时间-空间相关成像技术对糖尿病患者妊娠期胎儿心脏结构及心室收缩功能的评估

Application of spatio-temporal image correlation in fetal cardiac structure and systolic function of gestational diabetes mellitus

目的:利用时间-空间相关成像(STIC)技术观察妊娠期糖尿病对胎儿心脏结构及心室收缩功能的影响。方法:妊娠期糖尿病孕妇96例,其中饮食控制组71例,胰岛素治疗组25例,同期相应孕周的正常妊娠孕妇176例作为对照组。运用STIC技术后处理软件获得M型图像测量心室侧壁及室间隔厚度;运用STIC技术后处理软件获得容积数据,测量胎儿左、右心室收缩末期(EDV)、舒张末期容积(ESV),计算左、右心室每搏输出量(SV)、心输出量(CO)及射血分数(EF);比较妊娠期糖尿病胎儿胰岛素治疗组、饮食控制组与正常对照组的心脏结构及心室收缩功能的变化。结果:妊娠28周以前,胎儿心脏的各项测量指标在胰岛素治疗组、饮食控制组及正常对照组间差异均无统计学意义(P>0.05);妊娠28周以后,胰岛素治疗组胎儿心室侧壁及室间隔厚度均大于正常对照组胎儿,差异有统计学意义(P<0.05);妊娠28周以后,妊娠期糖尿病胎儿胰岛素治疗组、饮食控制组与正常对照组左、右心室收缩功能三组间差异无统计学意义(P>0.05)。结论:妊娠期糖尿病对胎儿心脏结构的影响主要在孕晚期。妊娠28周以后,妊娠期糖尿病胰岛素治疗组胎儿较正常妊娠胎儿心室侧壁及室间隔均有增厚;但胎儿左、右心室收缩功能无明显变化。

Objectlve：To investigate the influence of gestational diabetes mellitus on fetal cardiac structure and systolic function with spatio-temporal image correlation（STIC）. Methods： 96 pregnancies of well controlled GDM with 71 pregnancies with diet control and 25 pregnancies with insulin treatment and the same period 176 normal pregnancies were studied. M mode was obtained with afterprocessing of STIC. The thickness of ventricular wall and interventricular septal were measured with M mode. The end of systolic and diastolic ven- tricular volume were measured with afterprocessing of STIC. The left and right ventricular SV, EF and CO were calculated. The fetal cardiac structure and systolic function of GDM and normal pregnancy were compared. Re- suits ： There was no statistics difference on all the parameters before 28th week of pregnancy. After 28th weeks of pregnancy, there was a significant increase in ventricular walls and interventricular septal thickness in GDM with insulin treatment compared with normal pregnancies. After 28th weeks of pregnancy, there was no difference of systolic function in GDM group with that of normal group. Conclusion： Gestational diabetes mellitus affect fetal heart mainly in the third pregnancy. After 28th weeks of pregnancy, there was a significant increase in ventricular walls and interventricutar septal thickness in GDM with insulin treatment compared with normal pregnancies. The changes of systolic function were no statistics difference.