超声三维斑点追踪技术评价非酒精性脂肪性肝病合并2型糖尿病患者左心功能研究

Evaluation of left ventricular functions by three-dimensional speckle tracking imaging in patients with non-alcoholic fatty liver disease and type 2 diabetes mellitus

目的探讨采用超声三维斑点追踪技术(3D-STI)评价非酒精性脂肪性肝病(NAFLD)合并2型糖尿病(T2DM)患者左心功能的价值。方法2019年6月~2021年6月我院诊治的60例NAFLD合并T2DM患者(轻度NAFLD 30例,重度30例)和同期30例T2DM患者,检测血清空腹血糖(FPG)、糖化血红蛋白(HbA1c)、谷丙转氨酶(ALT)和谷草转氨酶(AST)水平。采用常规二维超声测量左室舒张末内径(LVDd)、左室收缩末内径(LVDs)和二尖瓣口舒张早期和舒张晚期峰值血流速度比值(E/A比值)。采用实时三维超声测量左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室射血分数(LVEF)和左室质量指数(LVMI)。采用3D-STI技术测量左心室整体纵向应变(GLS)、整体周向应变(GCS)、整体径向应变(GRS)和整体面积应变(GAS)。结果重度NAFLD合并T2DM患者血清HbA1c、ALT和AST水平分别为(8.9±2.4)%、(127.2±16.9)U/L和(91.2±11.5)U/L,显著高于轻度NAFLD合并T2DM患者【分别为(7.2±2.9)%、(61.6±10.4)U/L和(60.7±9.6)U/L,P<0.05】或单纯T2DM患者【分别为(7.0±2.5)%、(31.7±5.5)U/L和(33.5±4.8)U/L,P<0.05】;三组LVDd、LVDs、E/A比值、LVEF、LVEDV、LVESV和LVMI比较均无统计学差异(P>0.05);重度NAFLD合并T2DM患者GLS、GCS、GRS和GAS分别为(14.3±3.9)%、(17.3±3.3)%、(40.6±6.2)%和(24.1±4.6)%,显著低于轻度NAFLD合并T2DM患者【分别为(17.7±2.8)%、(19.4±2.7)%、(44.9±8.7)%和(27.0±4.4)%,P<0.05】或单纯T2DM患者【分别为(18.9±2.4)%、(19.6±3.1)%、(45.5±6.4)%和(28.8±3.6)%,P<0.05】。结论采用3D-STI技术检测可以敏感地反映NAFLD合并T2DM患者左心功能变化,有助于临床早期正确评估其心功能状态。

Objective The aim of this study was to explore the evaluation of left ventricular functions by three-dimensional speckle tracking imaging(3D-STI)in patients with non-alcoholic fatty liver disease(NAFLD)and type 2 diabetes mellitus(T2DM).Methods 60 patients with NAFLD and T2DM(mild NAFLD in 30 and severe in 30)and 30 patients with T2DM were admitted in our hospital between June 2019 and June 2021.Serum fasting plasma glucose(FPG),glycosylated hemoglobin(HbA1c),alanine aminotransferase(ALT)and aspartate aminotransferase(AST)levels were detected.The left ventricular end-diastolic diameter(LVDd),left ventricular end-systolic diameter(LVDs)and ratio of peak systolic velocity to end-diastolic velocity(E/A)were measured by routine two-dimensional ultrasound.The left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular ejection fraction(LVEF)and left ventricular mass index(LVMI)were measured by real-time three-dimensional ultrasound.The left ventricular global longitudinal strain(GLS),global circumferential strain(GCS),global radial strain(GRS)and global area strain(GAS)were detected by 3D-STI.Results Serum HbA1c,ALT and AST levels in patients with severe NAFLD and T2DM were(8.9±2.4)%,(127.2±16.9)U/L and(91.2±11.5)U/L,significantly higher than[(7.2±2.9)%,(61.6±10.4)U/L and(60.7±9.6)U/L,respectively,P<0.05]in patients with mild NAFLD and T2DM or[(7.0±2.5)%,(31.7±5.5)U/L and(33.5±4.8)U/L,respectively,P<0.05]in patients with T2DM;there were no significant differences in LVDd,LVDs,ratio of E/A,LVEF,LVEDV,LVESV and LVMI among the three groups(P>0.05);the GLS,GCS,GRS and GAS in patients with severe NAFLD and T2DM were(14.3±3.9)%,(17.3±3.3)%,(40.6±6.2)%and(24.1±4.6)%,significantly lower than[(17.7±2.8)%,(19.4±2.7)%,(44.9±8.7)%and(27.0±4.4)%,respectively,P<0.05]in patients with mild NAFLD and T2DM or[(18.9±2.4)%,(19.6±3.1)%,(45.5±6.4)%and(28.8±3.6)%,respectively,P<0.05]in patients with T2DM.Conclusion The 3D-STI detection could sensitively reflect changes of left ventricular functions in patients with NAFLD and T2DM,which is beneficial to correctly evaluate impairment of cardiac functions in this setting.