三维斑点追踪技术评价糖尿病微血管病变患者的左心室功能

Evaluation of Left Ventricular Function in Diabetes Patients with Microvascular Disease by Three-Dimensional Speckle Tracking Imaging

摘要: 目的：应用三维斑点追踪成像(3D-STI)评价2型糖尿病(T2DM)患者左心室三维应变，并讨论其与糖化血红蛋白(HbA1c)的关系。方法：收集临床诊断为T2DM的患者51例，分为无微血管病变组(DM1组) 21例、合并微血管病变组(DM2组) 30例，同时选取25例健康志愿者作为正常对照组，应用二维超声心动图测量左心房前后径(LAD)、左心室舒张末期内径(LVDd)、左心室收缩末期内径(LVDs)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、二尖瓣口舒张早期峰值流速(E)、二尖瓣口舒张晚期峰值速度(A)、二尖瓣环舒张早期峰值速度(e’)、左室射血分数(2D-LVEF)。应用3D-STI采集心尖全容积图像获得左心室整体长轴应变(GLS)、左心室整体轴向应变(GCS)、左心室整体径向应变(GRS)、左心室射血分数(3D-LVEF)及左心室质量(LVM)等参数，比较各指标组间差异，分析其与HbA1c的相关性。结果：IVST、E/A、e’、E/e’这4个指标在3组间差异有统计学意义(P < 0.001)，LVPWT在3组间差异有统计学意义(P < 0.05)；在组间两两比较中，IVST、LVPWT、E/A、e’、E/e’在DM2组与对照组、DM2组与DM1组间差异有统计学意义；与对照组相比，DM2组的IVST、LVPWT、E/e’增大，e’、E/A减小；与DM1组相比，DM2组的IVST、LVPWT、E/e’增大，e’、E/A减小。GCS、GLS、GRS、LVM、3D-LVEF这5个参数在3组间差异有统计学意义(P < 0.001)，组间两两比较中，GCS、GLS、GRS、LVM、3D-LVEF在DM1组与对照组、DM2组与对照组、DM2组与DM1组的组间差异有统计学意义：与对照组相比，DM1组、DM2组的GCS、GLS、LVM增大，GRS、3D-LVEF减小；与DM1组相比，DM2组的GCS、GLS、LVM增大，GRS、3D-LVEF减小。相关性分析显示，HbA1c与GCS、GLS、GRS、LVM、3D-LVEF均成负相关(r = −0.637、−0.562、−0.515、−0.606、−0.598，P < 0.001)。结论：T2DM患者左心室收缩与舒张功能均受损，其中，3D-STI指标组间差异更为显著，3D-STI可精准评估二型糖尿病患者左心功能状态，为临床及时防治T2DM患者心功能损害的发展提供有效依据。

Abstract: Objective: To evaluate the three-dimensional strain of the left ventricle in patients with type 2 dia-betes mellitus (T2DM) by three-dimensional speckle tracking imaging (3D-STI), and discuss the re-lationship between the three-dimensional strain and HbA1c. Method: A total of 51 patients who were clinically confirmed T2DM were collected and divided into a group of 21 patients without mi-crovascular disease (DM1 group) and a group of 30 patients with microvascular disease (DM2 group), and 25 healthy volunteers were selected as the control group at the same time. Two- di-mensional echocardiography was applied to measure the left atrial anteroposterior diameter (LAD), left ventricular end diastolic diameter (LVDd), left ventricular end systolic diameter (LVDs), and in-terventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), early peak diastolic flow rate (E), late peak diastolic flow rate (A), early peak diastolic velocity (e’) and left ven-tricular ejection fraction (2D-LVEF). 3D-STI was applied to collect apical full volume images, param-eters including left ventricular global long axis strain (GLS), left ventricular global axial strain (GCS), left ventricular global radial strain (GRS), left ventricular ejection fraction (3D-LVEF), and left ven-tricular mass (LVM) in order to access the differences between 3 groups of these parameters and explore their correlation with HbA1c. Result: The four parameters of IVST, E/A, e’, and E/e’ showed statistically significant differences among the three groups (P < 0.001), while LVPWT showed statis-tically significant differences among the three groups (P < 0.05). In pairwise comparisons between groups, there were statistically significant differences in IVST, LVPWT, E/A, e’, E/e’ between the DM2 group and the control group, as well as between the DM2 group and the DM1 group; Compared with the control group, the IVST, LVPWT, and E/e’ of the DM2 group increased, while e’ and E/A de-creased; Compared with the DM1 group, the IVST, LVPWT, and E/e’ of the DM2 group increased, while e’ and E/A decreased. The five parameters GCS, GLS, GRS, LVM and 3D-LVEF showed statisti-cally significant differences among the three groups (P < 0.001). In pairwise comparisons between the groups, GCS, GLS, GRS, LVM and 3D-LVEF showed statistically significant differences between the DM1 group and the control group, DM2 group and the control group, and DM2 group and DM1 group: compared with the control group, the GCS, GLS and LVM of the DM1 and DM2 groups in-creased, while the GRS and 3D-LVEF of the DM1 and DM2 groups decreased; Compared with the DM1 group, the GCS, GLS and LVM of the DM2 group increased, while the GRS and 3D-LVEF of the DM2 group decreased. Correlation analysis showed that HbA1c was negatively correlated with GCS, GLS, GRS, LVM, and 3D-LVEF (r = −0.637, −0.562, −0.515, −0.606, −0.598, P < 0.001). Conclusion: The left ventricular systolic and diastolic functions of T2DM patients were impaired, among which, the differences between 3D-STI parameters were more significant. 3D-STI can accurately assess the left ventricular function status of type II diabetes patients, so as to prevent and treat the heart function damage of T2DM patients timely.