妊娠期糖尿病对胎儿超声心动图肺静脉血流频谱及心脏功能的影响

Effects of gestational diabetes mellitus on fetal echocardiographic pulmonary venous flow pattern and its relationship with fetal left ventricular diastole

目的探讨妊娠期糖尿病(GDM)对胎儿超声心动图检查肺静脉血流频谱及心脏功能的影响。方法选取我院诊断的GDM孕妇190例作为GDM组,另选取同期在我院行超声检查的健康孕妇203例作为对照组,GDM组依据不同血糖控制水平分为GDM1组(血糖控制稳定)112例和GDM2组(血糖控制不佳)78例。比较各组孕妇糖化血红蛋白(HbAlc)水平,并行超声心动图检查,比较各组孕妇宫内胎儿左心室结构相关参数。结果GDM2组空腹血糖、餐后2 h血糖和HbAlc水平、左心室厚度(LVWT)、室间隔舒张末期厚度(IVSd)、肺静脉峰值流速(PVIV)、肺静脉搏动指数(PI)均高于对照组和GDM1组,GDM1组上述指标均高于对照组,差异有统计学意义(P<0.05);GDM2组左心室短轴缩短率(LVFS)、左心室射血分数(LVEF)、A峰流速均低于对照组和GDM1组,差异有统计学意义(P<0.05);GDM1组上述指标均低于对照组,差异有统计学意义(P<0.05)。GDM1组、GDM2组HbAlc与LVWT、IVSd均呈正相关(P<0.05),与LVFS、LVEF均呈负相关(P<0.05);GDM1组、GDM2组胎儿肺静脉血流频谱A峰流速与PVIV和PI均呈负相关(P<0.05)。结论GDM对胎儿肺静脉血流频谱参数A峰流速的下降和PVIV与PI的升高提示GDM孕妇胎儿左心室舒张功能的下降。

Objective To analyze the effects of gestational diabetes mellitus(GDM)on fetal echocardiographic pulmonary venous flow pattern and its relationship with fetal left ventricular diastole.Methods 190 pregnant women with GDM diagnosed were selected as the GDM group,and 203 healthy pregnant women who underwent ultrasound examination in the hospital during the same period were enrolled as the control group.The pregnant women in the GDM group were divided into GDM1 group(stable blood glucose control group,n=112)and GDM2 group(poor blood glucose control group,n=78)according to different blood glucose control levels.The level of glycosylated hemoglobin(HbAlc)of pregnant women in each group was compared and echocardiography was performed.Intrauterine fetal left ventricular structure-related parameters[left ventricular wall thickness(LVWT),left ventricular fractional shortening(LVFS),left ventricular ejection fraction(LVEF),inter-ventricular septum enddiastolic thickness(IVSd)]and left ventricular diastolic function-related pulmonary venous flow pattern parameters[peak systolic velocity(S peak),peak diastolic velocity(D peak),atrial end diastolic velocity(A peak),peak pulmonary vein velocity(PVIV)and pulmonary vein pulse index(PI)]were compared among the groups,and the correlation among the parameters was analyzed.Results In GDM group 2,fasting blood glucose,postprandial 2h blood glucose,HbAlc levels,LVWT,IVSd,PVIV,and PI were all higher than those in the control group and GDM group 1,while in GDM group 1,these indicators were higher than those in the control group(P<0.05).LVFS,LVEF,and A wave velocity were lower in GDM group 2 compared to the control group and GDM group 1(P<0.05);similarly,in GDM group 1,these indicators were lower than in the control group(P<0.05).In both GDM group 1 and GDM group 2,HbAlc levels were positively correlated with LVWT and IVSd(P<0.05)and negatively correlated with LVFS and LVEF(P<0.05).Furthermore,in both GDM group 1 and GDM group 2,the A wave velocity of fetal pulmonary vein blood flow spectrum was negatively correlated with PVIV and PI(P<0.05).Conclusion The decrease of fetal pulmonary venous flow pattern parameter A peak velocity and the increases of PVIV and PI in pregnant women with GDM suggest the decrease of left ventricular diastolic function of fetuses,and can provide evidence for clinical diagnosis and treatment.