左心房功能评估在糖尿病左心室舒张功能不全诊断中的价值  

Value of left atrial function evaluation on left ventricular diastolic dysfunction in type 2 diabetes patients

作　　者：李慧莹 黄守莲 薛毓琦 徐瑞燚[1] 赵维纲[2] 陈未[1] 朱文玲[1] 方理刚[1] 林雪[1] Li Huiying;Huang Shoulian;Xue Yuqi;Xu Ruiyi;Zhao Weigang;Chen Wei;Zhu Wenling;Fang Ligang;Lin Xue(Department of Cardiology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Science,Beijing 100730,China;Department of Endocrinology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Science,Beijing 100730,China;Department of Cardiology,the Second People’s Hospital of Yibin City,Yibin 644000,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院心内科,100730 [2]中国医学科学院北京协和医学院北京协和医院内分泌科,100730 [3]宜宾市第二人民医院心内科,644000

出　　处：《中国心血管杂志》2022年第3期235-241,共7页Chinese Journal of Cardiovascular Medicine

基　　金：国家“十三五”重大新药创制专项课题“创新药物全过程临床评价示范性技术平台建设”(2019ZX09734001);国家自然科学基金(81670349);北京市自然科学基金(7172166)。

摘　　要：目的探讨左心房功能评估在2型糖尿病患者的左心室舒张功能不全(DD)诊断中的价值。方法纳入2016年1~10月在北京协和医院糖尿病门诊长期就诊的无心力衰竭症状的2型糖尿病患者78例为糖尿病组;同时入选年龄、性别相匹配的健康人80名为健康对照组。应用斑点追踪超声心动图测量应变进行左心房功能评估,评估标准依据2016年美国超声心动图学会和欧洲心血管影像协会联合发布的左心室舒张功能超声心动图评估指南。收集患者和健康人的一般临床资料、超声心动图指标和左心房应变参数;进行多因素logistic回归分析与DD存在关联的因素;绘制受试者工作特征(ROC)曲线评价左心房功能对DD的预测价值。结果糖尿病组患者的DD总发生率为21.8%(17/78),其中Ⅰ级DD占15.4%。左心房平均管道功能下降与DD显著相关[F(3,74)=3.548,P=0.018]。单因素分析显示,左心室整体纵向应变、左心房峰值应变、左心房平均储器功能、左心房平均管道功能、房间隔管道功能与DD相关(均为P<0.05);多因素分析中仅左心房平均管道功能应变与DD有关(OR=0.756,95%CI:0.637~0.896,P=0.001)。在整体人群中,左心房管道功能应变为13.46%时,预测DD的敏感度为100%,特异度为62.5%;在糖尿病组中,左心房管道功能应变为13.05%时,预测DD的敏感度为100%,特异度为62.3%;若结合整体人群的E/e’比值,在糖尿病组中,左心房管道功能应变为6.19%、平均E/e’为12.73时,诊断DD的敏感度为77.0%,特异度为80.0%,ROC曲线下面积为0.859(95%CI:0.761~0.957,P=0.00)。结论通过斑点追踪技术测定左心房应变,评估左心房管道功能,可能是检测早期DD的一个简单而可靠的方法。Objective To explore the value of left atrial(LA)function evaluation on left ventricular diastolic dysfunction(DD)in patients with type 2 diabetes mellitus(T2DM).Methods A total of 78 T2DM patients without heart failure in diabetic clinic of Peking Union Medical College Hospital from January of 2016 to October of 2016 were enrolled.The 80 age and sex matched normal controls were recruited as control group.LA phase function was assessed by speckle tracking echocardiography(STE)-derived strain and diastolic function was evaluated according to Left Ventricular Diastolic Function by Echocardiography published by American Society of Echocardiography and European Association of Cardiovascular Imaging 2016.The general clinical data,echocardiographic characteristics and LA strain parameters of the T2DM patients and the normal controls were collected.Multivariate logistic regression analysis was used to investigate the association between LA function with DD.The receiver operating characteristic curve was plotted to evaluate the predictive value of LA function in the diagnosis of DD.Results The total percentage of DD in diabetic group was 21.8%(17/78),and 15.4%patient showed gradeⅠDD.Decreased average LA conduit function was significantly associated with the grade of DD[F(3,74)=3.548,P=0.018].Univariable analysis showed that left ventricle global longitudinal strain(GLS),peak LA strain,average reservoir function,average conduit function,septal conduit function were significantly related to DD(all P<0.05).Multiple regression analysis showed that only average LA conduit strain was associated with DD(OR=0.756,95%CI:0.637-0.896,P=0.001).In general population,the cutoff value of LA conduit strain was 13.46%with sensitivity 100%and specificity 62.5%.In diabetic patients,the cutoff value was 13.05%with sensitivity 100%and specificity 62.3%.If combing with E/e’ratio in the whole group,the predictive value of 6.19%of LA conduit function and 12.73 of E/e’with sensitivity 77.0%and specificity 80.0%to predict DD,the area under

关 键 词：左心房时相功能 左心房管道功能 斑点追踪超声心动图 舒张功能不全 

分 类 号：R587.2[医药卫生—内分泌] R541[医药卫生—内科学]