二维应变超声成像对糖尿病患者左室收缩功能的评价

目的探讨二维应变超声成像(2DSE)评价2型糖尿病患者左室收缩功能的临床价值。方法 2型糖尿病组患者28例,其左室射血分数50%,心脏运动、各腔室大小及室壁厚度正常;体检健康者22例为对照组。超声心动图记录两组左室心尖长轴观、二腔观、四腔观及胸骨旁左室短轴二尖瓣环、乳头肌、心尖水平切面,应用Echo-PAC工作站二维应变软件检测左室各室壁节段收缩期的纵向应变(SL)、圆周应变的应变峰值(SC)和左室扭转角度。结果①与对照组比较,糖尿病组左室长轴室壁各节段SL较低(P0.05),糖尿病组基底部、中间部、心尖部同水平以及左室长轴整体SL均小于对照组(P0.05)。②糖尿病组心尖部SC小于对照组(P0.05);③两组均有心尖部旋转角度大于心底部,同水平中前间隔和后间隔旋转角度较大,且糖尿病组大于对照组(P0.05)。糖尿病组扭转角度较对照组增大(P0.05)。结论 2DSE可对常规超声检查左室收缩功能正常的单纯2型糖尿病患者左室收缩功能进行比较准确评价,能早期发现心脏收缩功能的损害。

Evaluation of left ventricular systolic function in patients with diabetes mellitus using two-dimensional strain echocardiography

Objective To evaluate the left ventricular （LV） systolic function in patients with diabetes mellitus type 2 （DM2） using two-dimensional strain echocardiography （2DSE） and discuss the application value of 2DSE in clinic. Methods Twenty-eight patients with DM2 were enrolled in DM2 group whose LV ejection fraction （LVEF） were〉50%and chambers and walls were normal. Twenty-two healthy volunteers were enrolled in control group. LV apical long-axis view,two-chamber view,four-chamber view,the parasternal LV short-axis at the levels of mitral valve（MV）,papillary muscle（PM） and apex （AP） in both groups were acquired using two-dimensional echocardiography. LV peak systolic longitudinal strain（SL）, radial strain,circumferential strain,rotation and twist were assessed using the Echo-PAC workstation 2D-strain software. Results ①SL of each segment at LV long-axis view was lower in DM2 goup than that in control group （P〈0.05）. Each level （MV,PM,AP） and global mean SL in DM2 group were lower than that in control group （P 〈 0.05）. ②The circumferential strain in DM2 group were lower than that in control group at apical segments（P 〈 0.05）. ③The rotation of the AP was bigger than that of MV in two groups. The rotation of the ant-septum and post-septum were bigger than that of the other wall in the same group,and the rotation of the two segments were bigger in DM2 group than that in control group （P 〈 0.05）. The twist in DM2 was bigger than that in control group （P〈0.05）. Conclusion 2DSE can accurately assess the LV systolic function in patients with DM2 who have the normal LV systolic function evaluated by routine echocardiography and detect the early change of LV systolic function.