实时心肌超声造影评价2型糖尿病患者静息状态下心肌灌注特点的初步研究

Primary study on resting myocardial perfusion in type 2 diabetes mellitus patients with real-time myocardial contrast echocardiography

目的 应用实时心肌超声造影评价2型糖尿病患者静息状态下的心肌微循环灌注特点.方法 选取临床确诊的2型糖尿病患者13例为病例组,12例健康成人为对照组.经肘正中静脉注射SonoVue混悬液,采用GE Vivid 7 Dimension超声诊断仪实时心肌造影程序同步观察心尖四腔、两腔及左室长轴观的心肌内造影剂充填过程.存取上述切面闪烁成像前3个心动周期及闪烁后达稳定状态约15个心动周期的造影剂再充填动态图像,供脱机分析.结果 静息状态下2型糖尿病患者心肌灌注超声造影的平台期信号强度（A）值、曲线上升斜率（k）值、A×k值均较对照组明显减低（A：6.46±1.60对6.81±1.53,P＜0.05;k：1.04±0.39对1.28±0.31,P＜0.01;A×k：6.55±2.72对8.78±3.16,P＜0.01）.结论 心肌超声造影可评价2型糖尿病患者心肌微循环灌注的早期改变,为糖尿病心肌病的早期诊断和治疗提供重要参考.

Objective To explore the characteristics of resting myocardial perfusion of type 2 diabetes mellitus（T2DM） by real-time myocardial contrast echocardiography（RT-MCE）. Methods Thirteen patients with T2DM and 12 in control were enrolled in the study. RT-MCE was performed using a continuous infusion of SonoVue with vena mediana in elbow. Images of left ventricle filled with contrast were acquired from apical 4-, 2-chamber and long axis views with real-time myocardial contrast mode of GE Vivid 7 Dimension system. All above images were captured in continuous 3 cardiac cycles before ＂flash＂ ,and then 15 cardiac cycles after ＂flash＂. All clips were stored for off-line analysis. Results In quiescent condition, there were significant decrease on indices of A,k and A × k in patients compared with control group （A：6.46 ±1.60 vs 6.81 ± 1.53, P 〈0.05;k：1.04 ± 0.39 vs 1.28 ± 0.31＊, P 〈0.01;A× k：6.55 ± 2.72 vs 8.78 ±3.16, P 〈 0.01, respectively）. Conclusions RT-MCE could evaluate the early change of myocardial perfusion in T2DM patients and offers important reference for clinical diagnosis and treatment.