超声二维斑点追踪成像评估糖尿病患者左心功能和心肌缺血的临床研究  

Clinical study on evaluating left ventricular function and myocardial ischemia in patients with diabetes mellitus using ultrasound 2D speckle tracking imaging

作　　者：吐尔洪江·努尔拉 白合提尼沙·阿克阿吉 阿思亚·阿布来提 TURHONGJIANG·Nurla;BAIHETINISHA·Akaji;ASYA·Abulaiti(Department of Ultrasound Medicine,the First People's Hospital of Kashgar,Kashgar Xinjiang 844000,China)

机构地区：[1]喀什地区第一人民医院超声医学科,新疆喀什844000

出　　处：《中国临床医学影像杂志》2024年第10期706-710,715,共6页Journal of China Clinic Medical Imaging

基　　金：省部共建中亚高发病成因与防治国家重点实验室开放课题基金(批准号:SKL-HIDCA-2021-KS5)。

摘　　要：目的:探究超声二维斑点追踪成像(2D-STI)评估糖尿病患者左心功能和心肌缺血的临床应用价值。方法:选择2021年10月—2023年4月我院内分泌科和心内科收治的进行冠状动脉造影(CAG)检查的T2DM患者180例。依据CAG诊断心肌缺血的标准,纳入研究的180例患者中合并心肌缺血的患者87例,定义为T2DM+心肌缺血组,其余患者93例定义为T2DM组。所有患者均进行常规超声和2D-STI检查,收集患者的检查资料,单因素、多因素分析筛选影响T2DM患者心肌缺血的独立危险因素,并构建独立危险因素的受试者工作特征(ROC)曲线,并将多因素分析中2D-STI的独立影响因子构建列线图。结果:年龄、病程、PLR、LVEF、Rs、Cs、Ls是影响T2DM患者心肌缺血的独立危险因素,差异有统计学意义(P<0.05),且对T2DM患者心肌缺血的发生的影响从大到小依次是:LVEF(OR=4.299)、病程(OR=3.101)、Cs(OR=2.948)、Rs(OR=2.491)、Ls(OR=1.721)和年龄(OR=1.312);LVEF、Rs、Cs、Ls预测T2DM患者心肌缺血的AUC分别为0.636、0.672、0.628、0.678,最佳诊断点分别为51.24%、16.83%、18.17%、17.24%,LVEF、Rs、Cs、Ls预测T2DM患者心肌缺血的AUC分别为0.636、0.672、0.628、0.678,最佳诊断点分别为51.24%、16.83%、18.17%、17.24%,差异有统计学意义(P<0.05);2D-STI的独立影响因子构建的T2DM患者心肌缺血的预测列线图,经一致性检验,这一列线图的C-index为0.81。结论:2D-STI技术具有早期预测T2DM患者心肌缺血的能力,并且联合应用不同指标可以提高预测准确性和可靠性,有利于心血管科医生提供更为准确和精准的诊断和治疗建议。Objective:To explore the clinical application value of two-dimensional speckle tracking imaging(2D-STI)using ultrasound for assessing left ventricular function and myocardial ischemia in diabetic patients.Methods:A total of 180 T2DM patients who underwent CAG examination in our endocrinology and cardiology departments from October 2021 to April 2023were included in the study.Based on the diagnostic criteria for myocardial ischemia by CAG,87 patients with T2DM and myocardial ischemia were included in the T2DM+myocardial ischemia group,while the remaining 93 patients were included in the T2DM group.All patients underwent routine ultrasound and 2D-STI examinations,and their examination data was collected.Univariate and multivariate analysis were used to screen for independent risk factors for myocardial ischemia in T2DM patients,and ROC curves were constructed for the independent risk factors.A nomogram was constructed for the independent influencing factor of 2D-STI in the multivariate analysis.Results:Age,duration of illness,PLR,LVEF,Rs,Cs,and Ls were identified as independent risk factors for myocardial ischemia in T2DM patients,and their differences were statistically significant(P<0.05).Furthermore,the degree of influence of these risk factors on the occurrence of myocardial ischemia in T2DM patients was from large to smalL,starting with LVEF(OR=4.299),followed by duration of illness(OR=3.101),Cs(OR=2.948),Rs(OR=2.491),Ls(OR=1.721),and age(OR=1.312).The AUC values for LVEF,Rs,Cs,and Ls in predicting myocardial ischemia in T2DM patients were 0.636,0.672,0.628,and 0.678,respectively,with the best diagnostic cutoff points being 51.24%,16.83%,18.17%,and 17.24%,respectively.Notably,the differences between the AUC values were statistically significant(P<0.05).The predictive nomogram for myocardial ischemia in T2DM patients was constructed by independent influencing factors of 2D-STI.After consistency test,the C-index of this nomogram was 0.81.Conclusion:The 2D-STI technique has the ability to predict myocardial ische

关 键 词：糖尿病 心室功能 左 心肌缺血 超声心动描记术 多普勒 

分 类 号：R587.1[医药卫生—内分泌] R542.2[医药卫生—内科学] R540.45[医药卫生—临床医学]