2型糖尿病患者的右心功能评价  

Evaluation of right heart function in patients with type 2 diabetes mellitus

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

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

出　　处：《中华全科医学》2016年第2期197-199,共3页Chinese Journal of General Practice

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

摘　　要：目的应用超声心动图技术测量2型糖尿病患者右心各指标,探讨患者右心结构及功能随糖尿病病程发展的变化。方法根据糖尿病诊断标准,将149例临床诊断为2型糖尿病患者根据有无微血管病变,分为糖尿病无微血管病变组(T2DM-Ⅰ)70例和糖尿病合并微血管病变组(T2DM-Ⅱ)79例,同时选取90名健康成人为对照组。所有受试者行超声心动图检查,比较3组之间的右心室舒张、收缩功能指标及右心房、室大小指标。结果 2组糖尿病患者E/A较正常对照组均显著降低,差异有统计学意义(P<0.01),T2DM-Ⅱ组较T2DM-Ⅰ组E/E’比值增加、T2DM-Ⅰ组较正常对照组E/E’比值增加,差异有统计学意义(P<0.05),T2DM-Ⅱ较正常对照组E/E’比值明显增加,差异有统计学意义(P<0.01);T2DM-Ⅱ组的RV-strain和Tei指数与T2DM-Ⅰ组及正常对照组比较差异有统计学意义(P<0.01),3组间比较FAC和TAPSE指标差异无统计学意义(P>0.05);T2DM-Ⅰ、Ⅱ两组除RVWT各组间比较差异有统计学意义外(P<0.01),其余右心房室构型指标较正常对照比较差异无统计学意义(P>0.05)。结论 2型糖尿病患者随着病程的发展,右室心肌功能的变化早于右心构型的改变,且右心室舒张功能的降低明显早于收缩功能的减退。Objective To evaluate the right heart functions in patients with type 2 diabetes mellitus （T2DM）by echocardiography, and to find out the correlation between echocardiographic findings and the severity of T2DM. Methods A total of 149 patients with T2DM were selected and divided into the non-diabetic microangiopathy group（70 cases, T2DM- Ⅰ ） and the diabetic microangiopathy group （79 cases, T2DM- Ⅱ ） according to the diagnostic criteria of T2DM. And 90 healthy age-matched volunteers were selected as controls. All subjects underwent echocardiography. The right ventricular size and function were compared among the three groups. Results Tricuspid orifice E/A of Two T2DM groups were lower than that of the control group （P 〈 0.01 ） ;Tricuspid E/E＇ was significantly different between T2DM- Ⅰ and the control group （P 〈 0.05 ） , and it was significantly different between T2DM-Ⅱ and the control group （P 〈 0.01 ）as well. There were also significant differences of RV-strain and Tei index in the T2DM- Ⅱas compared with T2DM- Ⅰ and the control group（ P 〈 0.01 ）. There were no significant differences in FAC and TAPSE among the three groups（P 〉0.05）. The indexes except RVWT between T2DM- Ⅱand T2DM- Ⅰ were significant difference （ P 〈 0.01 ）. The right ventricular size and function were not significant difference （ P 〉 0.05 ）. Conclusion With the development of diabetes, the functional impairment of the right heart appears earlier than structural changes, and right ventricu]ar diastolic function is early impaired than the systolic function.

关 键 词：超声心动图 糖尿病 微血管 右心功能 

分 类 号：R587.1[医药卫生—内分泌] R540.45[医药卫生—内科学]