超声对妊娠糖尿病胎儿左室形态及功能的动态观察

Fetal left ventricular morphology and diastolic function in diabetic pregnancy:prenatal Doppler echocardiographic study

目的：对妊娠糖尿病胎儿左室形态及功能进行动态观察和系统研究，并与正常胎儿比较，为妊娠糖尿病的围产儿监护提供客观依据。方法：分别在妊娠20～28周、32～38周，应用胎儿超声心动图观察34例妊娠糖尿病孕妇和54例正常孕妇的胎儿心脏结构。测量了舒张末室间隔厚度（IVST）、左室后壁厚度（LVPWT）及左室内径（LVD），并计算左室射血分数（EF）、左室缩短分数（FS）和左室重量（LVMASS）。系统探测了二尖瓣E峰速度、A峰速度、E峰减速时间（DT）、左室等容舒张时间（IVRT），并计算二尖瓣E／A比值。结果：无论在中孕期或晚孕期，研究组舒张末室间隔厚度、左室重量与对照组之间均有明显差异（P〈0．05）。二尖瓣血流E／A比值两组之间差异没有统计学意义（P〉0．05）。左室等容舒张时间、二尖瓣血流E峰减速时间等指标两组之间比较无明显差异（P〉0．05）。结论：妊娠糖尿病胎儿左室形态及舒张功能在中孕期及晚孕期均已发生改变；胎儿室间隔厚度、左室重量较其它指标反映胎儿左室形态及舒张功能的变化更敏感。

Objective： To assess and to compare fetal left ventricular morphology and left ventricular diastolic function in pregnancies with diabetes and in normal pregnancies using fetal echocardiography. Methods： 34 cases of fetal hearts in pregnancies with diabetes and 54 cases of fetal hearts in normal pregnancies were prospectively studied by the detailed fetal echocardiography for two times （ fetus gestational age from 20 weeks to 28 weeks and 32 to 38 weeks） . The parameters of mitral valve were measured and E/A ratio were calculated. Isovolumetric relaxation time, E wave deceleration time, interventricular septum thickness, left ventricular post wall thickness, left ventricular diastolic dimentions, left ventricular fractional shortening, left ventricular ejection fraction, left ventricular mass were obtained. These variables were then analyzed using an unpaired 2 -tailed Student t test. Results： Fetal septal thickness and left ventricular mass in diabetic pregnancies were different from those of control group （ P 〈 0. 05 ） . The parameters of mitral valve, isovolumetric relaxation time, E wave deceleration time, left ventricular contract function had no evident difference between two groups （ P 〉 0. 05 ） . Conclusion： The fetuses of diabetic pregnancies demonstrate signs of altered left ventricular morphology and left ventricular diastolic function. Fetal septal thickness and left ventricular mass are more sensitive than other parameters to reflect the variation of fetal left ventricular morphology and diastolic function.