H型高血压对糖尿病肾病患者左心房及颈动脉功能的影响研究

目的 应用二维斑点追踪成像（two-dimensional speckle tracking imaging,2D-STI）和超声极速成像技术分别检测左心房壁心肌应变率参数和颈动脉弹性参数,评价H型高血压对糖尿病肾病患者左心房及颈动脉功能的影响。方法 收集2019年9月至2021年6月西安医学院第三附属医院就诊的糖尿病肾病患者136例,根据指南标准分为单纯高血压组53例及H型高血压组83例,选择同期健康受试者50例作为健康对照组。收集所有受试者常规超声心动图及多普勒超声检查参数。应用2D-STI计算左心房壁心肌应变率参数左心房收缩期平均纵向峰值应变率（mean peak longitudinal strain rate of left atrium in systolic phase,mSRs）,左心房舒张晚期平均峰值纵向应变率（mean peak longitudinal strain rate of left atrium in late-diastolic phase,mSRa）,左心房舒张早期平均峰值纵向应变率（mean peak longitudinal strain rate of left atrium in early-diastolic phase,mSRe）]。超声极速成像技术检测颈动脉弹性相关参数内-中膜厚度（intima-media thickness,IMT）,收缩早期脉搏波传导速度（beginning of the systole PWV,BS-PWV）,收缩晚期脉搏波传导速度（end of the systole PWV,ES-PWV）]。Pearson相关性分析左心房壁心肌应变率参数与颈动脉弹性参数间的相关性。结果 单纯高血压组和H型高血压组BMI、糖化血红蛋白浓度及收缩压、舒张压均高于健康对照组（P<0.05）。单纯高血压组和H型高血压组的左心房前后径（left atrial diameters,LAD）,二尖瓣口舒张早期血流速度峰值与二尖瓣环根部运动速度峰值比（E/e'）均高于健康对照组（P<0.05）,单纯高血压组LAD低于H型高血压组（P<0.05）。单纯高血压组和H型高血压组mSRs、mSRe均低于健康对照组,且H型高血压组mSRs、mSRe低于单纯高血压组（P<0.05）。单纯高血压组和H型高血压组IMT、BS-PWV及ES-PWV均高于健康对照组（P<0.05）;H型高血压组的IMT、BS-PWV及ES-PWV均高于单纯高血压组（P<0.05）。结论 相比健康人群,糖尿病肾病患者左心房和颈动脉功能明显发生损害,其中合并H型高血压的患者功能损害更加明显,且与颈动脉硬化及左心房功能损害具有相关性,提示H型高血压能加剧糖尿病肾病患者左心房及颈动脉功能损害。

Effect of H-type hypertension on left atrium and carotid artery dysfunction in patients with diabetic nephropathy

Objective Two-dimensional speckle tracking imaging （2D-STI） and ultrasonic speed imaging were used to detect the myocardial strain rate parameters of the left atrial wall and the elastic parameters of the carotid artery to evaluate the effect of H-type hypertension on left atrium and carotid artery dysfunction in patients with diabetic nephropathy. Methods 136 patients with diabetic nephropathy admitted to The Third Affiliated Hospital of Xi'an Medical College from September 2019 to June 2021 were collected and divided into hypertension group （n = 53） and H-type hypertension group （n = 83） according to the guidelines, and 50 healthy subjects were selected as healthy control group. Routine echocardiography and Doppler examination parameters of all subjects were collected. 2D-STI was used to calculate the myocardial strain rate parameters of the left atrial wall, including the mean peak longitudinal strain rate of left atrium systolic phase （mSRs）,mean peak longitudinal strain rate of left atrium in late-diastolic phase （mSRa）, and mean peak longitudinal strain rate of left atrium in early-diastolic phase （mSRe） of early diastolic left atrium. The parameters related to carotid artery elasticity were detected by ultrasonic speed imaging, including intima-media thickness （IMT）, beginning of the systole PWV （BS-PWV）, and end of the systole PWV （ES-PWV）. Pearson correlation was analyzed between strain rate parameters of left atrium wall and elasticity parameters of carotid artery. Results The BMI, glycosylated hemoglobin concentration, systolic blood pressure and diastolic blood pressure in the H-type hypertension group and the hypertension group were higher than those in the healthy control group （P<0.05）.The left atrial diameters （LAD）, and the ratio of the peak flow velocity in the early diastole of the mitral value to the peak velocity of the mitral annulus（E/e'） were significantly higher in the hypertension group and the H-type hypertension group than in the healthy control group （P<0.05）, and LAD were significantly lower in the hypertension group than the H-type hypertension group （P<0.05）. The mSRs and mSRe of the hypertension group and the H-type hypertension group were lower than those of the healthy control group, and the mSRs and mSRe of the H-type hypertension group were lower than those of the hypertension group （P<0.05）. The IMT, BS-PWV and ES-PWV in the hypertension group and the H-type hypertension group were higher than those in the healthy control group （P<0.05）; the IMT, BS-PWV and ES-PWV in the H-type hypertension group were higher than those in the hypertension group （P<0.05）. Conclusion Compared with healthy people, the function of left atrium and carotid artery was significantly impaired in diabetic nephropathy patients, and the function impairment was more obvious in patients with H-type hypertension, and carotid atherosclerosis was correlated with left atrium function impairment. 2D-STI combined with rapid ultrasound imaging can quantitatively evaluate the early changes of left atrium and carotid artery function in patients with diabetic nephropathy complicated with H-type hypertension, which can provide clinical evidence for reducing the occurrence of cardiovascular damage and cardiovascular complications in such patients.