三维斑点追踪技术评价糖尿病微血管病变患者的左心室功能  

Evaluation of Left Ventricular Function in Diabetes Patients with Microvascular Disease by Three-Dimensional Speckle Tracking Imaging

作　　者：周青 何香芹[1] 马建敏 孙瑞聪 姜志荣[1] 

机构地区：[1]青岛大学附属医院心脏超声科,山东 青岛

出　　处：《临床医学进展》2023年第12期18908-18916,共9页Advances in Clinical Medicine

摘　　要：目的:应用三维斑点追踪成像(3D-STI)评价2型糖尿病(T2DM)患者左心室三维应变,并讨论其与糖化血红蛋白(HbA1c)的关系。方法:收集临床诊断为T2DM的患者51例,分为无微血管病变组(DM1组) 21例、合并微血管病变组(DM2组) 30例,同时选取25例健康志愿者作为正常对照组,应用二维超声心动图测量左心房前后径(LAD)、左心室舒张末期内径(LVDd)、左心室收缩末期内径(LVDs)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、二尖瓣口舒张早期峰值流速(E)、二尖瓣口舒张晚期峰值速度(A)、二尖瓣环舒张早期峰值速度(e’)、左室射血分数(2D-LVEF)。应用3D-STI采集心尖全容积图像获得左心室整体长轴应变(GLS)、左心室整体轴向应变(GCS)、左心室整体径向应变(GRS)、左心室射血分数(3D-LVEF)及左心室质量(LVM)等参数,比较各指标组间差异,分析其与HbA1c的相关性。结果:IVST、E/A、e’、E/e’这4个指标在3组间差异有统计学意义(P < 0.001),LVPWT在3组间差异有统计学意义(P < 0.05);在组间两两比较中,IVST、LVPWT、E/A、e’、E/e’在DM2组与对照组、DM2组与DM1组间差异有统计学意义;与对照组相比,DM2组的IVST、LVPWT、E/e’增大,e’、E/A减小;与DM1组相比,DM2组的IVST、LVPWT、E/e’增大,e’、E/A减小。GCS、GLS、GRS、LVM、3D-LVEF这5个参数在3组间差异有统计学意义(P < 0.001),组间两两比较中,GCS、GLS、GRS、LVM、3D-LVEF在DM1组与对照组、DM2组与对照组、DM2组与DM1组的组间差异有统计学意义:与对照组相比,DM1组、DM2组的GCS、GLS、LVM增大,GRS、3D-LVEF减小;与DM1组相比,DM2组的GCS、GLS、LVM增大,GRS、3D-LVEF减小。相关性分析显示,HbA1c与GCS、GLS、GRS、LVM、3D-LVEF均成负相关(r = −0.637、−0.562、−0.515、−0.606、−0.598,P < 0.001)。结论:T2DM患者左心室收缩与舒张功能均受损,其中,3D-STI指标组间差异更为显著,3D-STI可精准评估二型糖尿病患者左心�Objective: To evaluate the three-dimensional strain of the left ventricle in patients with type 2 dia-betes mellitus (T2DM) by three-dimensional speckle tracking imaging (3D-STI), and discuss the re-lationship between the three-dimensional strain and HbA1c. Method: A total of 51 patients who were clinically confirmed T2DM were collected and divided into a group of 21 patients without mi-crovascular disease (DM1 group) and a group of 30 patients with microvascular disease (DM2 group), and 25 healthy volunteers were selected as the control group at the same time. Two- di-mensional echocardiography was applied to measure the left atrial anteroposterior diameter (LAD), left ventricular end diastolic diameter (LVDd), left ventricular end systolic diameter (LVDs), and in-terventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), early peak diastolic flow rate (E), late peak diastolic flow rate (A), early peak diastolic velocity (e’) and left ven-tricular ejection fraction (2D-LVEF). 3D-STI was applied to collect apical full volume images, param-eters including left ventricular global long axis strain (GLS), left ventricular global axial strain (GCS), left ventricular global radial strain (GRS), left ventricular ejection fraction (3D-LVEF), and left ven-tricular mass (LVM) in order to access the differences between 3 groups of these parameters and explore their correlation with HbA1c. Result: The four parameters of IVST, E/A, e’, and E/e’ showed statistically significant differences among the three groups (P < 0.001), while LVPWT showed statis-tically significant differences among the three groups (P < 0.05). In pairwise comparisons between groups, there were statistically significant differences in IVST, LVPWT, E/A, e’, E/e’ between the DM2 group and the control group, as well as between the DM2 group and the DM1 group;Compared with the control group, the IVST, LVPWT, and E/e’ of the DM2 group increased, while e’ and E/A de-creased;Compared with the DM1 group, the IVST, LVP

关 键 词：2型糖尿病 微血管病变 三维斑点追踪成像 左心室 

分 类 号：R54[医药卫生—心血管疾病]