超声二维应变成像评价2型糖尿病患者左心室收缩功能

摘要

目的 探讨超声二维应变成像评价2型糖尿病患者左心室收缩功能的临床价值.方法 应用二维应变成像技术,测量无明显冠心病的37例单纯糖尿病患者、22例糖尿病合并左心室肥厚患者和30例正常对照者收缩期左心室长轴基底段、中段、心尖段纵向二维应变值,左心室短轴二尖瓣水平、乳头肌水平、心尖水平的径向二维应变值及二尖瓣水平、心尖水平心室的旋转角度.结果 两组糖尿病患者的左心室长轴基底段、中段、心尖段最大收缩期纵向平均应变值及左心室整体应变值明显低于对照组(P＜0.001),而糖尿病合并左心室肥厚组较单纯糖尿病组降低(P＜0.05或P＜0.001);二尖瓣水平、乳头肌水平、心尖水平各组间最大收缩期平均径向应变及左心室整体径向应变差异无统计学意义(P＞0.05);糖尿病患者左心室基底部、心尖部旋转角度及左心室扭转角度较对照组增大(P＜0.01或P＜0.001),糖尿病合并左心室肥厚组较单纯糖尿病组左心室心尖部旋转角度和左心室扭转角度增大(分别为P＜0.01,P＜0.05).结论 超声二维应变成像对早期诊断无明显冠心病的糖尿病患者左心室收缩功能受损有临床价值.%Objective To assess the short-axis and long-axis systolic function of the left ventricle (LV) in patients with type 2 diabetes mellitus and without coronary artery disease using two-dimensional strain echocardiography.Methods Eighty-nine subjects with normal ejection fraction were included:37 with diabetes mellitus(DM group),22 with both diabetes and left ventricular hypertrophy(DH group), and 30 normal controls.Two-dimensional strain images were acquired from the LV short-axis view at the levels of mitral annulus, papillary muscle and apex, and the apical four-chamber view, two-chamber view and long-axis views of the LV respectively.The longitudinal strain was measured in the apical views.The radial strain and the rotation were measured in the LV short-axis views.The LV twist was defined as the apical rotation relative to the base.Results The average peak systolic longitudinal strain of different segments and the peak longitudinal global strain in DM group and DH group were significantly reduced when compared with those in control groups ( P＜0.001 ),and these parameters in DH group were significantly lower than those in DM group (P＜0.001 or P＜0.05).There was no significant difference in the average peak systolic radial strain of different segments and peak radial global strain among all groups ( P＞0.05).The LV rotations and the LV twist were significantly higher both in DM group and in DH group than in control group ( P＜0.001 or P＜0.01),and the basal LV rotation and the LV twist were larger in DH group than in DM group ( P＜0.01, P＜0.05).Conclusions Two-dimensional strain echocardiography may be used to identify the LV systolic function in patients with type 2 diabetes mellitus.