心肌运动定量技术在多囊卵巢合并胰岛素抵抗患者左室纵向心肌功能评价中的价值  

Evaluation of left ventricular longitudinal myocardial function in patients with polycystic ovary syndrome associated with insulin resistance by cardiac motion quantification

作　　者：杜启亘[1] 米香琴 徐宏伟 商玮珉 周立平[1] 陈巍[1] DU Qigen;MI Xiangqin;XU Hongwei;SHANG Weimin;ZHOU Liping;CHEN Wei(Department of Uhrasound,Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine,Hei-longjiang Province,Harbin 150000,China)

机构地区：[1]黑龙江中医药大学附属第二医院超声科,黑龙江哈尔滨150000

出　　处：《中国医药导报》2018年第19期71-74,86,共5页China Medical Herald

基　　金：黑龙江省自然科学基金面上项目(H2016079)

摘　　要：目的探讨心肌运动定量(CMQ)技术评价多囊卵巢合并胰岛素抵抗(PCOS-IR)患者左心室纵向运动的临床价值。方法选取2016年2月～2017年2月在黑龙江中医药大学附属第二医院妇科就诊的PCOS-IR患者55例为PCOS-IR组,另选择年龄相匹配的55名健康妇女为对照组。记录一般资料:腰臀比(WHR)、体重指数(BMI)、收缩压(SBP)、舒张压(DBP)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、空腹血浆胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR),进行常规超声心动图检查,测量左室舒张末期内径(LVDd)、左室收缩末期内径(LVDs)、舒张末期室间隔厚度(IVSTd)、舒张末期左室后壁厚度(LVPWTd)、左室射血分数(LVEF)、舒张早期二尖瓣口血流峰值速度(E)、舒张晚期二尖瓣口血流峰值速度(A)、舒张早期二尖瓣环运动峰值速度(Em),计算E/A及E/Em,测量E峰减速时间(DT)、等容舒张时间(IVRT)及等容收缩时间(IVCT)。应用CMQ技术跟踪描记心肌运动轨迹,获取左室18节段心肌收缩期纵向峰值应变(LS)及收缩期整体纵向峰值应变(GLS)。采用Pearson相关分析各参数之间的相关性。结果 PCOS-IR组WHR、BMI、FINS、HOMAIR、LDL-C高于对照组,差异有统计学意义(P<0.05)。两组年龄、SBP、DBP、FPG、HDL-C、TG比较,差异无统计学意义(P>0.05)。与对照组比较,PCOS-IR组DT、IVRT、E/Em增加,Em减小,差异有统计学意义(P<0.05);两组LVDd、LVDs、IVSTd、LVPWTd、LVEF、E、A、E/A、IVCT比较,差异无统计学意义(P>0.05)。PCOS-IR组各节段LS及GLS均较对照组减低,差异有统计学意义(P<0.05)。GLS与FINS、WHR及LDL-C均呈负相关(r=-0.58、-0.46、-0.44,P<0.05),与FPG、HOMA-IR、HDL-C、TG、BMI无相关性(P>0.05)。结论 PCOS-IR患者在LVEF正常情况下可出现早期纵向收缩功能下降。CMQ技术可早期检测出PCOS-IR患者左心室纵向运动异常,为临床及时干预治疗提供帮助。Objective To investigate the clinical value of myocardial motion quantification（CMQ） in evaluation of left ventricular longitudinal motion in patients with polycystic ovary combined with insulin resistance（PCOS-IR）. Methods From the February 2016 to February 2017, 55 patients with PCOS-IR in Department of Gynecology, the Second Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine were selected, 55 age matched healthy women were selected as control group. The general data were recorded： waist-to-hipratio（WHR）, body mass index（BMI）, systolic pressure（SBP）, diastolic pressure（DBP）, triglyceride（TG）, high density lipoprotein cholesterol（HDL-C）, low density lipoprotein cholesterol（LDL-C）, fasting blood glucose（FPG）, fasting plasma insulin（FINS）, homeostasis model assessment for IR index（HOMA-IR）, and all subjects were given routine echocardiography, the left ventricular end-diastolic dimension（LVDd） and left ventricular end-systolic diameter（LVDs）, end-diastolic interventricular septum thickness（IVSTd）, end-diastolic left ventricular posterior wall thickness（LVPWTd）, and left ventricular ejection fractional（LVEF）, early diastolic blood flow peak velocity（E）, late diastolic blood flow peak velocity（A）, mitral annular early diastolic motion peak velocity（Em） were measured, E/A and E/Em were calculated, E peak deceleration time（DT）, isovolumic relaxation time（IVRT） and isovolumic contraction time（IVCT） were measured. CMQ technique was used to trace tracing of myocardial trajectory, and systolic longitudinal peak strain（LS） and systolic global longitudinal peak strain（GLS） of 18 left ventricular segments were obtained. Pearson correlation was used to analyze the correlation between the parameters. Results The WHR, BMI, FINS, HOMA-IR and LDL-C in the PCOS-IR group were higher than those in the control group, the differences were statistically significant（P〈0.05）; there was no significant dif

关 键 词：多囊卵巢 胰岛素抵抗 心肌运动定量技术 左心室 

分 类 号：R711.75[医药卫生—妇产科学]