二维斑点追踪成像评估2型糖尿病患者右心室功能  

Echocardiographic evaluation of right ventricular function in type-2 diabetic patients using 2-dimensional speckle tracking imaging

作　　者：俞霏[1] 许幼峰[1] 毛锋[1] 姜月茗茗[1] 陈立斌[1] 胡芳芳[2] 张盛敏[1] 尹凤英[1] 

机构地区：[1]宁波市第一医院超声科,315010 [2]宁波市第一医院内分泌科,315010

出　　处：《中华超声影像学杂志》2015年第8期657-660,共4页Chinese Journal of Ultrasonography

基　　金：宁波市社会发展科研项目（2013C50046,2011C50023）;浙江省医学会临床科研资金项目（2013ZYC-A69）

摘　　要：目的应用二维斑点追踪成像（2D-STI）评估2型糖尿病患者的右心室收缩功能。方法连续选取50例2型糖尿病患者及50例年龄匹配的正常对照者行超声心动图检查，测量：①右心腔大小、右室壁厚度；②右心室面积变化率（RVFAC）、三尖瓣环侧壁收缩期组织速度（S’）、三尖瓣环平面收缩期位移（TAPSE）、四腔心切面右心室壁6个节段纵向应变；③三尖瓣口舒张期血流E、A峰比值（E／A）、E峰与组织多普勒三尖瓣环舒张速度E’峰比值（E／E＇）、右心室Tei指数等。统计分析组间测值差异。结果与对照组相比，糖尿病组右心腔大小差异无统计学意义（P〉0．05），而右室壁厚度增加（P=0．000）；右室侧壁中间段、室间隔中间段与基底段的二维应变绝对值降低（P=0．001、0．000及0．005），而另3个节段应变值以及RVFAC、TAPSE、S’差异无统计学意义（P〉0．05）；E／E’增高、E／A降低、右心室Tei指数增高（P=0．000、0．000及0．006）。结论2D-STI较常规参数更敏感，能在早期反映2型糖尿病患者的右心室收缩功能改变；而右心室6个节段中，侧壁中间段、室间隔中间段及室间隔基底段的应变测值更可靠。Objective To evaluate right ventricular （RV） systolic function in type-2 diabetes mellitus （T2DM） patients. Methods Fifty T2DM patients and fifty normal controls were included in the study and underwent echocardiographic examinations. The following parameters were measured.. 1 ） Right heart dimensions,pulmonary artery （PA） diameter, pulmonary acceleration time （AT） and PA systolic pressure （PASP） （2） RV systolic function.. RV fractional area change （RVFAC）, tissue Doppler-derived tricuspid lateral annular systolic velocity （S＇）, tricuspid annular plane systolic excursion （TAPSE） ,longitudinal strain of six RV segments by 2-dimensional speckle tracking imaging （2D-STI）;3） RV diastolic function.. E, A ratio of the tricuspid inflow spectrum （E/A）, E, Er （peak early diastolic velocity of the tricuspid annulus） ratio （E/E＇）;4） RV Tel index. Results Statistic analysis showed that T2DM patients had thicker RV walls,wider PAs and shorter AT than the control group （ P = 0.000,0.001 and 0.000）, while their right heart chamber sizes and PASP remained unchanged. Among systolic parameters, absolute values of RV longitudinal strain at the lateral wall-mid （lat-m）,septum-mid （sep-m） and septum-basal （sep-b） segments were significantly lower in the diabetic group than the control group （ P = 0.001,0.000 and 0.005）, whereas strain of the other three RV segments and RVFAC,TAPSE. S＇ were not significantly different. Moreover, E/A,E/E＇ and Tel index were all significantly different between the two groups （ P = 0.000,0.000 and 0.006）, indicating declined diastolic and general function of RV in the T2DM group. Conclusions RV myocardial strain by 2D-STI is more sensitive in detecting RV systolic dysfunction than TAPSE, Sr and RVFAC. Among the six segments of RV walls,lat-m,sep-m and sep-b are better locations for 2D-ST1 than the other three.

关 键 词：超声心动描记术 糖尿病 心室功能 右 应变 

分 类 号：R445.1[医药卫生—影像医学与核医学] R587.1[医药卫生—诊断学]