组织多普勒等容收缩期参数评价2型糖尿病患者右心室功能

Isovolumic contraction parameters of tissue Doppler imaging in evaluation on right ventricular function in patients with type 2 diabetes

目的应用脉冲组织多普勒参数评价无临床症状2型糖尿病患者的右心室功能。方法应用超声心动图脉冲组织多普勒技术检测血压正常的糖尿病患者(DM组,n=24)、合并高血压的糖尿病患者(DMHT组,n=22)及30名正常人(NC组)的右心室功能,得出常规二维超声测值及组织多普勒参数值,包括等容收缩期加速度(IVA)、等容收缩期峰值流速(IVV)、收缩期峰值流速(Sa)、舒张早期峰值流速(Ea)、舒张晚期峰值流速(Aa)、Ea/Aa、E/Ea及Tei指数,并进行统计学分析。结果 3组间常规二维超声测值差异无统计学意义。DMHT组和DM组的右心室脉冲组织多普勒参数中,Ea、Aa、Ea/Aa、E/Ea、IVA及Tei指数与NC组相比差异有统计学意义;其中DMHT组与DM组比较E/Ea及Tei指数差异有统计学意义,而IVA值差异无统计学意义。Sa及IVV在各组间比较差异均无统计学意义。IVA与Ea/Aa呈正相关(r=0.31,P<0.01),与E/Ea呈负相关(r=-0.44,P<0.05),与Tei指数呈负相关(r=-0.56,P<0.05)。结论脉冲组织多普勒等容收缩期参数可早期无创评价糖尿病患者右心室收缩和舒张功能。

Objective To assess the impact of preclinical diabetes mellitus （DM） on right ventricular function by using pulse wave tissue Doppler imaging （PW-TDI）-derived indices. Methods Totally 46 patients with type 2 DM （24 with DM only [DM group] and 22 coexisting DM and hypertension [DMHT group] and 30 normal controls （NC group） were enrolled. Conventional two-dimensional （2D） parameters of right heart and TDI-derived systolic velocities of tricuspid annulus, including isovolumic myocardial acceleration （IVA）, peak myocardial velocity during isovolumic contraction （IVV）, peak systolic velocity during ejection period （Sa）, early diastolic peak velocity （Ea）, late diastolic peak velocity （Aa）, E/ Ea, Ea/Aa and Tel index were measured and statistically analyzed. Results Conventional 2D parameters of right heart had no statistical difference among 3 groups. Ea, Aa, Ea/Aa, E/Ea, IVA and Tei index had statistical difference between DM, DMHT groups and NC group. E/Ea and Tei index were significant different between DM group and DMHT group, where- as IVA was similar in DM and DMHT group. There was no significant differences of Sa and IVV among 3 groups. Correlation analysis showed that right ventricular IVA was significantly correlated with E/Ea （r= -0.44, P〈0.05）, Ea/Aa （r= 0.31, P〈0.01） and Tei index （r= -0.56, P〈0.05）. Conclusion Isovolumic contraction parameters of PW-TDI can be used to evaluate the right ventricular systolic and diastolic function in patients with type 2 diabetes early and noninvasively.