定量组织多普勒技术在评价早期2型糖尿病左心室舒缩功能中的临床应用

目的探讨组织多普勒成像（TDI）技术在评价早期2型糖尿病患者（T2DM）左室功能方面的临床应用价值。方法对早期T2DM患者（T2DM组）及正常组（NC组）各45例,应用TDI技术检测二尖瓣环左室壁侧运动频谱,测量收缩期、舒张早期、舒张晚期运动峰值（分别为Vs、Ve、Va）,并计算Ve/Va;应用脉冲多普勒（PDE）检测二尖瓣口血流频谱,测量二尖瓣口舒张早期、舒张晚期血流速度（分别为E、A）,并计算E/A;常规超声心动图用Simpson′s法测量左室射血分数（LVEF）。结果收缩功能指标：T2DM组与NC组的LVEF均在正常范围,差异无统计学意义（P〉0.05）,而T2DM组二尖瓣环室壁侧Vs低于NC组（P〈0.05）。舒张功能指标：T2DM组Ve、Ve/Va、E/A均低于NC组（P均〈0.05）;T2DM组Va、A均高于NC组（P均〈0.05）;T2DM组舒张功能异常检出率TDI法为51.1%,高于PDE法的26.7%（P〈0.01）。结论 T2DM患者早期即存在舒张、收缩功能异常,TDI技术测量二尖瓣环运动速度可为评价左心室功能提供新的、更为敏感的定量指标。

The applied value of quantitative tissue Doppler imaging on assessing left ventricular function in patients with early stage type 2 diabetes

Objective To investigate the application of tissue Doppler imaging（TDI） in assessing left ventricular function of patients with early phase type 2 diabetes（T2DM）.Methods Forty-five early stage type 2 diabetes patients（T2DM group） and forty-five normal subjects（NC group） were enrolled in this study.In all individuals,the ventricular mural motion spectrum in the side of left ventricle of mitral valve ring was detected through TDI,and the motion peak velocity of systole,early diastole and late diastole（Vs,Ve,Va） was measured,and the ratio of Ve/Va was calculated;the flow spectrum of mitral orifice was detected through pulse Doppler（PDE）,and the flow velocity of early diastole and late diastole（E,A） and the ratio of E/A were calculated;the left ventricular ejection fraction（LVEF） was detected by Simpson′s method through conventional echocardiography.Results Systolic function parameters showed that the LVEF values of both T2DM group and NC group were all in normal range,and the values had no significant difference（P0.05）,while the Vs was lower in T2DM group than that in NC group（P0.05）.Diastolic function parameters demonstrated that the Ve,Ve/Va,E/A in T2DM group were lower than those in NC group（all P0.05）,while Va and A were higher in T2DM group than those in NC group（all P0.05）.The detectable rate of abnormality of diastolic function by TDI was higher than that by PDE（51.1% vs 26.7%,P0.01）.Conclusions The abnormalities of diastolic and systolic function exist already in early stage T2DM patients,and the measurement of the mitral annular motion velocity through TDI may provide a new and more sensitive quantitative index to assess the left ventricular function.