经胸超声心动图对Ⅱ型糖尿病冠状动脉血流储备的临床研究

Clinical Study on Coronary Artery Flow Reserve of Ⅱ-Type Diabetes Mellitus by Transthoracic Echocardiography

目的探讨经胸超声心动图对Ⅱ型糖尿病(DM)患者冠状动脉血流储备(CFR)和心功能的评价。方法正常对照组18例,Ⅱ型糖尿病患者22例,两组年龄、性别及一般情况相匹配,应用经胸超声心动图测量左室射血分数LVEF,在彩色血流显像引导下,显示位于室间沟心外膜脂肪垫内冠状动脉左前降支远段(LAD)长轴切面,记录静脉注射腺苷(0.84mg/kg,6min内)前后LAD血流频谱,计算CFR。结果经胸超声心动图检测LAD远段血流的成功率为88.89%。对照组注射腺苷后LVEF、LAD血流峰值流速显著增加,DM组注射腺苷后LVEF、LAD血流峰值流速无显著改变,DM组的CFR显著低于对照组(3.0±0.04vs1.75±0.12,P<0.01)。结论DM患者左室收缩和舒张功能减低,冠脉血流储备下降,提示DM患者冠脉微循环功能异常。经胸超声心动图为评价冠脉微循环提供了一种无创、简单易行的新技术,具有重要临床价值。

Objective To determine the situation of heart function and coronary flow reserve （CFR） of Ⅱ - type diabetes rnellitus （DM） by transthoracic echocardiography, Methods The study is made on 18 cases of control group and 22 patients with n -type DM, The left ventricular ejection fraction （LVEF） is measured by transthoracic echocardiography and under the guidance of color flow imaging, the distal LAD lying in the interventricular sulcus on epicardium is researched, The blood flow frequency spectrum of LAD is recorded before and after adenosine injection （0. 84 mg/kg, in 6 min, ） and the functions of two-group CFR are compared, Results LVEF and peak velocity of LAD for DM group is lower than that of the normal group after adenosine injection . The CFR for DM is lower obviously than the normal group （1.75±0.12 vs 3.0±0. 04,P〈0.01）.Conclusions The reducing of the left ventricular systolic and diastolic functions and CFR are evidences for abnormal function of coronary artery rnicrocirculation. To assess the coronary artery rnicrocirculation by transthoracic echocardiography is a valuable and practical method, has significant clinic value.