三维超声心动图结合心肌超声造影评价2型糖尿病患者心肌功能障碍

Three-dimensional echocardiography combined with myocardial contrast echocardiography for assessment of myocardial dysfunction in patients with type 2 diabetes mellitus

目的探讨实时三维超声心动图结合心肌超声造影对评价2型糖尿病(T2DM)患者心肌功能障碍的价值。方法选取单纯糖尿病组(Ⅰ组)和糖尿病合并微血管并发症组(Ⅱ组)各29例,对照组(C组)32名,运用实时三维超声心动图获取左心室16节段、12节段及6节段达最小收缩容积时间的标准差(Tmsv16-SD、Tmsv12-SD、Tmsv6-SD)和最大时间差值(Tmsv16-Dif、Tmsv12-Dif和Tmsv6-Dif)及其心率校正值。通过心肌超声造影获得各室壁各节段的峰值强度A、充盈速度β并计算A·β,进行组间数据分析。结果①同步性运动评估:Ⅱ组除Tmsv6-Dif以外,其余左心室同步化指标均较C组延长(P均<0.05);Ⅰ组Tmsv12-Dif、Tmsv12-SD、Tmsv12-Dif%和Tmsv12-SD%较C组延长(P均<0.05)。②心肌血流灌注整体评估:C组、Ⅰ组、Ⅱ组A、β、A·β均呈逐渐下降趋势,Ⅱ组A、β及A·β均低于C组(P均<0.05);Ⅱ组β及A·β均低于Ⅰ组(P均<0.05);Ⅰ组β及A·β均低于C组(P均<0.05);3组内同一指标3个节段差异均无统计学意义(P均>0.05)。结论单纯T2DM及合并血管并发症患者左心室运动均存在不同步现象;T2DM患者心肌灌注减低,呈弥漫性损害,随其他脏器微循环病变出现而加重。

Objective To explore the value of real-time three-dimensional echocardiography(RT-3 DE) combined with myocardial contrast echocardiography(MCE) in evaluating myocardial dysfunction in type 2 diabetes mellitus(T2 DM) patients. Methods Totally 58 T2 DM patients were divided into group Ⅰ(T2 DM isolated) and group Ⅱ(T2 DM associated with microvascular complications, each n=29). Group C included 32 normal individuals. The standard deviation(Tmsv16-SD, Tmsv12-SD, Tmsv6-SD) and the maximum time difference(Tmsv16-Dif, Tmsv12-Dif, Tmsv6-Dif) of the time to the minimum systolic volume of left ventricle were measured with RT-3 DE. MCE was performed to obtain perfusion measurement of each segment of ventricular wall, including the acoustic intensity(A), microvascular flow velocity(β) and A·β. Results There were statistically significant differences in all synchronize measurements except Tmsv6-Dif between group Ⅱ and group C(all P<0.05). Tmsv12-Dif, Tmsv12-SD, Tmsv12-Dif% and Tmsv12-SD% of group Ⅰ prolonged comparing with group C(all P<0.05). All the parameters of A, β and A·β showed a gradually decreasing trend in group C, group Ⅰ and group Ⅱ, while those in group Ⅱ were lower than group C(all P<0.05). The parameters of β and A·β in group Ⅱ were lower than those in group Ⅰ(both P<0.05). Compared with group C, the values of β and A·β in group Ⅰ decreased(both P<0.05). There was no significant difference of the same measurement in segments among three groups(all P>0.05). Conclusion Left ventricular desynchrony can be observed in T2 DM patients with or without microvascular complications. Myocardial perfusion reduce in T2 DM patients presenting as diffuse damage, which aggravated with microvascular complications in other organs.