心肌声学造影评价胰岛素不同干预时间点对糖尿病大鼠心肌灌注的影响  

Assessment of Myocardial Perfusion in Diabetes Mellitus Rats with Insulin Intervention at Different Times by Using Myocardial Contrast Echocardiography

作　　者：张展[1] 张军[2] 刘芳[1] 拓胜军[2] 岳瑾琢[1] 贺建国[2] ZHANG Zhan ZHANG Jun LIU Fang TA Shengjun YUE Jinzhuo HE Jianguo(Department of Ultrasound, Xijing Hospital, the Fourth Military Medical University, Xi＇an 710032, China)

机构地区：[1]西安市儿童医院超声科,陕西西安710003 [2]第四军医大学西京医院超声科,陕西西安710032

出　　处：《中国医学影像学杂志》2017年第6期405-408,413,共5页Chinese Journal of Medical Imaging

基　　金：国家自然科学基金项目(81271580)

摘　　要：目的应用心肌声学造影(MCE)技术评价胰岛素不同时间点干预糖尿病大鼠心肌微循环灌注的差异,探讨MCE在糖尿病心肌病(DCM)疗效评价中的价值。材料与方法将90只SD大鼠按随机数字表法分为对照组(NC)、糖尿病组(DM)和胰岛素干预组(INS),每组30只。成功制备糖尿病模型后,INS组随机分A、B、C 3个亚组,分别于成模0、4、8周后开始胰岛素干预,均连续给药12周;NC和DM组也随机分为3个亚组,与INS组各亚组同步饲养,不予干预。于成模后12、16、20周末对各亚组大鼠开胸行MCE检查,分析心肌血容量(A)、血流速度(β)和血流量(A×β)的变化,并取心肌组织行病理学检查。结果与DM组比较,INS组A、β和A×β均增加,差异有统计学意义(P<0.05);与NC组比较,INS组A亚组A×β减低,B亚组A、A×β减低,C亚组A、β、A×β均减低,差异有统计学意义(P<0.05);INS组各亚组间比较,A、B亚组间各指标差异无统计学意义(P>0.05);C亚组A、A×β低于A亚组,差异有统计学意义(P<0.05)。病理结果显示,INS组毛细血管基底膜厚度较DM组改善;毛细血管密度INS各亚组均较DM组增加,仅A亚组差异有统计学意义(P<0.05)。结论胰岛素早期干预可改善心肌微血管结构,增加心肌血流量。MCE可敏感、准确地对DCM大鼠的心肌微循环进行评价,可作为DCM早期诊断和动态疗效监测的重要方法,具有重要的临床指导意义。Purpose To evaluate the myocardial perfusion in diabetes mellitus（DM） rats with insulin intervention at different times by myocardial contrast echocardiography（MCE） so as to explore the value of MCE in evaluating the treatment of diabetic cardiomyopathy（DCM）. Materials and Methods Materials and Methods In this prospective study, 90 rats were randomly divided into normal control（NC） group, DM group and insulin intervention（INS） group, with 30 rats in each group. After the DM models were established, the INS group was then divided into three subgroups of A, B and C treated with insulin intervention at 0, 4 and 8 weeks respectively and further treated continuously for 12 weeks. The NC and DM groups were also randomly divided into three subgroups and fed synchronously just as the INS group but without insulin intervention. At the end of 12, 16 and 20 weeks after modeling, the rats in each subgroup were examined by MCE. The changes of myocardial blood volume（A）, blood velocity（β） and blood fl ow（A×β） were analyzed, and the myocardial tissues were also collected for pathological examination. Results A, β and A×β were increased in INS group compared with DM group（P〈0.05）. Compared with NC group, the values of INS group including A×β in A subgroup, A and A×β in B subgroup, A, β and A×β in C subgroup were decreased（all P〈0.05）. In INS group, there was no difference in the three values of myocardial blood between A and B subgroup（P〈0.05）, but A and A×β were lower in C subgroup than those in A subgroup（P〈0.05）. On pathology, the thickness of capillary basement membrane of INS group improved compared with DM group; the capillary density of INS group increased compared with DM group, but there was signifi cant difference only in A subgroup（P〈0.05）. Conclusion Early insulin intervention can improve myocardial microvascular structure and increase myocardial blood fl ow. MCE can be used to evaluate the myocardial microcirculation of DCM rats sensitively

关 键 词：糖尿病并发症 心肌疾病 胰岛素 超声心动描记术 造影剂 心肌再灌注 微循环 疾病模型 动物 大鼠 Sprague-Dawley 

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]