妊娠期糖尿病孕妇孕晚期糖化血红蛋白与母体左心室心肌做功改变的相关性

Correlation Between Hemoglobin A1c and Changes of Left Ventricular Myocardial Work in the Third Trimester of Pregnant Women with Gestational Diabetes Mellitus

目的应用压力-应变环定量评估妊娠期糖尿病孕妇孕晚期母体左心室心肌做功改变,并探讨糖化血红蛋白(HbA1c)水平与心肌做功参数的相关性。资料与方法前瞻性选取2021年6月—2022年6月河南省人民医院的妊娠期糖尿病且足月分娩者79例,分为HbA1c≥6%组(A组,39例)与HbA1c<6%组(B组,40例),同期纳入健康孕妇40例作为对照(C组)。研究对象均于妊娠24~28周行75 g口服葡萄糖耐量试验,并随访至分娩,记录相关数据,行超声心动图检查采集相关图像进行分析,获取左心室心肌做功参数[整体纵向应变(GLS)、心肌整体做功指数(GWI)、整体有用功(GCW)、整体做功效率(GWE)、整体无用功(GWW)]及左心室三维参数,并对3组间的参数进行比较分析。结果A、B组葡萄糖耐量试验参数、HbA1c较C组增高(P均<0.05);分娩前A组血糖参数、HbA1c较B、C组增高(P均<0.05)。A组GLS绝对值、GWE较B、C组降低,GWW较B、C组增高(P均<0.05),GWI、GCW较C组降低(P均<0.05)。HbA1c与GLS绝对值、GWI、GCW、GWE呈中度负相关(r=−0.513、−0.526、−0.485、−0.430,P均<0.001),与GWW呈中度正相关(r=0.568,P<0.001)。结论心肌做功参数GLS、GWE、GWI、GCW、GWW在评估妊娠期糖尿病孕妇孕晚期母体不同血糖水平下左心室心肌做功改变方面具有潜在应用价值,压力-应变环作为一种无创定量评估左心室心肌做功改变的新技术,可以为此提供一定有效依据。

Purpose To quantitatively evaluate the changes of maternal left ventricular myocardial work in the third trimester of pregnancy with diabetes mellitus by pressure strain loop(PSL),and to analyze the relationship between the level of hemoglobin A1c(HbA1c)and parameters of myocardial work.Materials and Methods A total of 79 pregnant women with diabetes mellitus who were diagnosed in Henan Provincial People's Hospital from June 2021 to June 2022 and delivered at full-term were prospectively selected,39 cases with HbA1c≥6%were divided into group A;40 cases with HbA1c<6%were divided into group B.At the same time,40 healthy pregnant women were included as controls(group C).All the participants performed a 75 g oral glucose tolerance test at 24-28w of pregnancy,followed up to delivery,and relevant clinical data were recorded.Relevant images for analysis were collected by echocardiography,and parameters of left ventricular myocardial work[global longitudinal strain(GLS),global work index(GWI),global constructive work(GCW),global work efficiency(GWE),global wasted work(GWW)]and three-dimensional data were obtained,and all parameters were compared and analyzed among the three groups.Results The parameters of oral glucose tolerance test and HbA1c in group A and B were all significantly higher than those in group C(all P<0.05);before delivery,blood glucose and HbA1c in group A were all significantly higher than those in group B and C(all P<0.05).The absolute value of GLS and GWE in group A were significantly lower than those in groups B and C,while GWW was significantly higher than those in groups B and C(all P<0.05),and GWI and GCW in group A were significantly lower than those in group C(all P<0.05).HbA1c was moderately negatively correlated with the absolute value of GLS,GWI,GCW and GWE of PSL parameters(r=−0.513,−0.526,−0.485,−0.430,all P<0.05),and moderately positively correlated with GWW(r=0.568,P<0.05).Conclusion GLS,GWE,GWI,GCW,GWW have potential application value in evaluating the changes of left ventricular myocardial work under different maternal blood glucose levels in the third trimester of pregnant women with diabetes,and as a new technology,PSL can provide some effective basis for this.