时间-空间相关成像联合组织多普勒超声观察妊娠期糖尿病孕妇胎儿心脏结构和功能

Spatio-temporal image correlation and tissue Doppler imaging ultrasound in observation on fetal cardiac structure and function in pregnant women with gestational diabetes mellitus

目的探讨时间-空间相关成像(STIC)联合组织多普勒(TDI)超声检测妊娠期糖尿病(GDM)孕妇胎儿心脏结构和功能的应用价值。方法选取140例GDM孕妇(胰岛素治疗组40例,饮食控制组62例,血糖控制不良组38例)和211名正常妊娠孕妇(对照组)。应用STIC后处理获得M型图像(STIC-M型),测量胎儿左、右心室壁和室间隔收缩末期和舒张末期厚度,以TDI测量胎儿心脏房室瓣环舒张早期运动速度(Ea)、舒张晚期运动速度(Aa)及收缩期运动速度(Sa),并计算Ea/Aa值,比较4组间参数的差异。结果 4组间胎儿左、右心室壁及室间隔舒张末期和收缩末期厚度总体差异均有统计学意义(P均<0.05),GDM各组均大于对照组(P均<0.05),GDM各组间差异均无统计学意义(P均>0.05)。4组间二尖瓣环Ea/Aa总体差异有统计学意义(P=0.002),GDM各组二尖瓣环Ea/Aa均小于对照组(P均<0.05),GDM各组间差异无统计学意义(P均>0.05)。4组间三尖瓣环Ea/Aa、二尖瓣环Sa、三尖瓣环Sa总体差异均无统计学意义(P均>0.05)。结论 GDM孕妇胎儿心室壁及室间隔厚度增加,心脏舒张功能降低,血糖控制情况的差异对胎儿心肌厚度和心脏功能改变无显著影响。STIC-M型联合TDI超声技术对评估GDM孕妇胎儿心脏结构和功能具有一定应用价值。

Objective To explore the potential of spatio-temporal image correlation (STIC) and tissue Doppler imaging (TDI) in observation on fetal cardiac structure and function in pregnant women with gestational diabetes mellitus (GDM). Methods Totally 140 GDM pregnancies (40 in the insulin treatment group,62 in the diet control group,38 in the glycemic uncontrolled group) and 211 normal pregnancies (control group) were enrolled.STIC with M-mode display (STIC-M) was used to measure the thicknesses of fetal ventricular wall and interventricular septum at the end of diastole and systole.TDI ultrasound was used to measure fetal atrioventricular annular velocity in early diastole (Ea),during atrial contraction (Aa),and in systole (Sa),and to calculate the Ea/Aa ratios.The parameters were compared among the 4 groups. Results The overall differences of thickness of the left and right ventricular wall and interventricular septum at the end of diastole and systole were statistically significant among the 4 groups (all P <0.05),and those in all GDM pregnancy groups were higher than in control group (all P <0.05),whereas there was no significant difference among the 3 groups of GDM pregnancy (all P >0.05).The overall differences of mitral annular Ea/Aa among the 4 groups were statistically significant ( P =0.002),and those in all GDM pregnancy groups were lower than in control group (all P <0.05),while there was no significant difference among the 3 groups of GDM pregnancies (all P >0.05).The differences in tricuspid annular Ea/Aa,mitral and tricuspid annular Sa were not statistically significant among 4 groups (all P >0.05). Conclusion The fetal ventricular wall and interventricular septum thicknesses are increased,cardiac diastolic function is decreased in GDM pregnancy independent of glycemic control condition.Combination of STIC-M and TDI has certain value to observe fetal cardiac structure and function in GDM pregnancy.