分层应变超声成像结合血清补体C3评估系统性红斑狼疮患者颈动脉内膜早期弹性功能

摘要

目的 应用分层应变超声成像技术定量评估系统性红斑狼疮(SLE)患者颈总动脉内膜环向应变参数的改变,以揭示该类患者可能已经出现的颈动脉早期弹性功能减低.方法 选取无动脉粥样硬化证据的SLE确诊患者72例,记录SLE患者近1周内血清补体C3的实验室检查结果 ,其中C3含量低于正常参考值范围低限者49例(SLE C3+组),C3含量在正常参考值范围内者23例(SLE C3-组);选取健康志愿者38例作为对照组.三组均进行颈动脉超声检查,获取颈动脉常规参数:颈总动脉内中膜厚度(CCA-IMT)、收缩期峰值流速(PSV)、舒张末期速度(EDV)、阻力指数(RI),颈动脉应变相关参数:颈总动脉内膜正向收缩环向峰值应变(CSendo)和颈总动脉收缩环向峰值应变率(CSr).比较各组之间相关参数的差异.结果 ①三组颈总动脉RI差异无统计学意义(均P>0.05),SLE C3+组与SLE C3-组CCA-IMT大于对照组(均P<0.05);②SLE C3+组与SLE C3-组CSendo、CSr均小于对照组,其中SLE C3+组测值较对照组显著减低(P<0.001),SLE C3-组与对照组差异无统计学意义(P>0.05);③SLE C3+组CSendo、CSr测值小于SLE C3-组(均P<0.05).结论 分层应变超声成像技术提供的CSendo结合近期血清补体C3的改变有可能为评估SLE颈动脉内膜早期弹性功能的受损提供可视化证据.%Objective To reveal the early elastic dysfunction of common carotid artery may have occurred in systemic lupus erythematosus( SLE) patients ,the circumferential strain parameters of common carotid artery intima in SLE patients at different serum complement levels were quantitatively evaluated by layer-specific strain imaging . Methods Seventy-two patients suffered from SLE without evidence of atherosclerosis were enrolled ,and the results of laboratory examination of serum complement C 3 in patients with SLE were recorded in detail ,49 cases of SLE patients whose serum C3 was lower than the normal reference range(SLE C3+ group) ,23 cases of SLE patients whose serum C3 was in the range of normal reference value(SLE C3 - group) . And a matched healthy control group ( n =38) were selected . Carotid ultrasound were performed in all three groups ,and the common carotid artery conventional parameters ,such as common carotid artery intima-media thickness ( CCA-IM T ) ,peak systolic velocity ( PSV ) ,end-diastolic velocity(EDV) ,resistance index(RI) and circumferential strain related parameters ,such as circumferential strain of common carotid artery intima(CSendo) and circumferential strain rate(CSr) were measured and derived.Therelatedparametersamongthosegroupswerecomparedfordifference.Results ①Therewas no significant difference in RI among the three groups(all P >0 .05) . The values of CCA-IMT in the SLE C3+ group and SLE C3- group were larger than that in the control group( all P <0 .05) . ②The values of CSendo and CSr in the SLE C3+ group and SLE C3 - group were lower than those in the control group ,the values of SLE C3+ group were significantly lower than those in the control group ( P <0 .001) ,and there was no significant difference between the SLE C3- group and control group( P >0 .05) . ③The CSendo and CSr in the SLE C3+ group were lower than those in the SLE C3- group(all P < 0 .05) . Conclusions CSendo which is provided by new ultrasonic technology of layer-specific strain combined with recent changes in serum complement C3 may provide visual evidence for assessing early elastic disfunction of carotid intima in SLE patients .