定量组织速度成像评价自主神经病变对Ⅰ型糖尿病患者左室功能的影响

目的应用定量组织速度成像(QTVI)技术评价自主神经病变对Ⅰ型糖尿病患者左室舒张功能的影响。方法应用QTVI软件测定糖尿病组(60例)及正常组(30例)二尖瓣环水平后间隔、侧壁、前壁、下壁、后壁、前间隔6个部位的收缩期(Vs)、舒张早期(Ve)、舒张晚期(Va)室壁运动峰值速度,比较两组间各参数的差异性。根据心率变异分析(HRV)将糖尿病组进一步分为心自主神经功能正常组(CAN-)(22例)及心自主神经功能异常组(CAN )(38例),比较两组间Ve/Va<1的检出率是否有统计学意义。结果糖尿病组Ve低于对照组,二者有统计学意义(P<0.05);Ve/Va明显低于正常组(P<0.001),二者有统计学意义。在CAN-组中的Ve/Va<1的节段数明显少于CAN 组(χ2=82.8,P<0.001),二者有显著性差异。结论QTVI能够准确定量评价糖尿病自主神经病变患者的左室舒张功能,并能敏感反映自主神经损害对左室舒张功能的影响,为临床选择合理的治疗措施及对疗效的评判提供了定量的指标。

Evaluation of Left Ventricular Diastolic Function in type-1 Diabetic Patients with Autonomic Neuropathy by Quantitative Tissue Velocity Imaging

Objective To evaluate the left ventricular diastolic function in type-1 diabetic patients with or without autonomic neuropathy by quantitative tissue velocity imaging(QTVI).Methods QTVI was performed in diabetes mellitus (n=60) and healthy subjects (n=30).The systolic peak velocity (Vs),the peak early diastolic relaxation velocity(Ve) and late diastolic velocity(Va) were measured at six mitral annular sites with QTVI software.The parameters of mitral annular were averaged,and compared with normal group.According to the heart rate variability(HRV),the DM group were divided into two subgroup:CAN-(n=22),CAN (n=38) and compared the detecting rate of Ve/Va<1 between the two subgroups.Results The Ve and Ve/Va<1 ratio in DM group were significantly lower than normal group(P<0.05 and P<0.001).The Vs and Va have no difference between the two group(P>0.05).The difference of Ve/Va<1 numbers between the two subgroup were significant(P<0.001).Conclusions QTVI could accurately quantify the ventricular diastolic function of DM,and sensitivity reflect the effect of autonomic neuropathy lesion.This technique provides a new sensitive indicator for clinic reasonable treatment selecting and prognoses determine.