糖代谢异常对老年冠心病患者左心功能影响的超声评估  

The influence of abnormal glucose metabolism to senile coronary heart disease patients' left ventricular function through ultrasound assessment

作　　者：蔡琦[1] 顾凯[1] 王连生[1] 周芳[1] 许迪[1] 曹克将[1] 周蕾[1] 

机构地区：[1]南京医科大学第一附属医院心血管内科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2011年第8期1212-1215,共4页Journal of Nanjing Medical University(Natural Sciences)

基　　金：江苏省"六大人才高峰"第五批高层次人才项目(苏人通[2008]329号);江苏省人民医院临床诊疗新技术新项目(院发[2008]201号)

摘　　要：目的:应用超声心动图分析老年冠心病合并糖代谢异常患者左心功能。方法:选取经冠脉造影确诊但未发生心肌梗死的老年冠心病患者87例,依据糖尿病诊断标准,分为糖尿病(DM)组、糖调节受损(IGR)组和正常(NGT)组。各组患者的血压值没有统计学差异。应用二维超声测量左室射血分数(LVEF)与左房容积指数(LAVI),彩色M型测量舒张期左室内血流传播速度(Vp),脉冲多普勒记录二尖瓣及主动脉瓣口血流频谱、测量二尖瓣口舒张早期与晚期血流峰值的比值(E/A),组织多普勒(DTI)测量二尖瓣环舒张早期运动速度(Em),计算E/Em及左室Tei指数以评估患者的左心功能。结果:与NGT组比较,DM组及IGR组患者的左室Tei指数(LV-tTei)[(0.59±0.09),(0.57±0.07)vs(0.52±0.06)]、E/Em比值[(12.61±1.41),(11.22±1.94)vs(9.85±1.93)]及LAVI[(29.22±3.41),(29.22±3.41)vs(27.24±3.35)]增大,Vp减小,差异有统计学意义。且上述4个超声指标有较好的相关性。结论:E/Em、LAVI、LV-tTei及Vp较传统测量的EF及E/A更早地反映了糖代谢异常对老年冠心病患者左心功能的影响。Objective：To analyze the effect of abnormal glucose metabolism on left ventricular function of senile patients with coronary heart disease through echocardiogram.Methods：Total 87 cases of patients with coronary heart disease but without myocardial infarction were definitely diagnosed by coronary angiography.According to the diagnosis and classification criteria,all of the patients were divided into the following three groups：diabetes mellitus（DM） group,impaired glucose tolerance（IGR） group and normal glucose metabolism group.Left ventricular eject faction（LVEF） and left atrium volume index（LAVI） were assessed by two dimensional echocardiography.The mitral valve and aortic valve blood flow spectra were obtained through pulse Doppler.Vp of early flow into the left ventricular cavity in normal and hypertensive patients were measured by color M-mode Doppler echocardiography.The mitral flow velocity was measured and the E / A was calculated.The mitral annular early diastolic velocities（Em） were determined by DTI（Doppler tissue imaging）,and the E / Em and Tei index were calculated.Then the function parameters of the three groups were compared with the control.Results：Compared with normal glucose metabolism group,the patients from DM group and IGR group had higher left ventricular Tei index,E / Em,and LAVI,lower Vp,and the differences between them were significant.What’s more,the above four parameters correlated well.Conclusion：To patients with coronary heart disease simultaneously without myocardial infarction,LAVI,E / Em,Vp and left ventral Tei index could reflect the influence of glucose metabolism disorders on left ventral function earlier than index of EF and E / A.

关 键 词：老年冠心病 糖代谢异常 左心功能 多普勒超声 

分 类 号：R540.45[医药卫生—心血管疾病]