左心自动应变分析评价高脂血症对2型糖尿病患者左心功能的影响

目的  分应用左心自动应变分析评价2型糖尿病（T2DM）患者的左心功能，旨在验证高脂血症是否加剧T2DM患者左心功能障碍，并探讨与左心应变相关的危险因素。方法  选取86例T2DM患者，根据是否合并高脂血症分为DM1组（不合并高脂血症，n=43）和DM2组（合并高脂血症，n=43）。另选取43例健康志愿者作为对照组。对所有入组人员进行常规超声心动图和左心自动应变分析检查，获取常规超声测量值和左心室心尖四腔心整体纵向应变（GLS_A4c）、左心室心尖三腔心整体纵向应变（GLS_A3C）、左心室心尖两腔心整体纵向应变（GLS_A2C）、左心室平均整体纵向应变（GLS_avg）、左房储存应变（LASr）、左房通道应变（LAScd）、左房收缩应变（LASct）。比较各组间观察指标的差异，采用多元线性回归分析确定影响左心应变的独立危险因素。结果  与对照组相比，DM1组LVGLS_A4C、LVGLS_A3C、LVGLS_A2C、LVGLS_avg、LASr、LAScd明显减低（P < 0.05）。DM2组LVGLS_A4C、LVGLS_A3C、LVGLS_A2C、LVGLS_avg、LASr、LAScd均低于其他两组（P < 0.05）。预估总胆固醇与左心LVGLS_A4C、LVGLS_A3C、LVGLS_A2C、LVGLS_avg、LASr、LAScd绝对值呈负相关关系（P < 0.001），甘油三酯与左心LVGLS_A4C、LVGLS_A3C、LVGLS_A2C、LVGLS_avg、LASr、LAScd绝对值呈负相关关系（P < 0.001）。多元线性回归分析显示，LVGLS_A4C、LVGLS_A3C、LVGLS_A2C、LVGLS_avg、LASr、LAScd绝对值与TG独立相关（P < 0.05）。结论  T2DM患者的左心应变明显受损，高脂血症可加剧糖尿病患者左心应变的恶化。TG可能是预测左心应变减低的独立危险因素。

Effect of hyperlipidemia on left ventricular function in patients with type 2 diabetes mellitus by left ventricular automatic strain analysis

Objective To evaluate the left ventricular function in patients with type 2 diabetes mellitus (T2DM) by left ventricular automatic strain analysis, and to verify whether hyperlipidemia aggravates left ventricular dysfunction in patients with T2DM, and to explore the risk factors related to left ventricular strain. Methods Eighty-six patients with T2DM were divided into DM1 group (without hyperlipidemia, n=43) and DM2 group (with hyperlipidemia, n=43). Forty- three healthy volunteers were selected as the control group. All participants underwent conventional echocardiography and left ventricular automatic strain analysis to obtain conventional ultrasound measurements and left ventricular apical four- chamber global longitudinal strain (GLSA4c), left ventricular apical three-chamber global longitudinal strain (GLSA3C), left ventricular apical two-chamber global longitudinal strain (GLSA2C), left ventricular mean global longitudinal strain (GLSavg), left atrial storage strain (LASr), left atrial channel strain (LAScd), left atrial systolic strain (LASct). The differences of observation indexes between groups were compared, and multiple linear regression analysis was used to determine the independent risk factors affecting left ventricular strain. Results Compared with the control group, LVGLSA4C, LVGLSA3C, LVGLSA2C, LVGLSavg, LASr and LAScd were significantly decreased in DM1 group (P < 0.05). LVGLSA4C, LVGLSA3C, LVGLSA2C, LVGLSavg, LASr and LAScd in DM2 group were significantly lower than those in the other two groups (P < 0.05).It was estimated that total cholesterol was negatively correlated with the absolute values of left ventricular LVGLSA4C, LVGLSA3C, LVGLSA2C, LVGLSavg, LASr and LAScd (P < 0.001), triglyceride was negatively correlated with the absolute values of left ventricular LVGLSA4C, LVGLSA3C, LVGLSA2C, LVGLSavg, LASr and LAScd (P < 0.001).The results of multiple linear regression analysis showed that the absolute values of LVGLSA4C, LVGLSA3C, LVGLSA2C, LVGLSavg, LASr and LAScd were independently correlated to TG (P < 0.05). Conclusion The left ventricular strain in patients with T2DM is significantly impaired, and hyperlipidemia can aggravate the deterioration of left ventricular strain in diabetic patients. TG may be an independent risk factor for predicting left ventricular strain reduction.