三維斑點追蹤技術評價糖尿病患者早期左心室功能

鄭英娟 溫德惠 劉偉亮 史寶林 谷君 徐樂 孫晨曦

[摘要] 目的 探討三維斑點追蹤技術評價糖尿病患者早期左心功能。 方法 選擇2017年1月～2018年4月河北北方學院附屬第一醫院門診或住院的2型糖尿病患者83例，其中2型糖尿病44例（糖尿病組）、糖尿病合并高血壓39例（糖尿病合并高血壓組），選擇同期健康人40例（對照組）。應用超聲心動圖測量常規參數及應用三維斑點追蹤技術測量左室整體應變，包括縱向應變（GLS）、圓周應變（GCS）、面積應變（GAS）、徑向應變（GRS）及三維左室射血分數（3D-LVEF），比較三組間差異。 結果 各組二維左室射血分數（2D-LVEF）等常規超聲心動圖測值比較，差異無統計學意義（P > 0.05）。與對照組比較，糖尿病組GLS、GAS、GCS、GRS明顯降低，差異有高度統計學意義（P < 0.01），糖尿病合并高血壓組GLS、GAS、GCS、GRS、3D-LVEF明顯降低，差異有高度統計學意義（P < 0.01），與糖尿病組比較，糖尿病合并高血壓組GLS、GAS、GRS、3D-LVEF降低，差異有統計學意義（P < 0.05）。 結論 三維斑點追蹤技術在糖尿病患者2D-LVEF正常時可及早發現糖尿病心功能的改變，為臨床預防糖尿病心腦血管并發癥的發生提供影像學依據。

[關鍵詞] 三維斑點追蹤技術；心肌整體應變：心肌損害；糖尿病；左心功能

[中圖分類號] R587.2 [文獻標識碼] A [文章編號] 1673-7210（2018）12（b）-0122-05

[Abstract] Objective To evaluate left ventricular function in early stage of diabetes mellitus by three-dimensional speckle tracking technique. Methods From January 2017 to April 2018， 83 patients with type 2 diabetes who were outpatient or hospitalized in the First Affiliated Hospital of Hebei North University were selected， including 44 cases of type 2 diabetes （diabetes group）， 39 cases of diabetes complicated with hypertension （diabetes complicated with hypertension group）， and 40 cases of healthy people in the same period （control group）. Conventional echocardiography and three-dimensional speckle tracking technology were used to measure the overall left ventricular strain， including global longitudinal strain （GLS）， global circumferential strain （GCS）， global area strain （GAS）， global radial strain （GRS） and three-dimensional left ventricular ejection fraction （3D-LVEF）， and the differences between the three groups were compared. Results The value of conventional echocardiography such as two-dimensional left ventricular ejection fraction（2D-LVEF） in each groups had no significant difference（P > 0.05）.Compared with the control group， GLS， GAS， GCS and GRS in the diabetes group were significantly reduced， with highly statistically significant differences （P < 0.01）. GLS， GAS， GCS， GRS and 3D-LVEF were significantly reduced in the diabetes complicated with hypertension group， and the differences were highly statistically significant （P < 0.01）. Compared with the diabetes group， GLS， GAS， GRS and 3D-LVEF in the diabetes complicated with hypertension group were decreased， and the differences were statistically significant （P < 0.05）. Conclusion Three-dimensional spot tracking technology can detect changes in diabetic heart function early when 2D-LVEF is normal in diabetic patients， providing imaging basis for clinical prevention of diabetic heart and cerebrovascular complications.