超声二维斑点追踪显像技术评价妊娠期糖尿病孕妇的胎儿心室力学及功能变化的研究

Assessment of ventricular mechanics and function changes of fetuses in gestational diabetic by two-dimensional ultrasound speckle tracking technology

目的应用超声二维斑点追踪显像技术评价妊娠期糖尿病孕妇的胎儿及产后新生儿左、右心室功能和结构的变化规律和特点。方法选择深圳市南山区妇幼保健院妊娠期糖尿病孕妇（妊娠期糖尿病孕妇组,年龄21~39岁,平均年龄27.1岁;孕24~28周、32~36周;按孕周分2组）及妊娠期糖尿病产妇的新生儿（糖尿病母亲婴儿组,年龄3~25 d,平均年龄12.0 d）各20例;正常对照孕妇（正常对照孕妇组,年龄20~36岁,平均年龄25.6岁;孕24~28周、32~36周;按孕周分2组）40例及正常产妇的新生儿（正常产妇的新生儿组,年龄7~26 d,平均年龄14.0 d）20例。行超声检查,存储心尖四腔心切面,应用二维斑点追踪显像技术测量左、右心室游离壁及室间隔的基底段、中间段及心尖段心肌和心内膜下心肌及室间隔收缩期最大应变率（SRs）、舒张期最大应变率（SRd）,脉冲多普勒测量二、三尖瓣口的舒张期早期峰值流速E峰、舒张晚期峰值流速A峰,计算E/A比值,超声心动图测量左、右心室及室间隔的心肌厚度。结果与对照组相比,妊娠期糖尿病孕妇组孕32~36周胎儿室间隔,左、右心室壁舒张末期厚度均较正常对照孕妇组增厚,差异有统计学意义（P〈0.05）。妊娠期糖尿病孕妇组胎儿心脏二、三尖瓣口血流频谱的E/A比正常对照孕妇组小,其中妊娠期糖尿病孕妇组孕32~36周胎儿及糖尿病母亲婴儿组E/A降低,差异有统计学意义（P〈0.05）;妊娠期糖尿病孕妇组孕32~36周胎儿及糖尿病母亲婴儿组心室各段心肌SRs、SRd均减低,差异有统计学意义（P〈0.05）;妊娠期糖尿病孕妇组孕24~28周胎儿SRs与正常对照孕妇组比较,无统计学意义（P〉0.05）,但SRd降低,差异有统计学意义（P〈0.05）。结论应用二维斑点追踪显像技术可以检测妊娠期糖尿病孕妇胎儿左、右心室长轴心内膜下心肌的应变变化,可以早期发现妊娠期糖尿病孕妇胎儿及新生儿心室肌舒缩功能的减退。因此二维斑点追踪显像技术可以无创、精确地检测妊娠期糖尿病孕妇胎儿心室肌功能的变化。

Objective To evaluate the changes in the function and structure of left and right ventricle of fetus in gestational diabetes and postpartum newborn by two-dimensional ultrasound speckle tracking imaging. Methods Twenty gestational diabetes women（gestational diabetes group： aged 21- 39 years old with mean age of 27.1 years old, divided into two subgroup with 24-28 weeks of pregnancy or 32- 36 weeks of pregnancy）, 20 infants of diabetic mothers（infants of diabetic mothers group： aged 3-25 days with mean age of 12.0 days）, 40 pregnant women（normal control group： aged 20- 36 years old with mean age of 25.6years old, divided into 2 subgroup with 24- 28 weeks of pregnancy or 32- 36 weeks of pregnancy） and 20 normal infants（neonatal group： aged 7- 26 days with mean age of 14.0 days） were enrolled. All of them were performed ultrasound examination and the apical four-chamber view was stored. The left and right ventricular free wall and septal basal segment, middle segment,apical segments, subendocardial myocardium ventricular septal systolic strain rate（SRs）, diastolic strain rate（SRd） were measured by dimensional ultrasound speckle tracking technology. The mitral and tricuspid peak early diastolic velocity of tricuspid E, late diastolic peak velocity A, E / A ratio were measured with pulsed Doppler, and the myocardial thickness of left and right ventricle and ventricular septum were measured with ultrasonic cardiogram. Results The fetal ventricular septum, left and right ventricular wall thickness at end-diastolic in diabetic pregnancy of 32- 36 weeks were thicker than those of normal control group, and the difference was statistically significant（P〈0.05）. The tricuspid flow spectrum E / A, SRsand SRdin gestational diabetes group was lower than that of normal control group, in which the E / A of fetuses of 32- 36 week gestational diabetes and infants of diabetic mothers was significantly decreased（P〈0.05）. The SRsof fetuses of 24- 28 week gestational diabetes was not significantly different as compared with normal control group（P〈0.05）, whereas the SRdof the former group was significantly decreased as compared with latter group（P〈0.05）. Conclusion It is demonstrated that the two-dimensional speckle tracking technology could noninvasively and accurately detect changes in the ventricular function of the fetus and infant of gestational diabetic women.