应用超声技术研究Ⅱ型糖尿病患者心脏-血管耦联

Study on ventricular-arterial coupling in patients with type 2 diabetes meilitus by ultrasound

目的应用超声技术研究Ⅱ型糖尿病患者心脏-血管耦联。方法Ⅱ型糖尿病患者80例，分为射血分数（EF）正常组（DMN组，EF≥50％）40例，EF减低组（DMA组，EFt50％）40例；健康志愿者42例作为对照组。测量左，t7室相对室壁厚度（RWT）、质量指数（LVMI）、每搏量（SV），计算每搏功（SW）、心率血压乘积（RPP）、循环血管阻力指数（SVRI）、左心室收缩末期弹性（Ees）、有效动脉弹性（Ea）和心脏-血管耦联指数（VVI）。获取左心室基底（LSsA）、乳头肌（LSrM）和心尖水平的纵向应变（LsAP）。结果①与对照组比较，DMN组RwT、LVMI增加（P〈0．01），LSBA、LSPM及LSAP减低（P〈0．01）。DMA组RwT减低（P〈0．01），LSBA、LSpM及LSAp均减低（P〈0．01）。DMA组LSBA、LSPM及LSAP明显低于DMN组（P〈0．01）。②与对照组比较，DMA组Ea、VVI、RPP及sVRI增高，Ees减低（P〈0．05），DMN组RPP增高（P〈0．01）。DMA组Ea、VVI、RPP、SVRI高于DMN组，Ees低于DMN组（P〈0．05）。③LsBA、LSrM及LSAr均与VVI呈负相关（P〈O．01）。进一步多元线性回归分析，LSAP、RwT、LVMI及SW是VVI的独立预测指标，标准回归系数分别为-0．613、-0．290、0．290和-0．205（P〈0．05）。结论DMN患者心脏-血管耦联，DNA患者心脏-血管脱耦联。左心室LSAP能独立反映心脏一血管耦联。

Objective To study the ventricular-arterial coupling in the patients with type 2 diabetes mellitus （DM） by ultrasound. Methods Eighty patients with DM were divided into 2 groups.-normal left ventricular ejection fraction （EF） group （DMN, EF≤50%, n = 40） and abnormal EF group （DMA, EFG 50%, n = 40）. At the same time,42 healthy volunteers were selected as a control group. The left ventricular （LV） relative wall thickness （RWT）, mass index （LVMI）,stroke volume （SV）, stroke works （SW）, ratepressure product （RPP）, systemic vascular resistance index （SVRI）, LV end-systolic elastance （Ees）, arterial elastance index （Ea） and ventricular vascular index （VVI） were measured and calculated. Longitudinal strain （LS） of myocardial segment including base（LSBA）, papillary muscle （LSpM） and apex （LShe） were analyzed by two-dimensional speckle tracking imaging. Results （1） Compared with the control,the RWT and LVMI were all increased （ P〈0.01）, hut the LSB,, LSpM and LS were decreased （P 〈 0.01） in the DMN and DMA groups （ P 〈0.01）. In DMA group, the RWT, LSBA, LSpM and LSAp were decreased （P 〈0.01）. Compared with the DMN group, the LSBA, LSpM and LSAp were decreased in DMN group （ P 〈0.01）. （2） Compared with the control, the Ea, VVI, RPP and SVRI were increased, but the Ees was decreased （ P 〈0.05）in DMA group （ P 〈0.01）. In the DMN,RPP was increased compared with the control group （ P〈0. 01）. Compared with the DMN group, the Ea, VVI, RPP and SVRI were increased,but Ees was decreased in the DMA （ P 〈0.05）. （3）The LSBA ,LSeM and LSAp were all positively correlated with VVI（ P〈0.01）. Multiple regression analysis showed that the LS,e, RWT,LVMI and SW were independent predictor of VVI （b＇ = - 0. 613, - 0. 290,0. 290 and - 0. 205, P 〈0.05）. Conclusions The ventricular-arterial coupling is normal in the DMN group, but is abnormal in DNA group. LSAp isindependent predictors for ventricular-arterial coupling.