多普勒超声联合脑钠素对2型糖尿病心肌病变的诊断价值

Doppler ultrasonography and brain natriuretic peptide for the diagnosis of myocardial lesion in type 2 diabetes

目的:探讨多普勒超声结合血浆脑钠肽(BNP)对2型糖尿病心肌病变的早期诊断价值。方法:选择96例符合诊断标准的住院患者,根据多普勒超声测定二尖瓣舒张早期峰值速度(Ea),舒张晚期峰值速度(Aa),根据Ea峰/Aa峰小于<1和≥1分为异常组和对照组;研究对象进行统一生化指标和血浆脑钠肽检测、十二导联心电图检查和M型二维超声心动图检测心脏四腔内径及心泵功能,记录左房前后径、左室内径(舒张/收缩)、收缩末期容积(ESV)、舒张末期容积(EDV)、射血分数(EF)、收缩分数(FS)、心搏出量(SV)等数值,进行统计比较。结果:异常组除左室内径(舒/缩)外其他选定指标与正常组和对照组比较均有统计学意义(P<0.01);对照组和正常组比较只有FS(%)和SV(ml)比较有显著性差异(P<0.05);对可能相关因素分析发现糖尿病患病年限与心室的舒缩相关(r=0.234,r=0.278,P<0.05),糖化血红蛋白与心肌内分泌(r=-0.375,P<0.05)和心泵功能密切相关(r=0.630,P<0.05)。结论:组织多普勒超声对糖尿病早期心肌病变无创伤性的诊断作用优势突出,并结合血浆脑钠肽的化验,更提高了诊断的准确性及敏感性,值得临床推广应用。

Objective: To study of plasma brain natriuretic peptide(BNP) by doppler imaging and the value in early diagnosis of myocardial lesion in type 2 diabetes. Methods: 96 cases of hospitalized patients of meeting the diagnostic criteria were selected in which mitral peak early diastolic velocity(Ea) and late diastolic peak velocity(Aa) were measured according to Doppler sonographic.All cases were divided into study group and control group according to the Ea peaks /Aa smaller than 1 and ≥1.Biochemical indices,plasma brain natriuretic peptide assay,twelve lead electrocardiogram,M type two-dimensional ultrasound heartbeat map detection heart four chamber diameter and cardiac pump function;the left atrial diameter,left ventricular diameter(diastolic/systolic),end systolic volume(ESV),end diastolic volume(EDV),shoot ejection fraction(EF),fractional shortening(FS),cardiac output(SV) numerical were observed and statistical comparisons in two groups. Results: The abnormal group except for left ventricular diameter(Shu/shrinkage),other selected index in the normal group and the control group were statistically significant(P<0.01);FS(%)and SV(ml)were only significant difference between the control group and the normal group(P <0.05).The possible correlated factors analysis showed that duration of diabetes and left ventricular diastolic,glycosylated hemoglobin and cardiac endocrine and cardiac pump function were closely correlation(γ=0.234,0.278;-0.375 and 0.630,P<0.05). Conclusion: The advantage of tissue doppler imaging diagnosis of non traumatic on myocardial lesions in diabetic early prominent is highlight,which combine with plasma brain natriuretic peptide assay can improve the diagnostic accuracy,sensitivity,and be worthy of clinical application.