超声斑点追踪成像评价2型糖尿病患者左心室收缩功能早期改变

Evaluation of early change of left ventricular systolic function in type 2 diabetes mellitus by ultrasound speckle tracking imaging

目的应用超声斑点追踪成像研究2型糖尿病患者左室短轴应变及左室扭转特征，探讨其临床应用价值。方法2型糖尿病患者60例，根据左室射血分数（LVEF）分为心功能正常组（A组，LVEF≥50％）40例，心功能衰竭组（B组，LVEF〈50％）20例；正常对照组35例。获取胸骨旁左室短轴二尖瓣水平、乳头肌水平、心尖水平二维图像，测定左室收缩期各水平径向和圆周局部及整体峰值应变，二尖瓣水平、心尖水平收缩期旋转角度及左室整体扭转角度。结果与对照组比较，糖尿病A组左室径向收缩期各室壁节段峰值应变、各水平平均峰值应变及左室整体应变减低不明显（P〉0．05），左室圆周部分室壁节段峰值应变、各水平平均峰值应变及左室整体应变减低（P〈0．05～0．01），心尖水平各室壁节段、各平面平均旋转角度、左室整体扭转角度增大（P〈0．05～0．001）。在糖尿病B组，左室各径向应变和圆周应变参数、左室局部及整体旋转角度、左室整体扭转角度较糖尿病A组和对照组明显减小（P〈0．05～0．001）。结论超声二维斑点追踪成像技术能够早期评价2型糖尿病患者左室收缩功能异常。

Objective To evaluate the early change of left ventricular（LV） systolic function in patients with type 2 diabetes mellitus（T2DM） by ultrasound speckle tracking imaging. Methods Ninety five subjects were included：40 T2DM with normal LV ejection fraction （LVEF≥50% ,group A） ,20 T2DM with abnormal LVEF（LVEF〈50%） （group B）, and 35 normal controls. Two dimensional strain images were acquired from LV short axis view. LV peak systolic global and segmental radial strain and circumferential strain at the levels of mitral annulus, papillary muscle and apex, and LV systolic global and segmental rotation at the levels of mitral annulus and apex and LV peak systolic global twist were assessed. Results In group A, compared with control group, LV peak systolic radial strain parameters were not significant difference （ P 〈0. 05） ,peak systolic circumferential strain of part segments, average peak strain of each plane and global strain were reduced （ P 〈0.05 -0. 001 ）, and LV peak systolic rotation of all apical segments, peak systolic global rotation at the levels of mitral annulus and apex, and peak systolic global twist were significantly increased （ P 〈0.05-0. 001 ）. Compared with control group and group A,all LV systolic radial strain and circumferential strain parameters, LV systolic global and segmental rotation and peak systolic global twist in group B were significantly reduced （ P 〈 0.05- 0. 003. ）. Conclusions Speckle tracking imaging could be used to evaluate the early change of LV torsional deformation and LV systolic function in T2DM.