三维斑点追踪技术评估2型糖尿病早期左室心肌应变及与糖化血红蛋白的相关性研究

Left ventricular myocardial strain in early type 2 diabetes mellitus assessed by three-dimensional speckle tracking imaging and its correlation with glycosylated hemoglobin

目的探究三维斑点追踪技术(3D-STI)评估2型糖尿病(T2DM)患者早期左室心肌应变及与糖化血红蛋白(HbA1c)的相关性。方法选取2018年1~12月上饶市人民医院内分泌科住院初次诊断为T2DM的54例患者作为T2DM组,并根据HbA1c水平分为A组(HbA1c<7%,24例)、B组(HbA1c≥7%,30例)。另选取同期的30例体检正常的健康志愿者作为对照组。应用3D-STI测量左室心肌应变指标,比较三组的参数差异,并分析其与HbA1c的相关性。结果T2DM组患者的舒张末期室间隔(IVST)大于对照组,差异有统计学意义(P<0.05),但A、B两组比较,差异无统计学意义(P>0.05);T2DM组患者的E、E/A值低于对照组,A值高于对照组,且B组的E、E/A值低于A组,A值高于A组,差异有统计学意义(P<0.05);T2DM组患者的左室整体径向应变(GRS)、圆周应变(GCS)、纵向应变(GLS)、射血分数(3D-EF)均低于对照组,且B组的GLS、3D-EF低于A组,差异有统计学意义(P<0.05);Pearson相关性分析显示,HbA1c与GRS、GCS、GLS、3D-EF均成负相关(r=-0.42、-0.36、-0.45、-0.44,P<0.05)。结论3D-STI在T2DM患者早期左室心肌功能受损情况的评估方面有较高的应用价值,可敏感、全面地监测心肌早期改变,且其早期左室心肌局部收缩功能损伤程度与HbA1c成负相关。

Objective To explore the early left ventricular myocardial strain in patients with type 2 diabetes mellitus (T2DM) assessed by three-dimensional speckle tracking imaging (3D-STI) and its correlation with glycosylated hemoglobin (HbA1c). Methods A total of 54 patients firstly diagnosed as T2DM in the department of endocrinology of Shangrao People′ s Hospital from January 2018 to December 2018 were selected as T2DM group. According to HbA1c level, the patients were divided into group A (HbA1c<7%, 24 cases) and group B (HbA1c≥ 7%, 30 cases). And another 30 people with healthy physical examination at the same time period were set as control group. The left ventricular strain indexes were measured by 3D-STI, and the parameters differences were compared among the three groups, and correlation with HbA1c was analyzed. Results The interventricular septum thickness (IVST) in T2DM group was greater than that in control group, and the difference was statistically significant (P<0.05), but there was no significant difference between group A and group B (P>0.05). The E and E/A values of the T2DM group were lower than those of the control group, and A values was higher than that of the control group. The E and E/A values of the group B were lower than those of the group A, and A values was higher than that of the group A, and the differences were statistically significant (P<0.05). The left ventricular global radial strain (GRS), circumferential strain (GCS), longitudinal strain (GLS) and ejection fraction (3D-EF) in T2DM group were lower than those in control group, and the GLS and 3D-EF in group B were lower than those in group A, and the differences were statistically significant (P<0.05). Pearson correlation analysis showed that HbA1c was significantly negatively correlated with GRS, GCS, GLS and 3D-EF (r=-0.42,-0.36,-0.45,-0.44, P<0.05). Conclusion 3D-STI has a high application value in the evaluation of early left ventricular dysfunction in patients with T2DM. It can detect early myocardial changes sensitively and comprehensively, and its early left ventricular regional systolic dysfunction is negatively correlated with HbA1c.