糖代谢紊乱患者左室舒张功能的早期评价

Evaluation on the left ventricular diastolic function in patients with abnormal glucose metabolism in the early stage

目的探讨糖尿病前期及T2DM患者左室舒张功能的改变情况。方法通过彩色血流多普勒、组织多普勒(DTI)及生化指标N末端B型钠尿肽前体(NT-proBNP)分别对IGT组、IFG组、T2DM组及正常对照(NC)组进行观察对照。主要检测指标包括舒张早期二尖瓣血流峰值速度(E值)、舒张晚期血流峰值速度(A值)、E/A值、二尖瓣环左侧壁附着处心肌舒张早期运动峰值速度(Em)、舒张晚期运动峰值速度(Am)、Em/Am值、E/Em值及NT-proBNP生化值。结果 E值、A值、E/A值、Am值在NC组、IGT组、IFG组间差异均无统计学意义(P>0.05),T2DM组与以上各组间差异均有统计学意义(P<0.05),Em、Em/Am、E/Em值在4组间两两比较除IGT组与IFG组间外,差异均有统计学意义(P<0.05)。NT-proBNP值在NC组、IGT组、IFG组间差异无统计学意义(P>0.05),T2DM组与以上各组间差异均有统计学意义(P<0.05)。E/Em值与NT-proBNP值之间具有良好相关性(r=0.827,P<0.01)。DTI对舒张功能异常检出率比传统多普勒高(χ2=8.1,P<0.01)。结论 IGT、IFG及T2DM患者均存在心脏舒张功能受损,DTI对舒张功能检测比传统彩色血流多普勒更敏感,NT-proBNP可作为舒张性心功能不全早期诊断的可靠指标。

Objectives To explore the changes of left ventricular（LV） diastolic function in pre-diabetes and T2DM patients.Methods The subjects were classified into the impaired glucose tolerance（IGT） group,the impaired fasting glucose（IFG） group,type 2 diabetes mellitus（T2DM） group,and normal control（NC） group.The LV diastolic function was assessed by color Doppler flow imaging,tissue Doppler imaging（DTI）,and NT-proBNP.The corresponding indices include early diastolic mitral flow velocity（E）,late diastolic mitral flow velocity（A）,E/A ratio,the peak early diastolic mitral annular velocity（Em）,the peak late diastolic mitral annular velocity（Am）,Em/Am ratio,and E/Em ratio.Results There were no significant differences in the levels of E,A,E/A ratio,and Am among the NC group,IGT group,and IFG group（P〉0.05）,while those of the T2DM group were significantly different from the above three groups（P〈0.05）,the Em,Em/Am and E/Em ratios were significantly different in the two-by-two comparison among the four groups except the IFG and IGT groups（P〈0.05）.The NT-proBNP values were not statistically different among the NC group,IGT group,and IFG group（P〉0.05）,but that of the T2DM group was significantly different from these three groups（P〈0.05）.The E/Em ratio was significantly correlated with the NT-proBNP levels（r=0.827,P〈0.01）.DTI detection rate of diastolic dysfunction was higher than that of color Doppler flow imaging（χ2=8.1,P〈0.01）.Conclusion Diastolic dysfunction exists in IGT,IFG,and T2DM patients.DTI is more sensitive than conventional color Doppler flow imaging in detection rate of diastolic dysfunction.NT-proBNP can be used as a reliable index for early diagnosis of diastolic dysfunction.