三维斑点追踪成像技术对糖尿病前期患者亚临床左室收缩功能受损的评价

Evaluation on subclinical left ventricular systolic dysfunction in patients with pre-diabetes by three-dimensional speckle tracking echocardiography

目的探讨三维斑点追踪成像(3D-STE)技术在检测糖尿病前期患者左室亚临床心肌损伤中的价值。方法选择未合并高血压病的糖尿病前期患者41例(糖尿病前期组)和同期与其年龄、性别相匹配的健康成人40例(对照组)。测量两组人体测量学指标、实验室指标及常规超声指标并对其进行比较;同时应用3D-STE技术测量并比较两组左室三维整体纵向应变(3D-GLS)、三维整体面积应变、三维整体径向应变及三维整体圆周应变,分析其与人体测量学指标和实验室指标间的相关性。结果与对照组比较,糖尿病前期组腰围、腰臀比、体质量指数、血压、甘油三酯、总胆固醇、空腹血糖、左房内径及二尖瓣舒张早期血流速度与二尖瓣环舒张早期组织运动速度比值均显著增加;3D-GLS显著减低,差异均有统计学意义(均P<0.05)。相关性分析显示:糖尿病前期组3D-GLS与腰臀比、体质量指数及糖化血红蛋白呈线性负相关(r=-0.534,P=0.003;r=-0.443,P=0.010;r=-0.587,P<0.01);且糖化血红蛋白、腰臀比与3D-GLS独立相关(β=-0.470,P=0.003;β=-0.739,P<0.01)。结论糖尿病前期患者左室出现显著的亚临床心肌损伤,3D-STE技术测量左室纵向应变是检测糖尿病前期患者左室亚临床心肌损伤的敏感指标。

Objective To evaluate the subclinical myocardial injury using left ventricular function with three dimensional（3D）speckle tracking echocardiography（STE） in patients with prediabetes. Methods Forty- one prediabetes patients without hypertension（prediabetes group）and 40 age and gender matched healthy volunteers（control group）were enrolled in this study. Anthropometric indices,lab test indexes and conventional echocardiographic parameters were taken measured and recorded for further analysis. The parameters of 3D-GLS,3D-GAS,3D-GCS and 3D-GRS were measured and recorded using 3D speckle tracking imaging,compared with the data of the anthropometric indices and lab test indexes. Results Compared with the control group,the waist circumference,waist hip ratio,BMI,blood pressure,triglyceride,total cholesterol,fasting blood glucose,left atrial diameter,mitral early diastolic flow velocity and mitral annular early diastolic velocity ratio were significantly increased in prediabetes group;the left ventricular 3D GLS was significantly decreased in prediabetes group,the differences were statistically significant（all P〈0.05）.3D-GLS was significantly reduced in patients with prediabetes compared to the control group（P〈0.05）. Correlation analysis showed that 3D-GLS were negatively correlated with waist hip ratio,BMI and HbA1c（r=-0.534,P =0.003;r =-0.443,P =0.010;r =-0.587,P 0.01）. In a multivariate analysis,HbA1c and waist hip ratio were independently associated with 3D-GLS（β=-0.470,P=0.003;β=-0.739,P 0.01）. Conclusion Subclinical left ventricular myocardial injury for patients with prediabetes could be detected using 3D-STE technique. The 3D global longitudinal strain appears to be useful and sensitive index in detection of subclinical left ventricular dysfunction in patients with prediabetes.