分层应变技术对糖尿病兔模型左心功能演变的动态监测  

Dynamic Monitoring of Left Ventricular Function by Layer-Specific Strain Echocardiography in Diabetic Rabbits

作　　者：乔英艳[1] 张玖[1] 郭艳琴[1] 段银玲[1] 任桐 郭华丽 Qiao Yingyan;Zhang Jiu;Guo Yanqin;Duan Yinling;Ren Tong;Guo Huali(Department of Ultrasound,The second Hospital o{ Shanxi Medical University,Tayuan,Shanxi 030001,China)

机构地区：[1]山西医科大学第二医院超声科,太原市030001

出　　处：《中国超声医学杂志》2018年第9期840-843,共4页Chinese Journal of Ultrasound in Medicine

基　　金：山西省卫计委科研课题(No.2017062);山西医科大学博士启动基金(No.03201646)

摘　　要：目的运用分层应变技术对糖尿病兔的左心功能进行动态监测,并通过不同时期病理切片进行对照,观察其心肌形变的特点,为进一步理解糖尿病的心脏病理生理学提供新的视角。方法采用注射四氧嘧啶(150mg/kg)诱导糖尿病兔模型;应用分层应变技术对左室纵向长轴及圆周应变进行评估,并将心肌组织标本采用石蜡包埋技术制备组织病理切片,并行Masson染色。结果 (1)成模6个月时,糖尿病组心内膜层的长轴应变及圆周应变均较对照组明显减低,差别有统计学意义;成模9个月时,心内膜层、中层及心外膜层的纵向应变及圆周应变差别均有统计学意义。(2)成模6个月时,将心内膜层长轴应变及心内膜层圆周应变做ROC曲线,结果显示:心内膜层长轴应变较圆周应变曲线下面积大,说明前者诊断糖尿病心肌损伤的灵敏度及特异度均较后者高。(3)随着糖尿病病程的进展,成模6个月时,也开始出现组织形态学的变化。结论 (1)分层应变技术可以识别糖尿病早期阶段微弱受损的左室心肌功能。(2)糖尿病组早期的心肌功能损伤是非透壁性的,其心内膜层在糖尿病的早期更容易受损。Objective This study aimed to investigate the time-course changes in the left ventricular myocardial deformation by layer-specific strain echocardiography which may provide insights to our understanding of the cardiac pathophysiology in diabetes mellitus.Methods DM was induced by intravenous injection of alloxan（ALX）.Layerspecific longitudinal and circumferential strains were assessed from endocardium,mid-myocardium and epicardium by 2-dimensional（2D）speckle-tracking echocardiography（STE）.All the rabbit rabbits were sacrificed after echocardiography and Masson staining was performed.Results（1）At 3 months,there was no significant difference in three-layer LS and CS（P〉0.05）between them;but at 6 months,the LS of endocardium（LSendo）and CS of endocardium（CSendo）were lower in DM group compared with the control group;while at 9 months,the longitudinal strain and the circumferential strain of the endocardial layer,middle and epicardial layer have significant difference.（2）Moreover,receiver operating characteristics analysis yielded better sensitivity and specificity in the detection of DCM usingLSendo instead of CSendo at 6 months.（3）With the progression of untreated diabetes,the histoanatomical alterations intensified gradually beginning at 6 months.Conclusions（1）Layer-specific strain echocardiography may identify subtle cardiac dysfunction in the early phase of DM.（2）Endocardial function is more susceptible to be affected by DM as compared to mid-myocardial and epicardial function.

关 键 词：糖尿病兔 心肌功能 糖尿病心肌损伤 分层应变 

分 类 号：R540.45[医药卫生—心血管疾病] R587.2[医药卫生—内科学]