四维斑点追踪显像定量评价糖尿病患者左心室心肌功能的研究  

Quantitative evaluation of left ventricular myocardial function in patients with diabetes mellitus 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;HUANG Jiesheng(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》2020年第15期1603-1608,共6页Zhejiang Medical Journal

基　　金：杭州市科技发展计划项目(172817)。

摘　　要：目的利用四维斑点追踪显像技术评估糖尿病患者在非微血管病变期和微血管病变期的左心室心肌功能。方法选取2018年1至7月杭州市余杭区第一人民医院临床要求进行超声心动图检查的2型糖尿病患者82例,其中糖尿病微血管病变41例,非微血管病变41例;另选取健康体检者45例作为正常对照组。利用四维斑点追踪显像技术测定受检者左心室心肌收缩期整体纵向、圆周、面积、径向应变(GPLS、GPCS、GPAS、GPRS);比较糖尿病微血管病变组、非微血管病变组及正常对照组的左心室心肌整体应变参数差异。参照正常对照组,绘制左心室四维应变参数预测糖尿病患者发生左心室心肌收缩功能不全的ROC曲线;参照糖尿病非微血管病变组,绘制左心室心肌四维应变参数预测糖尿病患者发生微血管病变的ROC曲线。结果GPLS、GPCS、GPAS、GPRS测值:糖尿病微血管病变组分别为(10.66±2.64)%、(13.34±4.19)%、(21.02±5.22)%、(31.56±8.84)%;糖尿病非微血管病变组分别为(12.22±2.70)%、(15.49±3.49)%、(24.63±4.90)%、(37.76±8.64)%;正常对照组分别为(18.89±2.21)%、(19.49±2.51)%、(33.24±2.92)%、(55.11±7.68)%;各参数测值在糖尿病微血管病变组、非微血管病变组和正常对照组间差异均有统计学意义(均P<0.01)。ROC曲线显示,GPLS诊断糖尿病患者存在左心室心肌收缩功能不全价值较高,AUC为0.980,界值为-16.50%时,其灵敏度及特异度分别为0.95和0.98;GPRS预测糖尿病患者存在微血管病变价值较高,AUC为0.694,当界值为38.50%时,其灵敏度及特异度分别为0.78、0.54。结论糖尿病患者存在左心室心肌收缩功能不全,且随着微血管病变,进一步加重;另外四维斑点追踪显像技术可定量诊断糖尿病患者发生左心室心肌收缩功能不全,预测其心肌是否发生微血管病变。Objective To evaluate the left ventricular myocardial function in patients with diabetes mellitus by four-dimensional speckle tracking imaging(4D-STI)technique.Methods Eighty two patients with type 2 diabetes mellitus(T2DM)undergoing echocardiography examination from January to July in 2018 were enrolled,including 41 cases without microangiopathy(non-microangiopathy group)and 41 cases with microangiopathy(microangiopathy group);45 healthy subjects were selected as normal control group.The systolic global peak longitudinal strain(GPLS),systolic global peak circumferential strain(GPCS),systolic global peak area strain(GPAS),and systolic global peak radial strain(GPRS)were measured by 4D-STI technique.Differences in left ventricular global strain parameters were compared among three groups by one-way ANOVA and LSD-t tests.The receiver operating characteristic(ROC)curves of four-dimensional strain parameters of left ventricular myocardium were drawn to predict left ventricular systolic dysfunctions in diabetes mellitus;According to the diabetic non-microangiopathy group,the ROC curves of four-dimensional strain parameters of left ventricular myocardium were drawn to predict the occurrence of microangiopathy in diabetic patients.Results The mean GPLS,GPCS,GPAS and GPRS were(10.66±2.64)%,(13.34±4.19)%,(21.02±5.22)%and(31.56±8.84)%in microangiopathy group,respectively;those in non-microangiopathy group were(12.22±2.70)%,(15.49±3.49)%,(24.63±4.90)%,and(37.76±8.64)%,respectively;and those in normal control group were(18.89±2.21)%,(19.49±2.51)%,(33.24±2.92)%and(55.11±7.68)%,respectively.There were significant differences among diabetic microangiopathy group,non microangiopathy group and normal control group(all P<0.05).The ROC curve showed that the area under curve(AUC)of GPLS in diagnosis of left ventricular systolic dysfunction was 0.980;when the cut-off value was-16.50%,the sensitivity and specificity of GPLS were 0.95 and 0.98,respectively.The AUC of GPRS in predicting diabetic microangiopathy was 0.694;whe

关 键 词：超声心动图 四维斑点追踪显像 糖尿病 左心室 心肌功能 

分 类 号：R587.2[医药卫生—内分泌]