二维斑点追踪超声心动图联合血清HbA1c评估妊娠期糖尿病胎儿心脏功能

Assessment of fetal cardiac function in gestational diabetes mellitus by two-dimensional speckle tracking echocardiography combined with serum HbA1c

目的应用二维斑点追踪超声心动图(2-dimensional speckle tracking echocardiography,2D-STE)评估胎儿心肌功能,以确定妊娠期糖尿病对胎儿心肌收缩功能的影响。方法本研究纳入了50例妊娠期糖尿病孕妇(其中A组28例,5.7%≤HbA1c<6.5%;B组22例,HbA1c≥6.5%),43例健康孕检孕妇(HbA1<5.7%)为对照组,应用2D-STE测量三组胎儿左室整体心肌纵向应变(Global longitudinal strain,GLS),根据孕妇HbA1c水平分层探讨妊娠期糖尿病对胎儿心脏收缩功能的影响。结果三组间胎儿室间隔厚度、左室后壁厚度依次增厚,两两相比差异有统计学意义(均P<0.001)。与对照组相比,B组预估的胎儿体重更大,两者间有统计学差异,B组预估的胎儿体重较A组大,但两者间差异无统计学意义。妊娠期糖尿病组胎儿二尖瓣E/A均高于对照组,差异有统计学意义,而妊娠期糖尿病组两组间的胎儿二尖瓣E/A差异无统计学意义。三组间胎儿GLS依次减低,两两相比差异有统计学意义(P<0.001)。结论妊娠期糖尿病胎儿存在左室收缩舒张功能障碍,二维斑点追踪超声心动图可以提供比传统超声心动图更多额外的信息,能检测到亚临床左室心肌收缩功能减退。积极控制妊娠期糖尿病母体HbA1c水平可改善胎儿心肌功能。

Objective To apply 2-dimensional speckle tracking echocardiography(2D-STE)to assess fetal cardiac function to determine the effect of gestational diabetes on fetal myocardial systolic function.Methods Fifty pregnant women with gestational diabetes mellitus(28 in group A,5.7%≤HbA1c<6.5%;22 in group B,HbA1c≥6.5%),and 43 pregnant women with healthy pregnancy test(HbA1<5.7%)were included in the study,and 2D-STE was applied to measure the peak of global longitudinal myocardial strain in the left ventricle(GLS)of the fetuses in all three groups,stratified according to the level of HbA1c,to explore the effect of gestational diabetes mellitus on the fetal cardiac systolic strain.Results Fetal IVST and LVPWT were thickened sequentially between the three groups,the differences were statistically significant(all P<0.001),and the predicted fetal weight was greater in group B compared to the control group,and the difference was,while the predicted fetal weight was greater in group B compared to group A,but the difference was not between the two groups.The fetal mitral E/A was higher in the gestational diabetes group than in the control group,and there were statistically differences,fetal mitral E/A there was no significant differences in between the two groups in the gestational diabetes group.GLS of the fetal left ventricular myocardium was reduced sequentially between the three groups,the differences were statistically significant both groups(P<0.001).Conclusion Fetuses with gestational diabetes mellitus have left ventricular systolic-diastolic dysfunction,and 2-dimensional speckle tracking echocardiography can provide additional information to detect subclinical left ventricular myocardial hypercontractility than conventional echocardiography.Active control of maternal HbA1c levels in gestational diabetes mellitus improves fetal myocardial function.