超声Tei指数评价不同孕期和血糖控制水平妊娠期糖尿病孕妇胎儿心功能的价值

Value of ultrasonic Tei index in evaluation of fetal heart function of pregnant women with gestational diabetes mellitus during different gestational periods and with different blood glucose control levels

目的探讨超声Tei指数对不同孕期和血糖控制水平妊娠期糖尿病(GDM)孕妇胎儿心功能的价值。方法选取2015年12月-2017年3月该院收治的GDM孕妇74例,根据其血糖控制情况将其分为研究组和对照组,其中血糖不可控的38例孕妇纳入研究组,血糖可控的36例孕妇纳入对照组。另选取同期在该院产检的健康孕妇30例作为健康组。对比3组不同孕周胎儿的左室射血分数(LVEF)以及左右心室Tei指数,于34~39周测量并对比3组胎儿的左室壁厚度(LVWT)、右室壁厚度(RVWT)、左室舒张末期内径(LVDd)、右室舒张末期内径(RVDd)、左室收缩末期内径(LVDs)、右室收缩末期内径(RVDs)及左室短轴缩短率(LVFS)。结果各个孕周时间段3组胎儿LVEF比较,差异无统计学意义(P>0.05)。随着孕周的逐渐增加,健康组胎儿左、右心室Tei指数呈递减趋势;对照组胎儿左、右心室Tei指数呈递增趋势,且在34~39周提升最明显;研究组胎儿左、右心室Tei指数呈递增趋势,且在29~33周提升最明显。在孕周各个时间段研究组胎儿左、右心室Tei指数高于健康组,在29~33周、34~39周研究组胎儿左心室Tei指数高于对照组,在29~33周、>39周研究组胎儿右心室Tei指数高于对照组(P<0.05);在29~33周、34~39周、>39周对照组胎儿左、右心室Tei指数高于健康组(P<0.05)。研究组胎儿RVDd、RVDs、LVFS均高于对照组,且LVWT、RVWT、RVDd、LVFS均显著高于健康组(P<0.05);对照组胎儿LVFS高于健康组(P<0.05)。结论超声Tei指数可较好地反映不同孕期和血糖控制水平GDM孕妇胎儿心功能的变化情况,对于评价GDM孕妇胎儿心功能有较高的临床价值。

Objective To explore the value of ultrasonic Tei index in evaluation of fetal heart function of pregnant women with gestational diabetes mellitus（GDM） during different gestational periods and with different blood glucose control levels. Methods From December 2015 to March 2017,74 patients with GDM were selected from Xianyang Central Hospital and divided into study group（38 patients with uncontrolled blood glucose） and control group（36 patients with controlled blood glucose） according to the level of blood glucose control.Thirty healthy pregnant women receiving prenatal examination in the hospital during the same period were selected as healthy group. The levels of left ventricular ejection fraction（LVEF） and Tei indexes of left and right ventricles were compared among the three groups. Left ventricular wall thickness（LVWT）,right ventricular wall thickness（RVWT）,left ventricular end diastolic diameter（LVDd）,right ventricular end diastolic diameter（RVDd）,left ventricular end systolic diameter（LVDs）,right ventricular end systolic diameter（RVDs）,and left ventricular fractional shortening（LVFS） were measured and compared among the three groups during 34-39 gestational weeks.Results There was no statistically significant difference in LVEF among the three groups during different gestational periods（P〈0. 05）.Tei indexes of left and right ventricles decreased gradually in healthy group with the increase of gestational age,while Tei indexes of left and right ventricles increased gradually in control group with the increase of gestational age,which was significant during 34-39 gestational weeks. Tei indexes of left and right ventricles increased gradually in study group,which was significant during 29-33 gestational weeks. Tei indexes of left and right ventricles in study group were higher than those in healthy group during different gestational periods. During 29-33,34-39 gestational weeks,Tei indexes of left ventricle in study group were statistically significantly higher than those in control group（P〈0. 05）. During 29-33,39 gestational weeks,Tei indexes of right ventricle in study group were statistically significantly higher than those in control group（P〈0. 05）. During 29-33,34-39,and 39 gestational weeks,Tei indexes of left and right ventricles in control group were statistically significantly higher than those in healthy group（P〈0. 05）. RVDd,RVDs,and LVFS in study group were statistically significantly higher than those in control group,LVWT,RVWT,RVDd,and LVFS in study group were statistically significantly higher than those in healthy group（P〈0. 05）. Fetal LVFS in control group was statistically significantly higher than that in healthy group（P〈0. 05）.Conclusion Ultrasound Tei index can reflect the changes of cardiac function in GDM pregnant women during different gestational periods and with blood glucose levels,which has high clinical value in evaluation of fetal cardiac function in GDM pregnant women.