四维超声心动图评价糖尿病肾脏微血管病变对左心房功能影响的价值

Left atrial function in patients with diabetic renal microangiopathy evaluated by four-dimensional echocardiography

目的探讨四维超声心动图评价糖尿病肾脏微血管病变对左心房功能影响的价值。方法选取2021年1至12月杭州市临平区第一人民医院收治的2型糖尿病患者95例,其中糖尿病肾微血管病变患者(肾微血管病变组)42例,非肾微血管病变患者(非肾微血管病变组)53例,另择同期健康体检者65名为正常对照组,所有入选者均行超声心动图检查,脱机分析左心室全容积四维图,测定左心房舒张末期容积(LAVd)、左心房收缩末期容积(LAVs)、左心房射血前期容积(LAVp)、左心房排血分数(LAEF)、左心房每搏排血容积(LAEV);计算左心房舒张末期容积指数(LAVdI)、左心房收缩期末期容积指数(LAVsI)、左心房射血前容积指数(LAVpI)、左心房每分排血量(LAOM)、左心房被动排血容积(LAPV)、左心房主动排血容积(LAAV)、左心房被动排血分数(LAPEF)、左心房主动排血分数(LAAEF)、左心房被动排空率(LAPER)、左心房主动排空率(LAAER)。将糖尿病患者的尿微量白蛋白、尿总蛋白/尿肌酐与左心房功能参数进行直线相关性分析。结果糖尿病肾微血管病变组的LAVd、LAVdI、LAVs、LAVsI、LAVp、LAVpI、LAOM、LAPV、LAAV、LAPEF、LAPER、LAAER与正常对照组比较差异均有统计学意义(均P<0.05);糖尿病肾微血管病变组的LAVd、LAVdI、LAVs、LAVsI、LAVp、LAVpI、LAOM、LAAV与非肾微血管病变组比较差异均有统计学意义(均P<0.05)。尿微量白蛋白与LAVdI相关性较强(r=0.67,P<0.01),直线回归方程为:Y=0.007X+8.710;尿总蛋白/尿肌酐与LAVd相关性较强(r=0.49,P<0.01),直线回归方程为:Y=0.005X+14.629。结论糖尿病肾脏微血管病变使左心房各期相容积负荷增大,使其贮备功能和泵血功能较非微血管病变患者更进一步代偿,尿微量白蛋白和尿总蛋白/尿肌酐可反映其功能,同时,左心房舒张末期容积及指数也能较好地反映糖尿病患者肾脏微血管病变程度。

Objective To evaluate left atrial function in patients with diabetic renal microangiopathy with four dimensional echocardiography.Methods Ninety five patients with type 2 diabetes mellitus(T2DM)admitted in Linping District Hospital were enrolled in the study,including 42 cases complicated with renal microangiopathy(RM group)and 53 cases without renal microangiopathy(non-RM group),65 healthy subjects served as normal control group.All subjects underwent echocardiography examination and the four-dimensional total volume maps of left ventricle were analyzed.Left atrial end diastolic volume(LAVd),left atrial end systolic volume(LAVs),left atrial pre-ejection volume(LAVp),left atrial ejection fraction(LAEF),left atrial ejection volume(LAEV)were measured.The Left atrial end diastolic volume index(LAVdI),left atrial end systolic volume index(LAVsI),left atrial pre-ejection volume index(LAVpI),left atrial output per minute(LAOM),left atrial passive drainage volume(LAPV),left atrial active drainage volume(LAAV),left atrial passive ejection fraction(LAPEF),left atrial active ejection fraction(LAAEF),left atrial passive emptying rate(LAPER),left atrial active emptying rate(LAAER)were caculated.The linear correlations between urinary microalbumin,urinary total protein/creatinine and left atrial function parameters were analyzed.Results There were significant differences in LAVd,LAVdI,LAVs,LAVsI,LAVp,LAVpI,LAOM,LAPV,LAAV,LAPEF,LAPER,and LAAER between RM group and normal control group(all P<0.05).There were significant differences in LAVd,LAVdI,LAVs,LAVsI,LAVp,LAVpI,LAOM,and LAAV between RM group and non-RM group(all P<0.05).The urinary microalbumin was significantly correlated with LAVdI(r=0.67,P<0.01),and the linear regression equation was Y=0.007X+8.710.The urinary total protein/creatinine was significantly correlated with LAVd(r=0.49,P<0.01),the linear regression equation was Y=0.005X+14.629.Conclusion Diabetic renal microangiopathy increased the volume load of left atrial phase,and the left atrial reserve function and blood pumping function were more compensated than those in patients with non-microangiopathy.Urinary microalbumin and urinary total protein/creatinine can reflect its functions,meanwhile,left atrial end diastolic volume and its index can also better reflect the degree of renal microvascular disease in diabetes patients.