实时三维超声心动图评价2型糖尿病伴或不伴高血压患者左心房功能

Assessment of left atrial function by real-time three-dimensional echocardiography in type 2 diabetes mellitus patients with or without hypertension

目的运用实时三维超声心动图(RT-3DE)技术评价2型糖尿病伴或不伴高血压患者左心房功能。方法62例确诊2型糖尿病患者根据有无高血压分为单纯糖尿病组(B组)和糖尿病伴高血压组(C组),另设30例健康志愿者为对照组(A组)。各组均行常规超声心动图测量左心室射血分数(LVEF)、左心房前后径(LAd)、左心室舒张末期内径(LVEDD)、室间隔厚度(IVS)、左心室后壁厚度(LVPW)、二尖瓣口舒张早期血流峰值速度(VE)。用组织多普勒测得二尖瓣环室间隔侧舒张早期峰值速度(Ve),计算E/e。用RT-3DE技术获取左心房图像,脱机得到左心房最大容积(LAVmax)、左心房主动收缩前容积(LAVpre A)、左心房最小容积(LAVmin),计算左心房总排空分数(LATEF)、左心房被动排空分数(LAPEF)及左心房主动排空分数(LAAEF)。结果常规超声心动图测得LVEF各组差异无统计学意义(P>0.05),C组LAd、IVS、LVPW、LVEDD及E/e高于A、B组(P<0.05或P<0.001);RT-3DE测量LAVmax、LAVpre A、LAVmin:B组、C组均高于A组,C组高于B组,且差异有统计学意义(P<0.05或P<0.01或P<0.001),而B、C组LATEF、LAPEF低于A组,C组低于B组,且差异有统计学意义(P<0.05或P<0.01或P<0.001),各组LAAEF差异无统计学意义(P>0.05)。LAVmax、LAVpre A、LAVmin、LATEF、LAPEF及LAAEF与E/e呈显著相关性(P<0.05或P<0.001)。结论 RT-3DE能定量发现2型糖尿病患者左心房功能改变,而伴有高血压的患者则更明显。

Objective To evaluate left atrial function in type2diabetes mellitus patients with or without hypertension by real-time three-dimensional echocardiography technique(RT-3DE).Methods62patients with type2diabetes mellitus were divided into diabetes mellitus without hypertention group(group B)and diabetes mellitus with hypertention group(group C),and30healthy individuals were selected as normal control(group A).Left ventricular ejection fraction(LVEF),left atrial diameter(LAd),left ventricular end-diastolic diameter(LVEDD),the thickness of interventricular septum(IVS),left ventricular posterior wall thickness(LVPW),peak transmitral flow velocity in early diastole(VE)were measured by conventional echocardiograpy in every group.Pulsed wave tissue Doppler imaging(TDI)was performed to record early diastolic peak velocity of mitral annulus(Ve)and E/e ratio was calculated.Left atrial maximum volume(LAVmax),left atrial preatrial contraction volume(LAVpreA),left atrial minimum volume(LAVmin)were detected by RT-3DE,and then left atrial total emptying fraction(LATEF),left atrial passive emptying fraction(LAPEF),left atrial active emptying fraction(LAAEF)could be calculated.Results The difference of LVEF measured by conventional echocardiography was not statistically significant among the groups(P>0.05).LAd,IVS,LVPW,LVEDD and E/e in group C were higher than those in group B and group A(P<0.05or P<0.001).LAVmax,LAVpreA and LAVmin measured by RT-3DE were significantly higher in group B and group C than those in group A,and they were significantly higher in group C than those in group B(P<0.05or P<0.01or P<0.001).LATEF and LAPEF were significant ly lower in group B and gruop C than those in group A,and they were significantly lower in group C than group B(P<0.05or P<0.01or P<0.001).There was no significant difference of LAAEF among all the groups(P>0.05).LAVmax,LAVpreA,LAVmin,LATEF,LAPEF and LAAEF were correlated with E/e(P<0.05or P<0.001).Conclusion RT3DE can quantitatively find the chang of left atrial function in patients with type2diabetes,especially for patients with hypertension.