二维斑点追踪技术评价2型糖尿病合并微血管病变患者左心室收缩功能的价值

摘要

Objective To evaluate the left ventricular systolic function of patients with type 2 diabetes combined with microangiopathy using two dimensional speckle tracking imaging. Methods A total of 29 simple diabetes patients from January 2016 to December in Zhejiang Chinese Medicine University Affiliated Jiaxing Hospital of Traditional Chinese Medicine (DM group), 35 diabetes patients with microvascular disease (diabetic microangiopathy group), and 35 healthy volunteers (healthy control group) were enrolled in present study. The conventional echocardiography was used to evaluated the left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVEDS), end diastolic ventricular septal thickness (IVSDD), left ventricular posterior wall end diastolic thickness (LVPWTD), left ventricular ejection fraction (LVEF), and left atrial volume index (LAVI). Using pulsed Doppler technique, the mitral early diastolic and late diastolic blood flow velocity ratio (E/A), E peak deceleration time (DCT), the organization of the mitral E wave velocity and the Doppler organization Doppler e' ratio (E/e) were measured. Automatic functional imaging was used to calculate the left ventricular apical axis, the four cavities of the apex, the two cavities of the apex and the overall mean longitudinal strain of the left ventricle. The clinical data, routine echocardiographic parameters and strain parameters among 3 groups were compared by one-way ANOVA. The Tukey HSD method was used to compare the differences between two groups. Pearson correlation analysis was used to analyze the correlation between the total mean longitudinal strain of left ventricle and the concentration of glycosylated hemoglobin, triglyceride concentration and systolic pressure. Results Among the 3 groups, the subject age, heart rate, body mass index had no significant difference. In diabetic microangiopathy group, the glycosylated hemoglobin concentration, triglyceride, systolic blood pressure were higher than that in healthy control and diabetic groups, and the differences were statistically significant (t=16.135, 8.947; t=8.777, 10.947; t=13.806, 8.278, all P＜0.05). The 3 groups had no significant differences in LVEDD, LVEDS, IVSDD, LVPWTD, DCT and LVEF. Compared with healthy controls, patients with diabetes mellitus showed decreased E/A and increased E/e; while patients with diabetic microangiopathy had decreased E/A and increased LAVI and E/e (t=13.786, 13.565; t=9.571, 11.267, 8.351, all P＜0.05). In the left ventricular apical long axis view, four chamber view, two chamber view and left ventricular overall average longitudinal strain values, increasing trend was found from healthy control group, to DM group, and to diabetic microangiopathy group, and the differences between any 2 groups were statistically significant (t=5.491, 10.907, 6.076; t=4.276, 7.011, 3.250; t=10.445, 11.633, 3.683; t=10.746, 18.731, 9.532; all P＜0.05). Pearson correlation analysis showed that the mean longitudinal strain value of left ventricle was negatively correlated with glycosylated hemoglobin concentration (r=-0.746, P=0.000), and there was no correlation with the triglyceride concentration and systolic blood pressure (r=0.079, P=0.438; r=0.067, P=0.416). Conclusion The two-dimensional speckle tracking imaging technique can effectively evaluate the left ventricular systolic function in patients with type 2 diabetic microangiopathy.%目的 应用二维斑点追踪技术评价2型糖尿病合并微血管病变患者左心室收缩功能.方法 选择2016年1至12月浙江中医药大学附属嘉兴中医院收治的单纯糖尿病患者29例(单纯糖尿病组)、糖尿病合并微血管病变患者35例(糖尿病合并微血管病变组)及体检的健康志愿者35名(健康对照组).常规超声心动图获得左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVEDS)、室间隔舒张末期厚度(IVSDD)及左心室后壁舒张末期厚度(LVPWTD)、左心室射血分数(LVEF)、左心房容积指数(LAVI),采用脉冲多普勒技术测量二尖瓣舒张早期与舒张晚期血流速度之比(E/A)、E峰减速时间(DCT),采用组织多普勒技术测量二尖瓣口E波流速与组织多普勒e'比值(E/e).应用自动功能成像技术计算左心室心尖长轴、四腔心、二腔心切面及左心室整体平均纵向应变值.采用单因素方差分析比较3组受检者一般临床资料、常规超声心动图参数、应变参数,进一步组间两两比较采用Tukey HSD法.采用Pearson相关分析法分析左心室整体平均纵向应变值与糖化血红蛋白浓度、甘油三酯浓度及收缩压的相关性.结果 3组受检者年龄、心率、体重指数差异均无统计学意义,而糖尿病合并微血管病变组患者糖化血红蛋白浓度、甘油三酯浓度、收缩压均较健康对照组受检者、单纯糖尿病组患者高,且差异均有统计学意义(t=16.135、8.947;t=8.777、10.947;t=13.806、8.278,P均＜0.05).3组受检者LVEDD、LVEDS、IVSDD、LVPWTD、DCT、LVEF差异均无统计学意义;与健康对照组受检者比较,单纯糖尿病组患者E/A减小,E/e增大;糖尿病合并微血管病变组患者E/A减小,LAVI、E/e均增大,且差异均有统计学意义(t=13.786、13.565;t=9.571、11.267、8.351,P均＜0.05).左心室心尖长轴、四腔心、二腔心切面及左心室整体平均纵向应变值均为健康对照组＞单纯糖尿病组＞糖尿病合并微血管病变组,且任意2组间差异均有统计学意义(t=5.491、10.907、6.076;t=4.276、7.011、3.250;t=10.445、11.633、3.683;t=10.746、18.731、9.532;P均＜0.05).Pearson相关分析结果显示,左心室整体平均纵向应变值与糖化血红蛋白浓度呈负相关(r=-0.746,P=0.000),与甘油三酯浓度、收缩压均无相关性(r=0.079, P=0.438;r=0.067,P=0.416).结论 二维斑点追踪技术可有效评估合并微血管病变的2型糖尿病患者左心室收缩功能.