四维斑点追踪显像在评价高血压对糖尿病患者左心室心肌功能影响中的应用  

Effect of hypertension on left ventricular myocardial function in patients with diabetes mellitus as evaluated by four-dimensional speckle tracking imaging

作　　者：高继康[1] 何海生[2] 马芳花[1] 黄洁晟 GAO Jikang;HE Haisheng;MA Fanghua(Department of Ultrasonography,First People’s Hospital of Yuhang District,Hangzhou 311100,China)

机构地区：[1]杭州市余杭区第一人民医院(浙江大学医学院附属第二医院余杭分院)超声科,311100 [2]杭州市余杭区第一人民医院(浙江大学医学院附属第二医院余杭分院)内分泌科,311100

出　　处：《浙江医学》2019年第19期2072-2076,I0003,共6页Zhejiang Medical Journal

基　　金：杭州市科技发展计划项目(172817)

摘　　要：目的探讨四维斑点追踪显像在评价高血压对糖尿病患者左心室心肌功能影响中的应用价值。方法选取糖尿病合并高血压组患者51例、非合并高血压组患者31例和正常对照组45例进行超声心动图检查,并分别脱机分析其左心室全容积四维图,分别测定左心室前壁、前间隔、前侧壁基底段、中段的纵向应变(LS)、圆周应变(CS)、面积应变(AS)、径向应变(RS);参照糖尿病非合并高血压组,利用ROC曲线预测高血压加重糖尿病患者左心室心肌收缩功能不全。结果糖尿病患者合并高血压组、非合并高血压组的左心室前壁、前间隔、前侧壁基底段、中段的LS、CS、AS、RS测值与正常对照组比较差异均有统计学意义(均P<0.01);糖尿病合并高血压组患者的前壁基底段LS、AS、RS,前壁中段LS,前间隔基底段、中段的LS、CS、AS、RS,前侧壁基底段CS测值与非合并高血压组患者比较差异均有统计学意义(均P<0.05);另外,糖尿病合并高血压组前壁基底段LS(ALSb)预测高血压病加重糖尿病患者左心室心肌功能不全诊断价值较大,曲线下面积为0.675,当界值为-10.50%时,其灵敏度为0.686,特异度为0.774。结论糖尿病患者无论是否合并高血压,左心室心肌收缩功能均出现减退,而高血压对糖尿病患者的左心室部分节段心肌的收缩功能会造成进一步损害,这种影响可通过四维应变参数进行定量评价。Objective To explore the effect of hypertension on left ventricular myocardial functions in patients with diabetes mellitus.Methods 51 diabetic patients with hypertension(hypertension group),31 diabetic patients without hypertension(non-hypertensive group)and 45 healthy subjects(control group)were enrolled in the study.The four-dimensional maps of full volume left ventricle were examined by echocardiography and off-line analyzed;the longitudinal strain(LS),circumferential strain(CS),area strain(AS),radial strain(RS)of the basal,mid segments of anterior wall,anterior septum,anterolateral wall of left ventricle were measured.Referring to non-hypertension group,prediction of left ventricular myocardial systolic dysfunctions in patients of hypertension group was analyzed with ROC curve.Results The LS,CS,AS,RS in basal,mid segments of anterior wall,anterior septum,anterolateral wall of left ventricle in hypertension group and non-hypertension group were significantly different from those in the normal control group(all P<0.01).There were significant differences in LS,AS,RS of basal segments of anterior walls,LS of mid segments of anterior walls,LS,CS,AS,RS of basal and mid segments of anterior septum,CS of basal segments of anterolateral walls between hypertension group and non-hypertensive group(all P<0.05).The area under the curve(AUC)of LS of basal segment of anterior wall(ALSb)for predicting the exacerbation of left ventricular myocardial insufficiency in hypertension group was 0.675,when the cut-off value was-10.50%,the sensitivity and specificity were 0.686 and 0.774,respectively.Conclusion The left ventricular systolic function is decreased in diabetic patients;and hypertension further impairs the left ventricular function of diabetic patient.Four-dimensional speckle tracking imaging can provide information for quantitative evaluation of left ventricular function of the patients.

关 键 词：超声心动图 糖尿病 高血压 四维斑点追踪显像 左心室 

分 类 号：R54[医药卫生—心血管疾病]