三维斑点追踪技术评价2型糖尿病合并非酒精性脂肪性肝病患者左心室功能

Three-dimensional speckle tracking echocardiography in evaluation on left ventricular function in type 2 diabetes mellitus patients with non-alcoholic fatty liver disease

目的探讨三维斑点追踪(3D-STE)技术评估2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)患者左心室功能的可行性。方法对30例T2DM不合并NAFLD(A组)、32例T2DM合并轻度NAFLD(B组)及35例T2DM合并中重度NAFLD患者(C组)行3D-STE检查,检测常规参数,包括二尖瓣口舒张早期与晚期峰值血流速度比值(E/A)、舒张末期室间隔厚度(IVSTd)、左心室下侧壁厚度(PWTd)及舒张末期左心室内径(LVDd)、收缩末期左心室内径(LVDs),左心室功能参数包括收缩末期左心房容积(LAV)、左心室质量(LVM)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室质量指数(LVMI)、左心室射血分数(LVEF),以及3D-STE应变参数左心室整体纵向应变(GLS)、整体面积应变(GAS)、整体径向应变(GRS)和整体圆周应变(GCS)。以Pearson线性相关分析3D-STE参数与糖化血红蛋白(HbA1c)、体质量指数(BMI)的相关性。结果3组E/A、IVSTd、PWTd、LVDd、LVDs、LVMI、LVEF、LVEDV及LVESV差异均无统计学意义(P均>0.05),A、B组GRS、GCS、GLS、GAS均较C组增加(P均<0.05)。GLS、GRS、GCS、GAS与HbA1c均呈负相关(r=-0.540、-0.476、-0.489、-0.623,P=0.040、0.032、0.037、0.020),与BMI均无相关性(P均>0.05)。结论3D-STE可用于评价T2DM合并NAFLD患者左心室功能。

Objective To evaluate the feasibility of three-dimensional speckle tracking echocardiography(3 D-STE) in evaluating left ventricular(LV) function in type 2 diabetes mellitus(T2 DM) patients with non-alcoholic fatty liver disease(NAFLD). Methods Totally 30 T2 DM patients without NAFLD(group A), 32 T2 DM patients with mild NAFLD(group B) and 35 T2 DM patients with moderate to severe NAFLD(group C) underwent 3 D-STE. Echocardiographic parameters were obtained, including conventional parameters of the ratio of transmitral peak early to late diastolic velocity(E/A), interventricular septum thickness diastolic(IVSTd), posterior wall thickness diastolic(PWTd), LV end-diastolic diameter(LVDd) and LV end-systolic diameter(LVDs), as well as LV function parameters including end-systolic left atrial volume(LAV), LV mass(LVM), LV end-diastolic volume(LVEDV), LV end-systolic volume(LVESV), LV mass index(LVMI) and LV ejection fraction(LVEF), also 3 D-STE parameters including global longitudinal strain(GLS), global area strain(GAS), global radial strain(GRS) and global circumferential strain(GCS). The correlation of 3 D-STE parameters and glycosylated hemoglobin(HbA1 c), body mass index(BMI) were analyzed with Pearson linear correlation analysis. Results There was no difference of E/A, IVSTd, PWTd, LVDd, LVDs, LVMI, LVEF, LVEDV nor LVESV among the 3 groups(all P>0.05), but patients in groups B and A had higher GCS, GRS, GLS and GAS than in group C(all P<0.05). The correlation analysis showed negative correlation between GLS, GRS, GCS, GAS and HbA1 c(r=-0.540,-0.476,-0.489,-0.623, P=0.040, 0.032, 0.037, 0.020), while there was no obvious correlation between 3 D-STE parameters and BMI(all P>0.05). Conclusion 3 D-STE can be used to assess LV function in T2 DM patients with NAFLD.