斑点追踪技术评价糖尿病早期左室心内膜下心肌收缩功能

Early detection of left ventricular subendocardial myocardium function in patients with diabetes mellitus by speckle tracking imaging

目的应用斑点追踪成像技术评价糖尿病早期患者及糖尿病合并高血压患者左室心内膜下心肌的收缩功能。方法应用斑点追踪成像技术测量无明显冠心病及左室心肌质量指数相近的30例单纯糖尿病患者、25例糖尿病合并高血压患者、30例正常人的超声心动图常规参数及左室心内膜下心肌长轴观基底段、中段、心尖段收缩期纵向二维应变值，比较三组间的差异。结果除E／A的差异有统计学意义（P〈0．01）外，两糖尿病组较正常对照组之间各常规参数的差异无统计学意义。两糖尿病组整体心肌纵向收缩期峰值应变较对照组虽有所减低，但仅部分节段差异有统计学意义（P〈0．01），而心内膜下心肌纵向收缩期峰值应变较对照组均减低，差异有统计学意义（P〈0．01～0．001）。除少数心肌节段外，糖尿病合并高血压组心内膜下心肌纵向收缩期峰值应变均比单纯糖尿病组减低，差异有统计学意义（P〈0．01）。结论斑点追踪成像可用于早期诊断无明显冠心病的糖尿病患者左心室收缩功能受损情况。

Objective To analyze the systolic function of subendocardial myocardium of the left ventricle in patients with diabetes mellitus （DM） and DM associated hypertension by speckle tracking imaging （STI）. Methods The left ventricular ejection fraction（LVEF） and left ventricular mass index （LVMI） of all subjects including 30 patients with diabetes mellitus （DM group）, 25 patients with DM associated hypertension （DH group） and 30 healthy volunteers （control group） were normal and near. The common parameters of echocardiogram were measured and the peak systolic longitudinal strain of subendocardial myocardium were analyzed from the long-axis view at the levels of mitral annulus, papillary muscle and apex by STI. All above parameters were compared among three groups. Results No significant difference in all parameters was found between the control group and two patient groups, but the ratio of E/A was significantly lower in the two patient groups than that of control group （ P G 0.01 ）. The peak systolic longitudinal strain of some segments were significantly lower in the two patient groups than that of control group （ P G0.01）. The peak systolic longitudinal strain of the subendocardial myocardium of all segments in the two patient groups were different decrease compared with the control group（ P G0.01 or P G 0.00I ）. The peak systolic longitudinal strain of the subendocardial myocardium of the DH group except some segments were decrease compared with the DM group （ P 〈0.01）. Conclusions STI may be early used to identify the left ventricular systolic function in patients with diabetes mellitus.