三维斑点追踪技术评价2型糖尿病患者左心室心肌收缩功能

Evaluation on left ventricular systolic function in patients with type 2 diabetes mellitus by three-dimensional speckle-tracking echocardiography

目的应用三维斑点追踪超声心动图(3D-STE)评估2型糖尿病(T2DM)患者血糖在控制与非控制情况下,左心室各应变指标的差异及其与糖化血红蛋白(HbA1c)水平的相关性。方法收集60例T2DM患者(病例组),依据HbA1c水平分为A1亚组(HbA1c<7%)和A2亚组(HbA1c≥7%),各30例,同时收集30名健康志愿者(对照组),其左心室射血分数(LVEF)均在正常范围(≥55%)。采集标准心尖四腔观左心室全容积图像,于Echopac PC工作站进行脱机分析,计算左心室整体纵向应变(LVGLS)、整体圆周应变(LVGCS)、整体径向应变(LVGRS)和整体面积应变(LVGAS)。比较病例组与对照组间各指标的差异,分析病例组应变值与HbA1c的相关性。结果与对照组比较,A1、A2亚组LVGLS均减低(P均<0.05),A2亚组减低更为明显,A2亚组LVGCS、LVGAS和LVGRS亦明显减低(P均<0.05),而A1亚组与对照组的差异均无统计学意义(P均>0.05)。A2亚组中LVGLS(r=0.33,P<0.01)、LVGAS(r=0.33,P<0.01)、LVGCS(r=0.40,P<0.01)、LVGRS(r=-0.54,P<0.01)均与HbA1c具有相关性。结论 3D-STE能较准确地评价T2DM患者左心室心肌收缩功能的改变,其中LVGLS可以作为一项敏感指标。对于血糖控制不佳者,其HbA1c与心肌收缩功能损害具有相关性,可用于临床监控心肌损害。

Objective To explore the differences of left ventricular strains index between type 2 diabetes mellitus （T2DM） patients with controlled glucosulated hemoglobin （HbA1c〈 7%） and uncontrolled glucosulated hemoglobin （HbA1 c≥7%） by three-dimensional speckle-tracking echocardiography （3D-STE） method, and the correlation of strains index and glycated hemoglobin levels. Methods A total of 60 T2DM patients （case group） were collected, and according to the HhAlc value, were divided into Al subgroup （HbA1c〈7%, n=30） and A2 subgroup （HhA1c≥7%, n=30）. At the same time 30 healthy individuals were collected as the control group. All participants had normal left ventricular ejec- tion fraction （left ventricular ejection fraction ≥55%）. The left ventricular apical four-chamber heart full volume images were collected and analyzed in Echopac PC workstation in order to calculate the left ventricular globle longitudinal strain （LVGLS）, left ventricular globle circumferential strain （LVGCS）, left ventricular globle area strain （LVGAS） and left ventricular globle radial strain （LVGRS） of all participants. The differences of strain values between case group and control group were compared, the correlation of strain index with HbA1 c in case group were analyzed. Results Compared with the control group, the LVGLS in A1, A2 subgroup were all decreased （all P〈0.05）, especially that in A2 suhgroup was low- er, and the LVGCS, LVGAS and LVGRS in A2 subgroup decreased significantly （all P〈0.05）, but there were no signifi- cant differences between A1 subgroup and the control group （all P〉0.05）. The LVGLS （r=0.33, P〈0.01）, LVGAS （r =0. 33, P〈0.01）, LVGCS （r=0.40, P〈0.01）, LVGRS （r=0.54, P〈0.01） was correlated with HbA1c in A2 sub- group, respectively. Conclusion 3D-STE can be used to accurately evaluate the left ventricular systolic function in patients with T2DM, especially the LVGLS. For the poor blood glucose control, the relationship of HbAlc and systolic function damage may be helpful for clinical monitoring of myocardial injury.