左心室壁中层缩短率评价2型糖尿病患者早期左心室收缩功能变化

Assessment of Early Changes of Left Ventricular Systolic Function by Ventricular Midwall Fractional Shortening in Patients With Type 2 Diabetes Mellitus

目的:运用左心室壁中层缩短率评价2型糖尿病患者早期左心室收缩功能改变。方法:51例2型糖尿病者(糖尿病组)及30例体验正常者(对照组),行常规及组织多普勒超声心动图检查,测量左心室壁中层缩短率(mFS),计算左心室经线及圆周收缩末期应力,对两组间左心室结构和收缩功能指标即mFS、左心室射血分数、左心室短轴缩短率(LVFS)和二尖瓣环收缩期峰值运动速度(Sm)进行比较,并对mFS与左心室结构参数、空腹血糖水平行相关分析。结果:糖尿病组与对照组比较,左心室舒张末径、左心室收缩末径、左心室质量、左心室心肌质量指数均增加(P<0.01),mFS减低[(21.9±3.4)%vs(24.2±2.6)%,P<0.01]。两组间舒张期室间隔厚度、舒张期左心室后壁厚度及相对室壁厚度比较,差异无统计学意义。mFS与左心室收缩末径、左心室质量、左心室心肌质量指数负相关(r值分别为-0.586、-0.332和-0.239,P<0.05),与空腹血糖水平亦呈负相关(r=-0.315,P=0.011),这种负相关在校正了年龄、性别、收缩压和体重指数的影响后仍然存在。结论:2型糖尿病患者存在亚临床的左心室收缩功能变化,室壁中层缩短率是检测糖尿病患者早期心肌收缩力下降的敏感指标。

Objective： To assess the early changes of left ventricular systolic function by ventricular midwall fractional shortening （mFS） in patients with type 2 diabetes mellitus （DM）. Methods： Our study included two groups, DM group, n = 51 and Control group, n=30 volunteers without DM. Echocardio- graphy was performed in all participants to detect mFS, to calculate left ventricular circumferential end-systohc stress and to com- pare left ventricular ejection fraction （LVEF）, left ventricular fractional shortening （LVFS）, and mitral annular systolic velocity （Sin） between two groups. In addition, the correlations between mFS and the parameters of cardiac structure and fasting blood glu- cose （FBG） level were analyzed. Results： Compared with Control group, DM group had increased diameter of left ventricle, increased left ventricular mass （LVM） and left ventricular mass index （LVMI）,P〈0. 01 respectively. DM group had lower mFS than that in Control group（21.9 ±3.4） % vs. （24. 2±2. 6）% ,P〈0. 01. There was no statistic difference for the relative thickness of ventricular wall between two groups, mFS was negatively correlated to left ventricular end-systolic diameter, LVM and LVMI（r=-0. 586, r=-0. 332 and r = -0. 239,P〈0. 05 respectively）, mFS was negatively related to FBG （ r = -0. 315,P= 0.011 ）. With the adjusted influence of age, gender, systolic blood pressure and body mass index, those negative correlations were still exist. Conclusion： Type 2 DM patients have sub-clinical left ventricular systolic functional changes, mFS is a sensitive parameter for assessing the early ventricular systolic dysfunction in DM patients.