组织多普勒技术在妊娠期糖尿病孕妇胎儿心脏功能评价中的应用  

Application of Tissue Doppler Technique in the Evaluation of Fetal Cardiac Function in Pregnant Women with Gestational Diabetes Mellitus

作　　者：陈文娇 赵旭[1] 葛婷婷 CHEN Wenjiao;ZHAO Xu;GE Tingting(Department of Obstetrics and Gynecology,Peking University Civil Avia-tion School of Clinical Medicine)

机构地区：[1]北京大学民航临床医学院妇产科

出　　处：《中国医学计算机成像杂志》2022年第1期86-90,共5页Chinese Computed Medical Imaging

基　　金：北京市科学技术委员会首都临床特色应用研究与成果推广项目(Z171100001017139)。

摘　　要：目的:探究组织多普勒(TDI)技术在妊娠期糖尿病(GDM)胎儿心脏功能评价中的应用价值。方法:选取220例GDM孕妇(血糖控制良好组133例,血糖控制不良组87例)和220例正常妊娠孕妇(对照组),按照孕周分为24~27+6周、28~31+6周、32~35+6周、36~40周。应用TDI技术测量胎儿心脏房室瓣环舒张早期运动速度(Ea)、舒张晚期运动速度(Aa)、及收缩期运动速度(Sa)、等容收缩时间(ICT)、等容舒张时间(IRT)、心室射血时间(ET),并计算Ea/Aa比值及Tei指数[Tei指数=(ICT+IRT)/ET]。结果:在孕32周后,GDM血糖控制良好组、血糖控制不良组和正常妊娠组间二尖瓣环Ea/Aa总体差异具有统计学意义(均P<0.05),GDM血糖控制良好和不良组二尖瓣环Ea/Aa均小于正常对照组(均P<0.05),GDM血糖控制良好与不良组之间差异无统计学意义(P>0.05)。在各孕周3组间三尖瓣环Ea/Aa、二尖瓣环Sa、三尖瓣环Sa总体差异均无统计学意义(均P>0.05)。在孕28周后,3组间左、右心室Tei指数总体差异具有统计学意义(均P<0.05),GDM血糖控制良好组与不良组左、右心室Tei指数均大于正常对照组(均P<0.05),GDM血糖控制良好与不良组间比较差异均无统计学意义(均P>0.05)。结论:GDM对胎儿心脏功能产生一定影响,表现为孕晚期左心室舒张功能降低,心脏整体功能下降,而在孕中、晚期收缩功能无显著变化,孕妇血糖控制情况与胎儿心脏功能改变无明显相关性。应用TDI技术对评估GDM胎儿心脏功能具有一定的应用价值。Objective:To investigate the value of tissue Doppler imaging(TDI)technique in the evaluation of fetal cardiac function in pregnant women with gestational diabetes mellitus(GDM).Methods:A total of 220 GDM pregnancies(133 in the good glycemic control group and 87 in the poor glycemic control group)and 120 normal pregnancies(normal control group)were selected as the research objects,and were divided into 24-27+6 weeks,28-31+6weeks,32-35+6weeks and 36-40 weeks according to gestational weeks.The TDI technique was applied to measure the ratio of mitral annular velocity in early diastole and velocity during atrial contraction(MVEa/Aa),ratio of tricuspid annular velocity in early diastole and velocity during atrial contraction(TVEa/Aa),mitral annular velocity in systole(MVSa),tricuspid annular velocity in systole(TVSa),left ventricle Tei(LVTei)and right ventricle Tei(RVTei)respectively.Results:MVEa/Aa was statistically different among the 2 GDM groups and normal control group above 32 weeks of gestation(P<0.05),and MVEa/Aa was smaller in both GDM groups than in normal control group(P<0.05),but there was no statistical difference between the 2 GDM groups(P>0.05).There were no statistical difference in TVEa/Aa,MVSa and TVSa among the 3 groups at each gestational week(P>0.05).LVTei and RVTei were statistically different among the 3 groups above 28 weeks of gestation(P<0.05),and LVTei and RVTei were greater in both GDM groups than in normal control group(P<0.05),but there was no statistical difference between the 2 GDM groups(P>0.05).Conclusion:GDM has a certain effect on fetal cardiac function,which is manifested by the decrease of left ventricular diastolic function and overall cardiac function in late pregnancy,while there is no significant change in systolic function in mid-to late-pregnancy,and there is no significant correlation between maternal glycemic control and fetal cardiac function changes.The application of TDI technique has some application value in assessing GDM fetal cardiac function.

关 键 词：妊娠期糖尿病 胎儿心脏功能 超声心动图 组织多普勒技术 TEI指数 

分 类 号：R445.1[医药卫生—影像医学与核医学]