组织多普勒成像评价多囊卵巢综合征患者左室舒张功能的研究

Evaluation of left ventricular diastolic function in polycystic ovary syndrome by tissue Doppler imaging

目的探讨组织多普勒成像技术评价多囊卵巢综合征(PCOS)患者左室舒张功能的临床应用价值。方法随机选取因不孕或月经不调于我院诊治的PCOS患者80例,分为体质量正常或过低40例(A组)和超重或肥胖40例(B组),均行常规超声心动图检查,测量二尖瓣舒张早期最大血流速度(E)、舒张晚期最大血流速度(A),以及二尖瓣环左侧壁附着处心肌舒张早期运动峰值速度(Em)、舒张晚期运动峰值速度(Am),并计算E/A、Em/Am及E/Em值。空腹12h后于次日清晨抽取静脉血测定血脂、血糖水平,检测血清胰岛素水平。比较两组上述参数的差异。结果B组腰臀比、胰岛素抵抗指数均高于A组,高密度脂蛋白低于A组,差异均有统计学意义(均P<0.05);两组胆固醇、甘油三酯、低密度脂蛋白水平比较,差异均无统计学意义。A组Em、Em/Am高于B组,E/Em值低于B组,差异均有统计学意义(均P<0.05);其余参数比较差异均无统计学意义。结论应用组织多普勒成像技术可观测PCOS患者左室舒张功能显著降低,其中肥胖合并胰岛素抵抗者左室舒张功能降低更明显。

Objective To explore the clinical application value of tissue Doppler imaging for evaluating left ventricular diastolic function in patients with polycystic ovary syndrome(PCOS). Methods A total of 80 patients with PCOS who were diagnosed or treated due to infertility or irregular menstruation were randomly selected,including 40 patients with normal or under-normal body mass(group A)and 40 patients with overweight or obesity(group B).Routine echocardiographic examination were performed and the data such as maximum blood flow velocity in the early stage of mitral valve relaxation(E), maximum blood flow velocity in late diastolic phase(A),peak velocity of early myocardial relaxation(Em)and peak velocity of late diastolic motion(Am)at the left wall of the mitral annulus were measured. The E/A,Em/Am and E/Em values were calculated.Venous blood of the two groups in the morning after 12 h of fasting was taken to determine blood lipids and blood glucose levels and serum insulin levels . The differences of the parameters between the above two groups were compared. Results The waist-to-hip ratio and insulin resistance index in group B were higher than those in group A,and high density lipoprotein cholesterol was lower than that in group A.The difference were statistically significant(all P<0.05).The differences of cholesterol,triglyceride and low density lipoprotein cholesterol were not statistically significant between the two groups.The Em, Em/Am in group A were higher than those in group B,and the E/Em value was lower than that in group B(all P<0.05).The differences of other parameters were not statistically significant. Conclusion The decreased left ventricular diastolic function of patients with PCOS can be observed by TDI.The left ventricular diastolic function of PCOS obese with insulin resistance is more obvious.