四维斑点追踪显像技术在评价2型糖尿病患者早期左室收缩功能中的应用  

Assessment of left ventricular systolic function by four-dimensional speckle tracking imaging in patients with early stage of Type 2 diabetes mellitus

作　　者：苏虹月 刘雪玲[1] 马振 李荣 连溯[1] 王金花[1] 赵华群 SU Hong-yue;LIU Xue-ling;MA Zhen;LI Rong;LIAN Su;WANG Jin-hua;ZHAO Hua-qun(The First Affiliated Hospital of Guangxi Unversity of Chinese Medlicine,Nanning 530023,Guangxi,China)

机构地区：[1]广西中医药大学第一附属医院超声科,广西南宁530023 [2]广西国际壮医医院超声科,广西南宁530201

出　　处：《广东医学》2020年第24期2495-2501,共7页Guangdong Medical Journal

基　　金：广西壮族自治区中医药局自筹经费科研课题(GZZC2019062);广西卫生健康委员会科研课题(Z2016676)。

摘　　要：目的应用四维斑点追踪显像技术(4D-STI)评价2型糖尿病(T2DM)患者早期的左室收缩功能。方法选取左室形态结构正常、左室射血分数(LVEF)≥55%的T2DM患者60例为糖尿病组,健康志愿者30例为对照组。采用4D-STI检测两组的左室整体纵向峰值应变(GPSL)、左室整体圆周峰值应变(GPSC)、左室整体面积峰值应变(GPSA)、左室整体径向峰值应变(GPSR)、左室整体扭转角度(GTA)及各分节段牛眼图。比较两组上述各参数的差异,以及糖尿病组的整体应变值与糖化血红蛋白(HbA1C)之间的相关性。结果糖尿病组的GPSL、GPSC、GPSA、GPSR均低于对照组,差异有统计学意义(P<0.05),两组的GTA差异无统计学意义(P>0.05)。4个方向的应变中,大部分节段糖尿病组均低于对照组,差异有统计学意义(P<0.05),除以下节段外:纵向应变中的前壁基底段、前间隔基底段,圆周应变中的侧壁基底段、后间隔基底段、侧壁中间段、前壁心尖段、心尖部,面积应变中的侧壁基底段、后间隔基底段、心尖部,径向应变中的侧壁基底段、心尖部。相关性分析显示HbA1C与GPSL的绝对值(R=-0.79)、GPSA的绝对值(R=-0.45)、GPSR(R=-0.50)呈负相关(P均<0.01)。结论左室心肌损伤在糖尿病早期即已出现,心肌损伤的程度与血糖控制的情况有关,4D-STI可方便、快捷且客观、准确地评价左室整体及局部收缩功能,具有重要的临床应用价值。Objective To assess the left ventricular systolic function in patients with early stage of Type 2 diabetes mellitus(T2 DM) by four-dimensional speckle tracking imaging(4 D-STI). Methods Sixty T2 DM patients with normal left ventricular morphology and left ventricular ejection fraction(LVEF) ≥55% were selected as diabetic group, and 30 healthy volunteers were selected as control group. The global longitudinal peak strain(GPSL), global circumferential peak strain(GPSC), global area peak strain(GPSA), global radial peak strain(GPSR), global torsion angle(GTA) and the bull′s eye map were measured by 4 D-STI. The differences in the above parameters between the two groups were compared. And the correlation between strain values and glycosylated hemoglobin(HbA1 C) in the diabetic group was also analyzed. Results Compared with control group, GPSL, GPSC, GPSA and GPSR were significantly reduced in diabetic group(P<0.05);while there was no significant difference in GTA was revealed between the two groups(P>0.05). Most segments were significant different between the two groups(P<0.05), except for the basal anterior, basal anteroseptal in longitudinal strain, basal lateral, basal posteroseptal, mid lateral, apical anterior and apex in circumferential strain, basal lateral, basal posteroseptal and apex in area strain, and basal lateral and apex in radial strain. Correlation analysis showed that HbA1 C was negatively correlated with the absolute value of GPSL(R=-0.79, P<0.01), the absolute value of GPSA(R=-0.45, P<0.01) and GPSR(R=-0.50, P<0.01). Conclusion Myocardial injury has emerged in the early stage of T2 DM. The degree of myocardial injury is correlated to blood glucose control. 4 D-STI is a convenient, noninvasive and accurate method for assessment of global left ventricular and regional myocardial function.

关 键 词：2型糖尿病 四维斑点追踪显像技术 应变 

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]