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二尖瓣环位移与实时三维超声心动图评价2型糖尿病患者左室舒张功能
作者:刘畅  颜紫宁  范莉  沈丹  李洁 
单位:南京医科大学附属常州第二人民医院 心超室, 江苏 常州 213003
关键词:二尖瓣环位移 斑点追踪显像 容积时间曲线 糖尿病 左室舒张功能 
分类号:R587.1;R445.1
出版年·卷·期(页码):2018·37·第五期(749-754)
摘要:

目的:采用二尖瓣环位移自动追踪技术(MAD)及实时三维超声心动图(RT-3DE)评价2型糖尿病患者左室舒张功能。方法:54例2型糖尿病患者根据病程分为2组:糖尿病1组26例,病程≤ 5年;糖尿病2组28例,病程>5年;选取27名体检健康的志愿者作为对照组。运用MAD测量二尖瓣环后间隔、侧壁、前壁、下壁4个位点的舒张早期位移(De)、舒张晚期位移(Da)和四腔心、两腔心舒张早期平均位移(EDe四腔心、EDe两腔心)、舒张晚期平均位移(EDa四腔心、EDa两腔心)以及双平面左室舒张早期平均位移(EDe双平面)、舒张晚期平均位移(EDa双平面)。应用RT-3DE获得左室射血分数(LVEF)、舒张末容积(EDV)、收缩末容积(ESV)及心搏出量(SV)、左室峰值充盈率(PFR),各组间进行比较。结果:二尖瓣环后间隔、侧壁、前壁、下壁4个位点的De及EDe四腔心、EDe两腔心、EDe双平面在各组间差异均有统计学意义(P<0.05);二尖瓣环4个位点的Da及EDa四腔心、EDa两腔心、EDa双平面在各组间差异无统计学意义(P>0.05)。各组间PFR差异有统计学意义(P<0.05);各组间LVEF、EDV、ESV及SV差异无统计学意义(P>0.05)。EDe双平面与PFR之间呈正相关(r=0.608,P=0.000),而EDa双平面与PFR之间无相关性(r=-0.130,P=0.348)。结论:2型糖尿病患者左心室舒张功能异常早于收缩功能异常,MAD与RT-3DE在评价2型糖尿病患者左心室整体及局部舒张功能方面有较好的相关性。

Objective:To evaluate the left ventricular diastolic function in patients with type 2 diabetes mellitus(T2DM) using mitral annulus displacement automatic tracking (MAD) and real-time three-dimensional echocardiography (RT-3DE). Methods:54 patients with T2DM were divided into two groups according to the course of disease:DM group 1(n=26) with a course less than or equal to 5 years,DM group 2(n=28) with a course more than 5 years; 27 healthy volunteers were selected as the control group. MAD was used to measure early diastolic (De) and late diastolic (Da) shifts at the posterior septum,lateral wall, anterior wall, inferior wall of the mitral valve annulus,and early mean displacement (EDefour-chamber, EDetwo-chamber), late diastolic mean displacement (EDafour-chamber, EDAtwo-chamber), double-plane of left ventricular diastolic's early mean displacement (EDedouble-plane), late diastolic mean displacement (EDadouble-plane).Left ventricular ejection fraction (LVEF), end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), and left ventricular peak filling rate (PFR) were calculated by using RT-3DE.Compared the differences between all groups. Results:There were significant differences between De and EDefour-chamber, EDetwo-chamber, and EDedouble-plane between the four sites of posterior septum,lateral wall, anterior wall, and inferior wall of mitral annulus (P<0.05). There was no significant difference in Da and EDafour-chamber, EDatwo-chamber,and EDadouble-plane in the four sites of the mitral valve annulus (P>0.05). There was a statistically significant difference in PFR between groups (P<0.05). There was no significant difference in LVEF,EDV, ESV, and SV between groups (P>0.05).There was a positive correlation between EDedouble-plane and PFR (r=0.608, P=0.000), but there was no significant correlation between EDadouble-plane and PFR (r=-0.130, P=0.348). Conclusion:Left ventricular diastolic dysfunction in patients with T2DM is earlier than systolic dysfunction. MAD and RT-3DE have a good correlation in evaluating left ventricular global and local diastolic function in T2DM patients.

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