超声心动图对2型糖尿病左心室功能的评价

Appraisal of left ventricular function in type 2 diabetes mellitus patients with echocardiography

目的应用超声心动图检测糖尿病患者左室舒张功能的改变,为早期诊断、治疗及预防糖尿病心肌病变提供依据。方法54例血压正常的Ⅱ型糖尿病患者,依据尿白蛋白量>15ml/min诊断为糖尿病微血管病变。实验分为3组。A组32例,糖尿病无微血管病变;B组22例,糖尿病合并微血管病变;C组20名,健康人对照。所有糖尿病患者均进行超声心动图检查,测定左室收缩功能、舒张功能及左室心肌重量指数(LVMI)。所有指标与对照组进行比较。结果各组收缩功能指标差异无显著性意义(P>0.05)。糖尿病组的LVMI较对照组增高(P<0.05)。两组糖尿病均有不同程度的舒张功能减低,表现为舒张早期血流速度减低;二尖瓣的VE/VA,组织多普勒的e/a和左室流入道彩色多普勒血流传播速度(LVFP)均降低;等容舒张时间(IVRT)延长(P<0.05)。结论超声心动图可以检测到无微血管病变的Ⅱ型糖尿病患者的左室舒张功能改变。

Objective To study the changes in echocardiography in normotensive patients with type2 diabetes mellitus （T2DM） in or- der to establish early diagnosis and give preventive measures for diabetic cardiomyopathy （DCM）. Methods Microvasculopathy was diag- nosed in T2DM patients when microalbuminuria exceeded 15ml/min. Fifty-four T2DM patients were divided into two groups： group A （patients without microvasculopathy, n = 32 ）, group B （patients with microvasculopathy, n= 22）. All of T2DM were submitted to echocardiography and the results were compared with healthy people of matched sex and age （group C, n=20）. Results There were no differences in systolic function parameters among the groups. Left ventricular mass index （LVMI） was higher in two groups of diabetics compared with group C. Diastolic dysfunction of various degrees was found in the two groups of diabetics, regardless of the presence of microvasculopathy, with a manifestation of a decrease of blood flow velocity in early diastolic phase and increase in late diastolic phase （P〈0. 05）. The mitral inflow VE/VA ratio, the ratio of myocardial early relaxation wave（e） and late myocardial diastolic wave（a）, and early diastolic velocity propagation （LVFP） were declined （P〈0. 05） ; isovolumetric diastolic time （IVRT） and rapid filling phase were prolonged （P〈0. 05）. Conclusion Left ventricle diastolic dysfunction （LVDD） is observed in the normotensive patients of T2DM without distinct microvasculopathy with Doppler echocardingraphy.