CAJ | 학술논문

目的应用定量组织速度成像(QTVI)技术检测2型糖尿病患者左心室心肌收缩及舒张功能的变化,为糖尿病性心肌病的早期预防和诊断提供可靠依据。方法 121例2型糖尿病(T2-DM)患者,其中不伴微血管并发症者(DM1组)61例,伴微血管并发症者(DM2组)60例。对照组为50名健康查体者。常规超声心动图测量各组患者左心室射血分数(LVEF)、短轴缩短率(FS)、二尖瓣口舒张早期血流速度(E)、舒张晚期血流速度(A),并计算E/A值。应用QTVI技术测量左心室壁二尖瓣环6个位点(侧壁和后间隔、前壁和下壁、前间隔和后壁)处的收缩期峰值运动速度(Sm)、舒张早期峰值运动速度(Em)、舒张晚期峰值运动速度(Am)。计算6个位点平均速度(MSm、Mem、Mam)以及Mem/Mam值。所有指标与对照组进行比较分析。结果 DM1组、DM2组MSm[(7.13±1.42) cm/s、(6.49±1.29)cm/s]、Mem[(6.22±1.39) cm/s、(4.53 ±0.94)cm/s]及Mem/Mam值(0.79±0.17、0.59±0.19)较对照组[分别为(8.61±1.18) cm/s、(7.91±1.15) cm/s、1.03±0.15]显著降低,差异有统计学意义(F值分别为5.32、8.01和4.89,P均＜0.05)。对照组与其他2组LVEF[(68.01±6.16)％、(67.45±5.47)％、(65.91±4.83)％],FS[(40.17±4.53)％、(38.84±4.23)％、(37.82±5.43)％]差异无统计学意义(F值分别为1.89和2.46,P均＞0.05)。DM2组E/A值(0.71±0.21)较DM1组(0.91±0.18)及对照组(1.02±0.24)显著降低,差异有统计学意义(F值为4.71,P＜0.05)。结论 QTVI比常规超声心动图更敏感地发现糖尿病所致的左心室功能障碍。这种功能障碍在糖尿病无微血管并发症时即已发生,并随着微血管并发症的出现左心室舒缩功能进一步降低。
목적 응용정량조직속도성상(QTVI)기술검측2형당뇨병환자좌심실심기수축급서장공능적변화,위당뇨병성심기병적조기예방화진단제공가고의거。방법 121례2형당뇨병(T2-DM)환자,기중불반미혈관병발증자(DM1조)61례,반미혈관병발증자(DM2조)60례。대조조위50명건강사체자。상규초성심동도측량각조환자좌심실사혈분수(LVEF)、단축축단솔(FS)、이첨판구서장조기혈류속도(E)、서장만기혈류속도(A),병계산E/A치。응용QTVI기술측량좌심실벽이첨판배6개위점(측벽화후간격、전벽화하벽、전간격화후벽)처적수축기봉치운동속도(Sm)、서장조기봉치운동속도(Em)、서장만기봉치운동속도(Am)。계산6개위점평균속도(MSm、Mem、Mam)이급Mem/Mam치。소유지표여대조조진행비교분석。결과 DM1조、DM2조MSm[(7.13±1.42) cm/s、(6.49±1.29)cm/s]、Mem[(6.22±1.39) cm/s、(4.53 ±0.94)cm/s]급Mem/Mam치(0.79±0.17、0.59±0.19)교대조조[분별위(8.61±1.18) cm/s、(7.91±1.15) cm/s、1.03±0.15]현저강저,차이유통계학의의(F치분별위5.32、8.01화4.89,P균＜0.05)。대조조여기타2조LVEF[(68.01±6.16)％、(67.45±5.47)％、(65.91±4.83)％],FS[(40.17±4.53)％、(38.84±4.23)％、(37.82±5.43)％]차이무통계학의의(F치분별위1.89화2.46,P균＞0.05)。DM2조E/A치(0.71±0.21)교DM1조(0.91±0.18)급대조조(1.02±0.24)현저강저,차이유통계학의의(F치위4.71,P＜0.05)。결론 QTVI비상규초성심동도경민감지발현당뇨병소치적좌심실공능장애。저충공능장애재당뇨병무미혈관병발증시즉이발생,병수착미혈관병발증적출현좌심실서축공능진일보강저。
Objective To assess the left ventricular systolic and diastolic function in patients with type 2 diabetes mellitus(DM) using quantitative tissue velocity imaging(QTVI) ,and to provide reliable evidence for early diagnosis and prevention in diabetic cardiomyopathy.Methods One hundred and twenty one type 2 DM patients were divided into two DM 1 groups (61 patients without microangiopathy) and DM2 group (60 patients with microangiopathy).Fifty normal subjects were enrolled as control group.The index of echocardiography,including the LVEF, FS and mitral peak flow velocity during early and late diastole (E/A) were measured by conventional echocardiography,and the ratio of E/A was calculated.The average peak velocities of six LV wall sites at mitral annuluses during systole, early and late diastole(MEm, MEm, MAm) were measured by QTVI, and the ratio of MEm/MAm was calculated.Results Compared with the normal group, MSm ([7.13 ± 1.42])cm/s vs.([6.49 ± 1.29]cm/s), MEm ([6.22 ± 1.39]cm/s) vs.([4.53 ± 0.94]cm/s) and MEm/MAm ([0.79 ±0.17]vs.[0.59 ± 0.19]) in DM patients were significantly decreased(F = 5.32,8.01 ,4.89 ; Ps ＜0.05).There was no significant differences among three groups in the comparisons of LVEF ([67.45 ±5.47]％),([65.91 ±4.83]％),([68.01 ±6.16]％) and FS([38.84±4.23]％,[37.82±5.43]％),([40.17 ± 4.53]％) (F = 1.89 and 2.46 respectively, P ＞ 0.05) .In addition, E/A of DM2 group (0.71 ±0.21) decreased more dramatically than DM1 and normal (0.91 ± 0.18,1.02 ± 0.24) (F = 4.71, P ＜ 0.05) Conclusion Compared with EF,FS and E/A obtained by conventional echocardiography,QTVI-derived MSm,MEm and MEm/MAm are more sensitive indexes to defect early LV dysfunction.The functional disorder appears early than microangiopathy, and the left ventricular systolic and diastolic function gets worse along with the microangiopathy.