹性成像；2型糖尿病视网膜病变；视网膜中央动脉;睫状后短动脉 |
| 关键词: 视神经；剪切波弹性成像；2型糖尿病视网膜病变；视网膜中央动脉 睫状后短动脉 |
| DOI： |
| 投稿时间：2022-10-26修订日期：2023-06-04 |
| 基金项目:1.2022年“草原英才”工程专项资金支持科研项目2.内蒙古自治区卫生健康委医疗卫生科技计划(项目编号:202202252) |
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| Study of optic nerve in patients with type 2 diabetic retinopathy by shear wave elastography |
| caoyue,WuCaihong |
| (Baotou Medical College,Inner Mongolia University of Science and Technology;The Second Affiliated Hospital of Inner Mongolia University of Science and Technology) |
| Abstract: |
| ABSTRACT Objective To investigate whether shear wave elastography（SWE） can be a new noninvasive diagnostic method for optic nerve stiffness in patients with diabetic retinopathy（DR）.Methods SWE was performed in 30 healthy subjects and 95 patients with diabetes mellitus（DM）.ROC curve analysis was performed.Blood glucose，blood lipid，age and body mass index（BMI） were correlated with SWE.Blood flow parameters of central retinal artery（CRA） and short posterior ciliary artery（PCAs） were observed by color Doppler ultrasonography.Results There were significant differences in SWE values of optic nerve among the groups（P＜0.001），and there were significant differences in SWE values of fat tissue in frame among the groups（P＜0.001）. There were significant differences in PSV and EDV between CRA and PCA in each group (all P < 0.001); RI of CRA and PCA would increase with the severity of DR disease progression, and RI of CRA and PCA in each group was significantly different (P < 0.001);SWE values of optic nerve and in-frame adipose tissue were positively correlated with BMI, age, triglycerides and fasting blood glucose,It was negatively correlated with high-density lipoprotein;ROC curve analysis showed that the SWE value determination of the optic nerve had a high diagnostic accuracy（AUC of 0.971，[95% CI，0.956-0.981]）；the SWE value determination of in-frame adipose tissue had a high diagnostic accuracy（AUC of 0.969，[95% CI，0.954 – 0.980]）.For the combined diagnosis of DR, the area under the curve (AUC) was 0.976 (95% confidence interval: 0.963 -0.986).Conclusion SWE value and retrobulbar vascular hemodynamics have changed in diabetic patients without retinopathy，which can provide an important basis for timely clinical intervention and control of diabetic retinopathy.The mean shear wave elasticity（Emean） and retrobulbar vascular hemodynamics in DR patients are quite different from those in normal subjects，which is of great significance for early clinical intervention and diagnosis of DR.
KEYWORDS optic nerve；shear wave elastography；type 2 diabetic retinopathy；central retinal artery；short posterior ciliary artery |
| Key words: optic nerve, shear wave elastography, type 2 diabetic retinopathy, Central retinal artery, short posterior ciliary artery |
