多参数超声评估妊娠期糖尿病患者右心室功能早期损害的研究

The value of multiparameter ultrasound in evaluating the early impairment of right ventricular function in gestational diabetic mellitus(GDM)

目的探讨多参数超声评估妊娠期糖尿病患者(GDM)右心室功能早期损害。方法选择2018年1月~2018年11月我院60例孕28~40周糖尿病患者为(GDM)组及60例非糖尿病妊娠28~40周为对照。选择测量右心室侧壁厚度、三尖瓣E/A、E/E'、三尖瓣环侧壁收缩期组织速度(S)、三尖瓣环侧壁收缩期位移(TAPSE)、右心室整体功能指数(RV-Tei)及右心室二维斑点追踪(2D-STI)成像技术等参数,统计分析各参数测值差异。结果(GDM)组与对照组相比,GDM患者右心室侧壁厚度较对照组稍增厚,且差异有统计学意义(P<0.05)。三尖瓣环侧壁收缩期位移(TAPSE)、三尖瓣环侧壁收缩期组织速度(S)、右心室大小(右心室基底段左右径)、右心室面积变化率(RVFAC)与对照组无明显差异,无统计学意义(P>0.05);GDM患者E/A参数对比较对照组减低,E/E'参数对比较对照组明显增高,右心室整体功能指数(RV-Tei)较对照组明显增高,差异有统计学意义(P<0.05)。右心室壁2D-STI成像纵向应变峰值显示GDM患者在右室侧壁-Bas、-Mid段,室间隔-Bas、-Mid段应变峰值较对照组减小,差异有统计学意义(P<0.05)。结论右心室侧壁厚度、三尖瓣E/A、E/E'、RV-Tei、右心室2D-STI成像技术等多参数评估右心室功能早期改变,且早于右心室收缩功能受损出现之前,可作为妊娠期糖尿病患者右心功能评估早期敏感指标。

Objective To explore the value of multiparameter ultrasound in evaluating the early impairment of right ventricular function in gestational diabetic mellitus(GDM).Methods Sixty patients diagnosed GDM from 28 weeks to 40 weeks at shenzhen longgang central hospital from 2018 January to 2018 November,were selected then 60 pregnant women with no diabetic pregnancy from 28 weeks to 40 weeks were taken as control group.Then the thickness of the right ventricle side wall,tricuspid E/A,E/E',Tmitral flap lateral wall systolic tissue velocity(S),Tridentate ring wall contraction phase displacement(TAPSE),the right ventricle overall function index(RV-Tei)and two-dimensional speckle tracking imaging technology were measured,then statistical differences analysis of each parameter were made between two groups.Results Compared with control group,the thickness of the right ventricle side wall in GDM patients was slightly thicker than that of the control group,and the difference was statistically significant(P<0.05).There was no significant difference about tridentate ring wall contraction phase displacement(TAPSE),Tmitral flap lateral wall systolic tissue velocity(S),Right heart size(right ventricle basal segment left and right),RVFAC between two groups(P>0.05);The E/A parameters of GDM patients were reduced for the control group.E/E',parameters increased significantly for the control group.The right ventricular total function index(RV-Tei)was significantly higher than that of the control group,and the difference was statistically significant(P<0.05).Longitudinal strain peak of 2D-STI imaging in right ventricle wall,the Right ventricle side wall-Bas,-Mid segment,ventricular septum-Bas,-Mid segment,the strain peak were decreased compared with the control group.The differences were statistically significant(P<0.05).Conclusion Multiple parameters such as thickness of the right ventricle side wall,tricuspid E/A,E/E,right ventricle overall function index(RV-Tei),right ventricular 2D-STI imaging to assess were all early changes in right ventricular function,and the changes happened before the right ventricular contractility was impaired,It can be used as an early sensitive index for right heart function evaluation in gestational diabetes patients.