The Prediction And Analysis Of Type 2 Diabetic Retinopathy Through Carotid Artery Elasticity Evaluated By Shear Wave Elastography

Objective The aim of the study were to reaserch influencing factors of carotid elasticity,and analyze the correlation between carotid elastic modulus and DR,meanwhile discuss the diagnostic value of SWE for DR by comparing carotid elastic modulus,IMT and related clinical data of T2 DM with DR and NDR.Methods Research objects: 89 patients who were hospitalized in the Endocrinology Department of the Second People’s Hospital of Yunnan Province from March to December 2019 and met the WHO T2 DM diagnostic criteria were selected as the research objects.According to the "Diabetic Retinopathy" issued by the Chinese Society of Fundus Diseases in 2014 "Clinical Diagnosis and Treatment Guidelines" divide the study subjects into groups: diabetic retinopathy group(DR group,n=38),non-diabetic retinopathy group(NDR group,n=51).Patient’s baseline data and laboratory indicators were collected;the elastic parameters of left and right carotid artery were measured quantitatively by SWE,including the maximum Young’s modulus(Emax),the average Young’s modulus(Emean),and the smallest Young’s modulus(Emin),the average carotid artery elasticity(anterior wall MEmean,anterior wall MEmin,anterior wall MEmax,posterior wall MEmean,posterior wall MEmin,posterior wall MEmax)can be obtained by averaging bilaterally;at the same time,the ultrasonic instrument’s IMT function was used to automatically measure and calculate the average IMT thickness;SPSS 25.0 was used for statistical analysis of the data.Results1.Compared with NDR group baseline factors,including age,gender,BMI,WHR,smoking and drinking history,as well as family history of diabetes,were no statistically significant difference in DR group(P>0.05).Compared with the NDR group,the DR group has a higher limb sensory threshold and a longer disease course(P<0.05);Compared with NDR group,the detection rate of diabetic nephropathy in the DR group was significantly higher(P=0.001),but there was no significant difference in the detection rate of hypertension,cardiovascular and cerebrovascular diseases,and diabetic foot detection rate(P>0.05);Compared with NDR group laboratory indicators,including UA,Scr,TBIL,DBIL,ALB,T3,FT3,were statistically significant difference in DR group(P<0.05).2.All 89 patients measured the elastic modulus of the carotid artery by SWE,and obtained clear elastography images.The color of the area of interest was evenly filled.The color distribution of the DR group was mainly yellow/red,and the NDR group was mainly blue/green.Compared with the NDR group,the carotid anterior wall elastic modulus(anterior wall MEmean,anterior wall MEmin and anterior wall MEmax)increased in the DR group(P<0.05).3.Pearson correlation analysis showed that there was a linear positve correlation between the elastic modulus’ anterior wall of carotid artery(MEmean,MEmax,MEmax)and indicators(disease course,BMI,TG,TC,Hb A1c),and negatively correlated with HDL-C(P < 0.05).There was no significant correlation with age,carotid artery diameter,IMT,UA,SCR,LDL,TBil,ALB,FBG,T3,T4,TSH(P>0.05).The results of multiple linear regression analysis suggested that disease course,TG and TC were the risk factors for the increase of MEmean and MEmax.4.ROC curve analysis results showed that the area under the ROC curve of the anterior wall MEmean predicts DR was 0.630(95%CI,0.508～0.752)(P=0.037),the cut-off point was 21.250 k Pa,the sensitivity was 39.5%,and the specificity was 92.2%,the area under the ROC curve of the anterior wall MEmax predicted DR was 0.630(95%CI,0.508～0.753)(P=0.036),the cutoff value was 25.475 k Pa,the sensitivity was50.0%,and the specificity was 78.4%.Conclusion1.Carotid artery elastic modulus has certain diagnostic efficiency and predictive value for DR.It is linearly positively correlated with disease course,BMI,TG,TC,Hb A1 c,and linearly negatively correlated with HDL-C.Among them,the course of disease,TG,TC are the risk factors for the increase of carotid elastic modulus.2.SWE is simple to operate,inexpensive,and can quantitatively measure the elastic modulus of the carotid artery.It can be used as an auxiliary diagnostic method for DR in clinical practice.