无创左室压力-应变环技术在妊娠期糖尿病患者心肌做功评估中的应用价值  

Application Value of Non-invasive Left Ventricular Pressure-Strain Loop in Assessing the Myocardial Work of Patients with Gestational Diabetes Mellitus

作　　者：张加琪 常彩虹 彭瑶 李明群 冯伟 王青涛 ZHANG Jia-qi;CHANG Cai-hong;PENG Yao;LI Mingqun;FENG Wei;WANG Qing-tao(Department of Ultrasound Imaging,Xiangyang No.1 People′s Hospital,Hubei University of Medicine,Xiangyang,Hubei,441000,China;Hubei Clinical Medical Research Center for Precise Diagnosis of Fetal Complex Malformations,Xiangyang No.1 People′s Hospital,Hubei University of Medicine,Xiangyang,Hubei,441000,China;Department of Obstetrics and Gynecology,Xiangyang No.1 People′s Hospital,Hubei University of Medicine,Xiangyang,Hubei,441000,China;Department of Cardiotho-racic Surgery,Xiangyang No.1 People′s Hospital,Hubei University of Medicine,Xiangyang,Hubei,441000,China)

机构地区：[1]湖北医药学院附属襄阳市第一人民医院超声影像科,湖北襄阳441000 [2]湖北医药学院附属襄阳市第一人民医院湖北省胎儿复杂畸形精准临床医学研究中心,湖北襄阳441000 [3]湖北医药学院附属襄阳市第一人民医院妇产科,湖北襄阳441000 [4]湖北医药学院附属襄阳市第一人民医院心胸外科,湖北襄阳441000

出　　处：《湖北医药学院学报》2025年第1期64-69,共6页Journal of Hubei University of Medicine

基　　金：湖北省重点研发计划(2022BCE004)。

摘　　要：目的:采用左心室压力-应变环(LV-PSL)技术评估妊娠期糖尿病(GDM)患者的左心室心肌功能变化,并探讨导致心肌功能减退的相关风险因素。方法:本研究为前瞻性随机研究,纳入2022年7月至2024年7月期间来我院就诊并确诊为GDM的孕妇98例(GDM组),另选取同期健康孕妇80例作为对照组(NC组)。收集两组孕妇的常规超声心动图和二维斑点追踪超声心动图指标,并利用LV-PSL技术对左心室心肌做功指标进行评估。结果:与对照组相比,GDM组的整体纵向应变(GLS)、整体做功指数(GWI)、整体做功效率(GWE)和整体有效做功(GCW)值均显著降低,整体无效做功(GWW)显著增高(均P<0.01),而常规超声心动图指标在两组间无显著差异(均P>0.05)。GWI、GWE、GCW、GWW和GLS在预测GDM患者心功能变化方面表现出较高的预测价值,ROC曲线下面积(AUC)分别为0.859、0.912、0.871、0.823和0.903。GWI、GWE、GCW与GLS呈负相关(r=-0.518,-0.477,-0.463,均P<0.001),而GWW与GLS呈正相关(r=0.392,P<0.001)。GWI、GWE、GCW与HbA1c水平呈负相关(r=-0.354,-0.302,-0.271,均P<0.05),而GWW与HbA1c水平呈正相关(r=0.181,P<0.05)。多因素Logistic回归分析表明,1 h OGTT、2 h OGTT和HbA1c是GDM患者左心室收缩功能的显著影响因素。结论:LV-PSL技术是早期检测GDM患者左心室收缩功能损害的有效工具。Objective To evaluate the changes in left ventricular myocardial function in patients with gestational diabetes mellitus(GDM)using the left ventricular pressure-strain loop(LV-PSL)technique and to explore related risk factors contributing to myocardial dysfunction.Methods This prospective,randomized study included 98 pregnant women diag⁃nosed with GDM who visited the Xiangyang No.1 People’s Hospital,Hubei University of Medicine between July 2022 and July 2024(GDM group,n=98).Additionally,80 healthy pregnant women during the same period were selected as a con⁃trol group(NC group,n=80).Routine echocardiographic and two-dimensional speckle-tracking echocardiographic indices were collected from both groups,and the LV-PSL technique was used to assess the left ventricular myocardial work indices.Results Compared with the NC group,the GDM group had reduced global longitudinal strain(GLS),global work index(GWI),global work efficiency(GWE),and global constructive work(GCW),while global wasted work(GWW)was in⁃creased(all P<0.01).There were no differences in routine echocardiographic indices between the two groups(all P>005).GWI,GWE,GCW,GWW,and GLS demonstrated a high predictive value for changes in cardiac function in GDM patients,with the areas under the ROC curve(AUC)of 0.859,0.912,0.871,0.823,and 0.903,respectively.GWI,GWE,and GCW were negatively correlated with GLS(r=-0.518,-0.477,-0.463,all P<0.001),while GWW was posi⁃tively correlated with GLS(r=0.392,P<0.001).GWI,GWE,and GCW were negatively correlated with HbA1c(r=-0354,-0.302,-0.271,all P<0.05),while GWW was positively correlated with HbA1c(r=0.181,P<0.05).Multiva⁃riate logistic regression analysis showed that 1-hour OGTT,2-hour OGTT,and HbA1c were significant factors influencing left ventricular systolic function in GDM patients.Conclusion LV-PSL is an effective technique for the early detection of left ventricular systolic dysfunction in GDM patients.

关 键 词：妊娠期糖尿病 无创左室压力-应变环 心肌做功 

分 类 号：R714.256[医药卫生—妇产科学]