心肌分层应变联合心肌做功评价糖尿病伴或不伴高血压患者的左心室功能  

Evaluation of left ventricular function in type 2 diabetes mellitus patients complicated with or without hypertension by myocardial layer-specific strain combined with myocardial work

作　　者：洪瑞洋 朱向明 张青陵 Hong Ruiyang;Zhu Xiangming;Zhang Qingling(Wannan Medical College,Wuhu,Anhui 241001,China;The First Affiliated Hospital of Wannan Medical College,Wuhu,Anhui 241001,China)

机构地区：[1]皖南医学院,安徽芜湖241001 [2]皖南医学院第一附属医院,安徽芜湖241001

出　　处：《齐齐哈尔医学院学报》2024年第10期901-907,共7页Journal of Qiqihar Medical University

基　　金：安徽省中央引导地方科技发展专项(2017070802D152)。

摘　　要：目的 通过心肌分层应变联合心肌做功(MW)评估伴或不伴高血压(HT)的2型糖尿病(T2DM)患者的亚临床左心室(LV)心肌收缩功能障碍。方法 选择2023年3—11月本院收治的114例T2DM患者作为研究对象,其中57例伴HT的T2DM患者作为T2DM HT组,剩余57例患者作为T2DM组;另在本院医学检查中心招募了61名年龄和性别匹配的体检者61例作为对照组。分析和量化三组的左心室收缩期的层特异性应变GLS(GLSEndo、GLSMid和GLSEpi分别代表心内膜、中层和心外膜心肌应变)及MW等变量。通过进行受试者工作特征(ROC)曲线分析,比较心肌分层应变及MW在评估伴或不伴HT的T2DM患者的亚临床LV收缩功能障碍方面的效能。结果 从对照组、T2DM患者到T2DM HT患者,各组左心室心肌各层纵向应变的绝对值逐渐降低。与T2DM患者相比,T2DM HT患者的做功指数(GWI)、有用功(GCW)和无用功(GWW)明显升高(P<0.05),GCW/GWW与工作效率(GWE)有所降低(P<0.05)。与正常对照组相比,T2DM患者的GWI、GCW、GWE及GCW/GWW明显降低(P<0.05)。ROC曲线分析GLSendo和GWE联合评价T2DM HT患者亚临床左心室收缩功能障碍具有良好的敏感性(80.70%)和特异性(70.18%)。结论 心肌分层应变联合心肌做功可以早期评估伴或不伴HT的T2DM患者的亚临床左心室收缩功能障碍。Objective To assess sub-clinical left ventricular(LV)myocardial systolic dysfunction in patients with type 2 diabetes mellitus(T2DM)complicated with or without hypertension(HT)by myocardial layer-specific strain combined with myocardial work.Methods A total of 114 patients with T2DM(including 57 patients complicated with HT)who were admitted to the First Affiliated Hospital of Wannan Medical College from March to November 2023 and 61 normal controls(matched in age and sex)were included in this study.Variables such as layer-specific strain GLS(GLSEndo,GLSMid and GLSEpi represent endocardial,middle,and epicardial myocardial strain,respectively)and MW during LV systole were analyzed and quantified in the three groups.The efficacy of myocardial stratification strain and MW in assessing sub-clinical LV systolic dysfunction in patients with T2DM complicated with or without HT was compared by performing receiver operating characteristics(ROC)curve analysis.Results The absolute values of longitudinal strain in all layers of LV myocardium were progressively reduced in all groups from the control group,T2DM group to T2DM HT group.Compared with T2DM patients,global work index(GWI),global constructive work(GCW),and global wasted work(GWW)of T2DM HT patients significantly increased(P<0.05);GCW/GWW and work efficiency(GWE)decreased(P<0.05).Compared with normal controls,GWI,GCW,GWE and GCW/GWW were significantly decreased in patients with T2DM(P<0.05).ROC curve analysis indicated that the combination of GLSendo and GWE combined in evaluating sub-clinical LV systolic dysfunction in T2DM HT patients had good sensitivity(80.70%)and specificity(70.18%).Conclusions Myocardial layer-specific strain combined with myocardial work can provide early detection of sub-clinical left ventricular systolic dysfunction in T2DM patients complicated with or without HT.

关 键 词：2型糖尿病 高血压 亚临床左室心肌收缩功能障碍 分层应变 心肌做功 

分 类 号：R455.1[医药卫生—运动医学]