斑点追踪显像技术对糖尿病患者左心室舒张功能的研究

Evaluation of left ventricular diastolic function in patients with diabetes mellitus by speckle tracking imaging

目的探讨斑点追踪显像技术评价糖尿病患者左室舒张功能早期改变的价值。方法45例正常人及36例糖尿病患者，分别测量左室心尖长轴18节段每个节段纵向应变率（SrL）和基底段、中间段、心尖段各段平均SrL的舒张早期E’峰值和晚期A’峰值，及短轴各水平总体圆周应变率（SrC）、径向应变率（SrR）和旋转率（RotR）的E’和A’，计算E’／A’、解旋率（UntwR）和解旋减半时间（HTU），同时测量左心常规超声指标。结果与对照组相比，糖尿病组15个节段SrL的E’、16个节段的E’／A’降低，14个节段的A’升高；对照组各节段总体SrL、SrC的E’及SrL、SrC、SrR的E’／A’降低，SrL、SrC、SrR的A’及RotR的E’和E’／A’升高；两组左心常规超声指标、UntwR和HTU的差异无统计学意义。结论糖尿病患者左室舒张功能受损的早期改变是SrL和SrC的降低，RotR的增加以及SrL、SrR运动规律的消失。

Objective To evaluate the early changes of left ventricular（LV） diastolic function in patients with diabetes mellitus （DM） by two-dimensional speckle tracking echocardiography. Methods Thirty-six patients with DM and forty-five normal subjects （NOR） were studied. The peak early （E＇） diastole,peak late （A＇） diastole of longitudinal strain rate（SrL） in 18 myocardial segments and the average peak E＇ and A＇ of SrL on base segments, mid segments, apical segments were measured on apical long-axis views respectively. The global peak E＇and A＇ of circumferential strain rate （SrC）, radial strain rate （SrR） and rotation rate （RotR） at three levers were measured on short axis views respectively. The ratio of E＇ and A＇, untwisting rate and untwisting half time were calculated. At the same time, LV conventional ultrasound parameters were measured. Results Compared with NOR group in SrL,E＇ of 15/18 segments and E＇/A＇ of 16/18 segments were decreased in DM group,A＇ of 14/18 segments were increased. The E＇ of global SrL and SrC,E＇/A＇ of global SrL,SrC and SrR were decreased in DM group. The A＇ of global SrL,SrC and SrR, E＇ and E＇/A＇ of global RotR were increased. There was no significant difference in LV conventional ultrasound parameters,untwisting rate and untwisting halgtime between DM and NOR groups. Conclusions The decrease of SrL and SrC, increase of RotR and disappearance of myocardial regular movement in SrL and SrR are the early changes of diastolic dysfunction in patients with DM.