实时三维超声心动图评价2型糖尿病患者左室局部功能早期损害的临床研究

Clinical research on evaluating early injury of left ventricular function in diabetes patients by real-time three-dimensional echocardiography

目的利用实时三维超声心动图评价2型糖尿病患者左室局部功能的变化,以提示心肌早期损害与否,为临床诊治提供参考。方法确诊为2型糖尿病的患者30例,正常对照组30例。于胸骨旁左室长轴切面测量左房内径(LAD)、左室舒张末期内径(LVDd)、左室收缩末期内径(LVSd)、室间隔厚度(IVSTd)及左室后壁厚度(LVWTd),应用实时三维超声心动图全容积成像技术获得左室容积—时间曲线,计算出左室射血分数(LVEF),左室16、12、6节段达最低收缩末容量时间的标准差(Tmsv16-SD、Tmsv12-SD、Tmsv6-SD),以及最大差异(Tmsv16-Dif、Tmsv12-Dif、Tmsv6-Dif)。结果糖尿病组LAD、IVSTd、LVWTd,二尖瓣口舒张期血流频谱E、A峰峰值速度、E/A比值(E/A),以及左室心肌指数(LVMI)高于正常对照组(P﹤0.05),实时三维超声心动图测量LVEF糖尿病组低于正常对照组(P﹤0.05),糖尿病组Tmsv16-SD、Tmsv12-SD、Tmsv6-SD、Tmsv16-Dif、Tmsv12-Dif及Tmsv6-Dif均高于正常对照组(P﹤0.05)。结论左室容积—时间曲线及参数可作为定量评估左室机械非同步运动的有效指标,实时三维超声心动图可以客观评价糖尿病患者早期左室局部收缩功能及运动同步性的异常。

Objective To evaluate left ventricular regional systolic and diastolic function in patients of diabetic cardiomyopathy by real-time three-dimensional eehocardiography （RT-3DE） in order to offer reference for clinical treatment. Methods Thirty patients with type 2 diabetes and 30 healthy volunteers were enrolled. Left atrial diameter （LAD）, left ventricular end-diastolic diameter（LVDd）, left ventricular end-systolic diameter（LVSd）, interventricular septum thickness（IVSTd） and left ventrieular posterior wall thickness （LVWTd）were measured at parasternal left ventricular long axis view. Left ventricular segments volume-time curves were measured with RT-3DE,left ventricular ejection fraction （LVEF） and the standard deviation and the maximal difference of the time to the point with minimal systolic volume of 16, 12,6 segments （Tmsv 16-SD, Tmsv 12-SD, Tmsv6-SD,Tmsv16-Dif, Tmsv12-Dif, Tmsv6-Dif）were calculated. Results LAD, IVSTd, LVWTd, E/A, left ventrial mass index （LVMI） were higher in diabetic group than in control group （P 〈 0.05）.LVEF measured by RT-3DE was lower in diabetic group than in control group （P 〈 0.05）.Tmsv16-SD,Tmsv12-SD,Tmsv6-SD,Tmsv16-Dif, Tmsv12-D-if, Tmsv6-Difwere significantly higher in diabetic group than control group （P 〈 0.05）. Conclusion The volume-time curves can be used to evaluate left ventricular mechanic systolic synchrony. RT-3DE can assess regional left ventricular systolic function and systolic asynchrony.