二维斑点追踪技术联合心肌声学造影评价2型糖尿病患者心肌微血管病变的研究

Impact research of 2D-speckle tracking echocardiography with myocardial contrast echocardiography in evaluating myocardial microvascular lesions in type 2 diabetes mellitus

目的探讨二维斑点追踪技术(2D-STE)联合心肌声学造影(MCE)评价T2DM患者心肌微血管病变的价值。方法选取2022年8~11月于空军军医大学第一附属医院内分泌科诊治的T2DM患者45例,分为单纯T2DM组(n=22)和T2DM合并微血管病变组(MIC,n=23)。另选取体检健康者24名为正常对照(NC)组。2D-STE获取整体纵向应变(GLS)、整体圆周应变(GCS),MCE获取左室平均峰值强度(A)、灌注斜率(β),计算心肌血流量(Aβ),进行组间比较。结果与NC组比较,T2DM、MIC组GLS、GCS、β、Aβ降低(P<0.05)。2D-STE及MCE各参数中,GLS、Aβ具有较高的诊断效能(P<0.05),GCS、β具有中等诊断效能(P<0.05)。受试者工作特征曲线分析显示,T2DM患者心肌微血管病变最佳截断值为-17.63%(GLS)、-21.55%(GCS)、0.845 s^(-1)(β)、7.045dB/s(Aβ)。结论T2DM患者未检出外周微血管病变时已出现心肌力学应变及灌注降低,2D-STE联合MCE可实时评估T2DM心肌弹性及微血管病变,有助于临床早期诊断糖尿病心肌病并指导干预。

Objective To evaluate myocardial microvascular lesions in patients with type 2 diabetes mellitus(T2DM)by 2D-speckle tracking echocardiography(2D-STE)and myocardial contrast echocar-diography(MCE).Methods A total of 45 T2DM patients admitted to the Endocrine Department of The First Affiliated Hospital of Air Force Military Medical University from August to November 2022 were enrolled in this study.All the patients were divided into two groups:simple T2DM group(n=22)and T2DM with microvascular complication group(MIC,n=23).In addition,24 healthy subjects were included as normal control(NC)group.2D-STE obtained the global longitudinal strain(GLS)and global circumferential strain(GCS);MCE obtained the average acoustic intensity(A),perfusion slope(b)of left ventricular segment,then myocardial blood flow(Aβ)was calculated and compared between groups.Results Compared with NC group,GLS,GCS,βand Aβwere lower in T2DM and MIC group(P<0.05).Among the parameters of 2D-STE and MCE,GLS and Aβhave high diagnostic performance(P<0.05)and GCS andβhave medium diagnostic performance(P<0.05).ROC curve analysis showed that the early warning values of myocardial microcirculation disorders were-17.63%(GLS),-21.55%(GCS),0.845 s^(-1)(β),7.045 dB/s(Aβ)in patients with T2DM.Conclusion The mechanical strain and perfusion of myocar-dium in T2DM patients have already decreased even no lesion was shown in the peripheral micro-vessels.2D-STE combined with MCE can assess the changes of myocardial elasticity and microcirculation in T2DM in real time,which is helpful for early clinical diagnosis of diabetes cardiomyopathy and intervention guidance.