超声心动图评价糖尿病妊娠胎儿心脏功能变化的研究

Study on the echocardiographic evaluation of fetal heart function of gestational diabetes

目的:应用超声心动图技术观察糖尿病妊娠胎儿心脏功能的变化。方法:测量糖尿病妊娠组与正常对照组胎儿的心脏结构与功能的各项指标,并分析其与不同孕周间的关系。结果:孕34周后两组胎儿左室短轴缩短率(LVFS)、右室短轴缩短率(RVFS)、二尖瓣E、A峰值速度比值(E/AMV)、三尖瓣E、A峰值速度比值(E/ATV)、主动脉瓣血流峰值速度(VPAO)、肺动脉瓣血流峰值速度(VPPA)差异有统计学意义(P<0.05)。30周后两组胎儿Tei指数、室间隔舒张末期厚度(IVSd)、左室壁厚度(LVWT)、右室壁厚度(RVWT)差异有统计学意义(P<0.05)。结论:糖尿病妊娠胎儿心功能及结构变化发生于30周后,Tei指数是评价糖尿病妊娠胎儿心脏功能变化的敏感指标。

Objective：To study the change of fetal heart function of gestational diabetes by echocardiography. Methods： Nineteen fetuses of diabetic mothers and 96 healthy subjects were involved. Interventricular septum thickness at end-diastole （IVSd）, left ventricular wall thickness （LVWT）, right ventricular wall thickness （RVWT）, left ventricular fraction shortening （LVFS） and right ventrieular fraction shortening （RVFS） were detected by M-mode echocardiography. The Tel index, peak velocity o＇f aortic valve （ VPAO）, peak velocity of pulmonary valve （ VPPA）, the ratio of E and A of mitral and tricuspid flow （E/AMV, E/ATV） were obtained by pulsed Doppler. Isovolumic contraction time （ICT）, isovolumic relaxation time （IRT） and ejection time （ET） of fetal left and right ventricle were measured and the Tel index calculated using the formula （ICT＋IRT） /ET. Results： After 34 weeks, there was significant difference in LVFS, RVFS, E/ AMV, E/ATV, VPAO and VPPA between fetuses of diabetic mothers and normal fetuses. After 30 weeks, there was significant difference in Tel Index, IVSd, LVWT and RVWT between the two groups. Conclusion： The fetal heart function was impaired and cardiac hypertrophy happened after 30 weeks in diabetic mothers. The Tel index may be the sensitive method of estimating myocardial performance in fetuses with maternal diabetes.