三维斑点追踪超声心动图对2型糖尿病患者左心室亚临床心肌损伤的评价

Evaluate subclinical left ventricular myocardial damage in patients with diabetes mellitususing three-dimensional speckle-tracking echocardiography

目的探讨三维斑点追踪技术对评价早期糖尿病患者左心室亚临床损伤的价值。方法选择血糖控制良好且无糖尿病并发症的2型糖尿病患者41例为糖尿病组,排除合并高血压以及冠心病的患者,选择年龄、性别相匹配的健康志愿者39例作为对照。留取三维左心室全容积图像,采用三维斑点追踪技术测量左心室三维纵向应变(GLS)、三维面积应变(GAS)、三维圆周应变(GCS)和三维径向应变(GRS),比较两组上述参数,分析左心室三维应变指标与Hb A1c之间的相关性。结果糖尿病组左心室射血分数(LVEF)、心室舒张末期容积(LVEDV)与对照组比较差异无统计学意义(P>0.05),而左心室质量显著高于对照组,差异有统计学意义(P<0.05)。糖尿病组|GCS|和GRS与对照组比较差异无统计学意义(P>0.05),而|GLS|、|GAS|显著低于对照组,差异有统计学意义(P<0.05)。相关性分析显示,|GLS|(r=-0.633,P<0.05)、|GAS|(r=-0.451,P<0.05)与Hb A1c呈线性负相关。结论糖尿病早期即显示左心室收缩功能受损,三维斑点追踪技术可以敏感的检出这种亚临床改变。

Objective To evaluate the value of three-dimensional speckle-tracking technique in evaluating left ventricular subclinical injury in patients with early diabetes mellitus. Methods 41 patients with of type 2 diabetes mellitus with good blood glucose control and without diabetes mellitus were selected as the diabetes group,and with hypertension and coronary heart disease were excluded.39 healthy volunteers with age and sex matched as control were selected as the control group. Left ventricular total volume images were measured by three-dimensional speckle tracking technique to measure left ventricular three-dimensional longitudinal strain（GLS）,three-dimensional area strain（GAS）,three-dimensional circumferential strain（GCS）,and three-dimensional radial strain（GRS）.The above parameters were compared between the two groups.The correlation between left ventricular three-dimensional strain index and Hb A1 c was analyzed. Results Differences in the left ventricular ejection fraction（LVEF）and left ventricular end diastolic volume（LVEDV）of the diabetes group and the control group had no statistical significance（P〉0.05）,while the left ventricular mass was significantly higher than that in the control group（P〈0.05）.Differences in GRS and ｜GCS｜ of the diabetes group and the control group had no statistical significance（P〉0.05）,while ｜GAS｜ and ｜GLS｜ were significantly lower than those in the control group（P〈0.05）.Correlation analysis showed that ｜GLS｜（r=-0.633, P〈0.05）,｜GAS｜（r=-0.451,P〈0.05） was negatively correlated with Hb A1 c. Conclusion the early stage of diabetes mellitus shows that left ventricular systolic function is impaired, and the three-dimensional speckle-tracking technique can be sensitive to the detection of subclinical changes.