二维斑点追踪技术评估糖尿病前期患者左心室亚临床收缩功能价值

Value of two-dimensional speckle tracking echocardiography to evaluating subclinical left ventricular systolic dysfunction in patients with prediabetes

目的探讨二维斑点追踪技术在评估糖尿病前期患者左心室亚临床心肌损伤中的价值。方法糖尿病前期患者46例为观察组,同期45例体检健康者为对照组,均行超声心动图检查,测量左心室舒张末期容积(left ventricular end-diastolic volume,LVEDV)、左心室收缩末期容积(left ventricular end-systolic volume,LVESV)、左室射血分数(left ventricular ejection fraction,LVEF)、室间隔舒张末期厚度(interventricular septal end-diastolic thickness,IVST)、左心室后壁舒张末期厚度(left ventricular posterior wall end-diastolic thickness,LVPWT)、左心房内径(left atrial inner diameter,LAID)、跨二尖瓣舒张早期血流速度(E峰)和舒张早期二尖瓣环运动速度(E峰);然后切换至二维斑点追踪技术模式,获取左心室二维16节段的应变-时间曲线和牛眼图,读取左心室二维整体纵向应变(global longitudinal strain,GLS)、二维整体圆周应变(global circumferential strain,GCS)以及二维整体径向应变(global radial strain,GRS),并进行比较。结果观察组LVEDV[(82.8±7.1)mL]、LVESV[(30.6±3.9)mL]、LVEF[(62.6±4.2)%]、IVST[(7.7±1.2)mm]、LVPWT[(7.3±1.1)mm]与对照组[(80.3±6.1)mL]、LVESV[(29.3±3.7)mL]、LVEF[(63.3±4.1)%]、IVST[(7.6±1.2)mm]、LVPWT[(7.1±1.1)mm]比较差异无统计学意义(P>0.05),LAID[(33.7±3.9)mm]和E/E(8.7±1.6)高于对照组[(31.4±2.6)mm和(7.7±0.9)](P<0.05);观察组|GLS|(17.7±2.6)低于对照组(21.3±4.7)(P<0.05),|GCS|(23.5±3.2)、GRS(32.7±3.9)与对照组(24.5±3.8、33.7±3.6)比较差异无统计学意义(P>0.05)。结论糖尿病前期患者左心室已出现亚临床心肌损伤,GLS是糖尿病前期患者左心室亚临床心肌损伤的敏感指标。

Objective To evaluate the value of two-dimensional speckle tracking echocardiography （21~STE） to evaluating subclinical left ventricuiar myocardial injury in patients with prediabetes. Methods Echocardiography was performed in 46 patients with prediabetes （observation group） and 45 healthy volunteers （control group） to measure left ventricular end diastolic volume （LVEDV）, left ventricular end-systolic volume （LVESV）, left ventricular ejection fraction （LVEF）, interventricular septal end-diastolic thickness （IVST）, left ventricular posterior wall end-diastolic thickness （LVPWT）, left atrial inner diameter （LAID）, E and E＇ values. 2D-STE mode was used to obtain strain-time curves of left ventricular 16-segment and bull eyes pattern, global longitudinal strain （GLS）, global circumferential strain （GCS） and global radial strain （GRS）. The above parameters were compared between two groups. Results There were no significant differences inLVEDV （（82.8±7.1） mL vs （80. 3±6. 1） mL）, LVESV （（30. 6±3. 9） mL vs （29.3±3.7） mL）, LVEF （（62.6±4.2） vs （63.3±4.1）%）, IVST （（7.7±1.2） mm vs （7.6±1.2） mm）, LVPWT （（7.3± 1.1）mm vs （7.1±1.1）mm） between observation group and control group （P〉0.05）. LAID and E/E＇ were significantly higher and IGLSl was significantly lower in observation group （（33.7±3.9） mm, 8.7±1.6, 17.7±2.6） than those in control group （（31.4±2.6）mm, 7.7±0.9, 21.3±4.7） （P〈0.05）. There were no significant differences in IGCSI and GRS between observation group （23.5±3. 2, 32. 7±3. 9） and control group （24. 5±3.8, 33. 7±3. 6） （P〈0.05）. Conclusion The patients with prediabetes have the evidence of subclinical left ventricular myocardial injury and GLS appears to be its useful and sensitive index.