斑点追踪技术评价2型糖尿病患者右心室收缩功能与C肽水平的关系

Assessment of Right Ventricular Systolic Function and Its Relationship with C-peptide Level in Patients with Type 2 Diabetes Mellitus Using Two-dimensional Speckle Tracking Imaging

目的应用超声二维斑点追踪显像技术(two-dimensional speckle tracking imaging,2D-STI)观察分析2型糖尿病患者(type 2 diabetes mellitus,T2DM)右心室心肌的应变及应变率参数变化特点,并探讨其与T2DM患者血清C-肽水平(C-peptide)的相关性。方法分别选择T2DM患者为T2DM组(n=60例)以及正常健康人为NC组(n=60例),应用2D-STI分析并记录患者右心室心肌各节段以及整体的应变、应变率参数:收缩期峰值应变(ε、G-ε)、收缩期峰值应变率(SRs、G-SRs)。采用直接化学发光法分别对患者的空腹及餐后2h血清C肽水平进行测定。结果 T2DM组的血糖、Hb A1c以及E/e水平均较NC组升高,而空腹以及餐后2h血清C肽水平均较NC组下降(P<0.05);T2DM组右心室游离壁心肌的基底段,室间隔心肌的中间段以及心尖段ε、SRs均较NC组下降(P<0.05);T2DM组右心室心肌G-ε、G-SRs均较NC组下降(P<0.05);G-ε、G-SRs分别与空腹血清C肽水平(r=0.59,0.63,P<0.05)、餐后2h血清C肽水平(r=0.65,0.68,P<0.05)均呈正相关;以G-ε、G-SRs判定T2DM患者右心室收缩功能异常时临界值、灵敏度、特异度分别为:-17.30(%)、82.41%、76.95%;-0.89(s-1),86.27%、89.14%。结论 2D-STI的应变、应变率参数能敏感地对T2DM患者右心室心肌的局部以及整体收缩功能进行客观评价,同时以T2DM患者空腹以及餐后2h血清C肽水平状态作为参考,可对T2DM患者的右心室收缩功能作进一步深入评估。

Objective To analyse strain/strain rate parameter variation characteristics of right ventricular myocardium in patients with type 2 diabetes mellitus （T2DM） using two-dimensional speckle tracking imaging （2D-STI）, and to explore its relationship with file serum C-peptide level. Methods T2DM patients were selected as T2DM group （N = 60） and normal people were selected as NC group （N = 60）, using 2D-STI to analyze and record the right ventricular myocardial segments and the whole strain/strain rate pa- rameters： the systolic peak strain （ε G-ε）, peak systolic strain rate （SRs, G-SRs）. Fasting and postprandial 2H serum C-peptide levels were measured by direct chemiluminescence. Results Compared with NC group, blood sugar, HbAlc and E/e were increased in T2DM group, the fasting and postprandial 2H serum C-peptide levels were lower in T2DM group （ P 〈 0.05） ; ε, SRs were lower in the basal segment of right ventricttlar free wall myocardium and the intermediate and apical segments of ventricular septal myocar- dial in T2DM group （ P 〈 0.05） ; G-s, G-SRs were lower in T2DM group （ P 〈 0.05） ; G-ε, G-SRswere positively correlated to fast- ing serum C-peptide levels （ r = 0.59, 0.63, P 〈 0.05） and postprandial 2H sermn C-peptide levels （ r = 0.65,0.68, P 〈 0.05）. in using, The cut-off, sensitivity, specificity of patients with T2DMthat right ventricular systolic functionabnormal determined by the G- s, G-SRs were-17.30（%）, 82.41%, 76.95%; -0.89（s-1）, 86.27%, 89.14%, respectively. Conclusions The strain/strain rate parameters of 2D-STI can objectively, sensitively evaluate thelocal and global systolic function of right ventricular myocardium in patients with T2DM, and at the same time, fasting and postprandial 2H serum C-peptide level state can be as a reference, whichhelp to further evaluate right ventricular systolic function in T2DM patients.