超声在评价糖尿病患者右心功能中应用研究

Evaluation of right heart function in diabetic patients by echocardiography

目的探讨应用超声技术评价糖尿病患者右心功能改变情况的应用价值。方法选取糖尿病患者100例,其中,患有糖尿病性心肌病(DCM)患者50例为DCM组,糖尿病无心肌病(NDCM)患者50例为NDCM组;同时,选取50例健康人作为健康对照(NC)组。分别测量并比较各组患者右室收缩功能、舒张功能、右房功能,评价糖尿病患者右心功能的改变。右室收缩功能包括M型超声测量右室侧壁三尖瓣环收缩期位移(TPASE),QLAB-MVI测量整体纵向应变(GLS),右心造影Simpson法测量右室收缩期末期容积(RVESV)及舒张期末期容积(RVEDV),并计算右室射血分数(RVEF)。舒张功能包括SDI测量舒张早期充盈速度(Ve),心房收缩期充盈速度(Va),舒张早期充盈应变率(Esr),心房收缩期充盈应变率(Asr)。右房功能包括右心造影Simpson法测量右房最大(Vmax)及最小容积(Vmin),计算右房每搏量(RAV),测量右房收缩前容积(Vpre)、右房被动排空容积(RAPEV)、右房被动排空分数(RAPEF)、右房主动脉排空容积(RAAEV)、右房主动排空分数(RAAEF)。结果 NDCM组及DCM组患者的TAPSE、GLS、RVEF、Ve、Ve/Va、Esr水平均低于NC组,差异均有统计学意义(P<0.01);随着病程的进展,DCM组患者的上述指标低于NDCM组,差异均有统计学意义(P<0.05)。NDCM组及DCM组患者的RVEDV、RVESV、Asr水平均高于NC组,差异均有统计学意义(P<0.01);而且,DCM组患者的上述指标均高于NDCM组,差异均有统计学意义(P<0.05)。各组间Va水平比较,差异均无统计学意义(P>0.05)。NDCM组及DCM组患者Vmax、Vmin、RAV、Vpre、RAAEF水平均高于NC组,差异均有统计学意义(P<0.01);而且,DCM组患者上述指标均高于NDCM组,差异均有统计学意义(P<0.05)。NDCM组及DCM组患者RAPEF水平均低于NC组,但差异均无统计学意义(P>0.05)。相关性分析显示,右房RAAEF与右室ASR呈正相关(r=0.390,P<0.05),右房RAPEF与右室ESR呈正相关(r=0.508,P<0.01)。结论糖尿病患者存在明确的右心功能损伤,多种方法相结合可以早期评价糖尿病患者右心功能改变。

Objective To evaluate the right heart functional changes in diabetic patients by echocardiographic technology. Methods Atotal of 100 cases of diabetic patients were selected, among them ,50 patients with diabetic cardiomyopathy （DCM） were divided into the DCM group,50 patients with non-diabetic cardiomyopathy（NDCM） were in the NDCM group;at the same time,50 ca- ses of healthy people were in the non-cardiomyopathy （NC） group. The right ventricular systolic function, diastolic function and right atrial function were measured and compared respectively, and right heart function changes in diabetic patients were evaluated. Right ventricular systolic functions included M mode echocardiography in obtaining tricuspid annular plane systolic excursion （TAPSE）, QLAB-MVI in obtaining global longitudinal strain（GLS） ,right ventricular contrast echocardiography in obtaining right ventricular end systolic volume（RVESV） and right ventricular end diastolic volume（RVEDV） by Simpson,calculating right ventricular ejection frac- tion（RVEF）. Right ventricular diastolic functions included speckle tracking imaging（SDI） in obtaining early diastolic filling velocity （Ve）, atrial systolic filling velocity（ Va）, early diastolic filling strain rate （Esr） and atrial systolic filling strain rate （Asr）. Right atrial functions included right atrial contrast echocardiography in obtaining right atrial max volume（Vmax） and min volume（ Vmin）, calcu- lating right atrial stroke volume （RAV） ;obtaining volume of right atrium before contraction（ Vpre）, right atrium passive emptying vol- ume（ RAPEV）, right atrium passive emptying volume fraction（ RAPEV）, right atrium active emptying volume（ RAAEV）, right atrium active emptying volume fraction（RAAEF）. Results The level of TAPSE, GLS, RVEF, Ve, Ve/Va and Esr in NDCM and DCM group were lower than those in NC group（P 〈0. 01 ）. With the extension of course,the level in DCM group was lower than that in NDCM group（P 〈 0. 05 ）. The level of RVEDV, RVESV and Asr in NDCM group and DCM group were higher than those in the NC group （ P 〈 0＋ 01 ）＋ With the extension of course, the level in DCM group was higher than that in NDCM group （ P 〈 0.05 ）. The level of Va in the three groups had no statistically significant difference （P 〉 0. 05 ）. The level of Vmax, Vmin, RAV, Vpre and RAAEF in NDCM and DCM groups were higher than those in NC group （ P 〈 0. 01 ）. With the extentsion of course, the levels in DCM group was increased compared with those in NDCM group（P 〈 0. 05）. The level of RAPEF in NDCM and DCM groups were lower than those in NC group, while the difference was not statistically significant（ P 〉 0. 05 ）. Correlation analysis showed that the right artial RAAEF was positively related with right ventricular ASR（ r = 0. 390 ,P 〈 0. 05 ）, the right artial RAPEF was positively related with right ventricular ESR（ r = 0. 508, P 〈 0. 05 ）. Conclusion There was exactly right heart function damages in diabetic patients, right heart function change can be early evaluated by combining a variety of methods.