组织多普勒成像对糖尿病孕妇胎儿左心室舒张功能的研究

Prenatal study of fetal diastolic function in diabetic pregnancy by tissue Doppler imaging

目的应用组织多普勒成像（TDI）技术对糖尿病孕妇胎儿二尖瓣环的运动速度进行动态观察，并与正常胎儿比较，探讨其评价糖尿病孕妇胎儿左室舒张功能变化的可行性。方法分别在妊娠20～28周、32-38周，应用TDI技术测量31例妊娠糖尿病孕妇和45例正常孕妇胎儿二尖瓣环的运动速度。用传统多普勒技术测量舒张期胎儿二尖瓣血流速度，并与舒张期二尖瓣环的运动测值进行比较。结果无论在中孕期或晚孕期，应用TDI技术测量的糖尿病组胎儿Ea／Aa与正常对照组比较差异有统计学意义（P〈0．05），而传统采用的二尖瓣血流E／A值两组之间差别无统计学意义（P〉0．05）。结论糖尿病孕妇胎儿左室舒张功能在中孕期及晚孕期均已发生改变；TDI技术较传统多普勒技术更能敏感反映胎儿左室舒张功能的微小变化。

Objective To assess the feasibility of evaluating fetal left ventricular diastolic function in diabetic pregnancies by tissue Doppler imaging. Methods Tissue Doppler images were obtained in 31 fetuses of diabetic mother and 45 normal fetuses for two times （fetus gestational age from 20 weeks to 28 weeks and 32 to 38 weeks）. The peak velocities of mitral valve during systole, early diastole, and late diastole were measured. The ratio of Ea/Aa were calculated. The parameters of mitral valve were measured by pulsed Doppler and E/A were calculated. These variables were then analyzed using an unpaired 2-tailed Student t test. Results The ratio of Ea/Aa in diabetic pregnancies were different from those of control group（ P 〈 0.05）. The traditional E/A had no evident difference between two groups （ P 〉0.05）. Conclusions The fetuses of diabetic pregnancies demonstrated signs of altered left ventrieular diastolic function. TDI is a new method and is more sensitive than traditional pulsed Doppler technique to reflect the variation of fetal left ventricular diastolic function.