CAJ | 학술논문

目的：探讨超声二维斑点追踪显像技术（ STI）评价2型糖尿病患者左心室心肌扭转运动的特点及其与空腹血清C肽水平的关系。方法选取2012年5月-2013年9月浙江医院门诊或住院确诊为2型糖尿病的患者93例，根据左心室射血分数（LVEF）分为糖尿病左心室收缩功能正常组（A组，LVEF≥0.50）46例、糖尿病左心室收缩功能衰竭组（B组，LVEF＜0.50）47例，另选择同时期我院体检中心体检健康者46例为对照组。采集空腹血清检测C肽水平；采用常规超声心动图检测左心室舒张末期内径（ LVEDD）、左心房前后径（ LAD）、室间隔舒张末期厚度（IVS）、左心室后壁舒张末期厚度（LVPW）、左心室短轴缩短率（LVFS）、LVEF、左房室瓣口E峰值/左房室瓣口A峰值（ E/A）、左房室瓣口血流频谱E峰/组织多普勒左房室瓣环运动e峰（ E/e）；采用STI计算出左心室扭转角度峰值（ Peaktw）、主动脉瓣关闭时间点扭转角度（ AVCtw）、左房室瓣开放时间点扭转角度（ MVOtw）。结果与对照组比较，A组和B组血糖、糖化血红蛋白（ HbA1c ）水平升高，C肽水平降低，A组IVS、LVPW、E/e、Peaktw、AVCtw、MVOtw升高，B组LVEDD、LAD、E/e升高，B组LVFS、LVEF、E/A、Peaktw、AVCtw、MVOtw降低（P＜0.05）；与A组比较，B组血糖、HbA1c、LVEDD、LAD、E/e升高，C肽水平、LVFS、LVEF、E/A、Peaktw、AVCtw、MVOtw降低（P＜0.05）。2型糖尿病患者Peaktw、AVCtw、MVOtw与空腹血清C肽水平均呈正相关（r值分别为0.763、0.756和0.738，P＜0.05）。结论 STI能够早期识别2型糖尿病患者左心室收缩功能的异常变化，参考空腹血清C肽水平，可了解2型糖尿病患者左心室收缩功能的状态。
목적：탐토초성이유반점추종현상기술（ STI）평개2형당뇨병환자좌심실심기뉴전운동적특점급기여공복혈청C태수평적관계。방법선취2012년5월-2013년9월절강의원문진혹주원학진위2형당뇨병적환자93례，근거좌심실사혈분수（LVEF）분위당뇨병좌심실수축공능정상조（A조，LVEF≥0.50）46례、당뇨병좌심실수축공능쇠갈조（B조，LVEF＜0.50）47례，령선택동시기아원체검중심체검건강자46례위대조조。채집공복혈청검측C태수평；채용상규초성심동도검측좌심실서장말기내경（ LVEDD）、좌심방전후경（ LAD）、실간격서장말기후도（IVS）、좌심실후벽서장말기후도（LVPW）、좌심실단축축단솔（LVFS）、LVEF、좌방실판구E봉치/좌방실판구A봉치（ E/A）、좌방실판구혈류빈보E봉/조직다보륵좌방실판배운동e봉（ E/e）；채용STI계산출좌심실뉴전각도봉치（ Peaktw）、주동맥판관폐시간점뉴전각도（ AVCtw）、좌방실판개방시간점뉴전각도（ MVOtw）。결과여대조조비교，A조화B조혈당、당화혈홍단백（ HbA1c ）수평승고，C태수평강저，A조IVS、LVPW、E/e、Peaktw、AVCtw、MVOtw승고，B조LVEDD、LAD、E/e승고，B조LVFS、LVEF、E/A、Peaktw、AVCtw、MVOtw강저（P＜0.05）；여A조비교，B조혈당、HbA1c、LVEDD、LAD、E/e승고，C태수평、LVFS、LVEF、E/A、Peaktw、AVCtw、MVOtw강저（P＜0.05）。2형당뇨병환자Peaktw、AVCtw、MVOtw여공복혈청C태수평균정정상관（r치분별위0.763、0.756화0.738，P＜0.05）。결론 STI능구조기식별2형당뇨병환자좌심실수축공능적이상변화，삼고공복혈청C태수평，가료해2형당뇨병환자좌심실수축공능적상태。
Objective To evaluate the left ventricular twist in patients with type 2 diabetes mellitus(T2DM)by two-dimensional speckle tracking imaging( STI )and its relationship with the level of fasting serum C peptide. Methods 93 out-patients and inpatients diagnosed as T2DM in Zhejiang Hospital from May 2012 to September 2013 were selected and divided into group A(normal left ventricular systolic function group,LVEF≥0. 50,46 cases)and group B(abnormal left ventricular sys-tolic function group,LVEF<0. 50,47 cases). Another 46 healthy people having physical examination over the same period were selected as the control group. The levels of fasting serum C peptide were obtained,and the left ventricular end-diastolic di-ameter( LVEDD),left atrial diameter( LAD),interventricular septum end-diastolic thickness( IVS),left ventricular back wall end-diastolic thickness( LVPW),left ventricular short-axis shortening rate( LVFS),LVEF,mitral valve E peak/mi-tral valve A peak( E/A),mitral valve flow spectrum E peak/tissue Doppler mitral valve ring motion e peak( E/e)were detec-ted by conventional echocardiography. The peak of left ventricular twist angle ( Peaktw ), aortic valve closure time twist angle (AVCtw)and mitral valve opening time twist angle(MVOtw)were calculated by STI. Results Compared with the control group,the blood glucose,HbA1c increased,but the C peptide levels were lower in group A and group B. The IVS,LVPW,E/e,Peaktw,AVCtw and MVOtw were increased in group A,while the LVEDD,LAD and E/e were increased and the LVFS, LVEF,E/A,Peaktw,AVCtw and MVOtw were decreased in group B(P<0. 05). Compared with group A,the blood glu-cose,HbA1c,LVEDD,LAD and E/e in group B were higher,while the C peptide,LVFS,LVEF,E/A,Peaktw,AVCtw and MVOtw were lower(P<0. 05). The Peaktw,AVCtw and MVOtw were positively correlated with fasting C peptide in T2DM patients(r=0. 763,0. 756 and 0. 738,P<0. 05). Conclusion STI can be used for early detection of T2DM with abnormal changes of left ventricular systolic function. The levels of fasting serum C peptide can help us understand the state of left ventricu-lar systolic function in T2DM.