CAJ | 학술논문

目的应用速度向量成像结合多巴酚丁胺负荷试验评价射血分数(EF)正常的糖尿病 DM)患者左室短轴收缩功能.方法 30例排除冠心病、高血压、瓣膜性心脏病、先天性心脏病,并且经常规的超声心动图检查EF值＞50％的DM患者,另选20例性别、年龄相匹配的健康志愿者作为对照,分别在静息状态、多巴酚丁胺负荷(10、20、30、40μg·kg-1·min 1)状态存储胸骨旁左室短轴基底段、中间段及心尖段动态二维图像.应用Sygno VVI软件进行脱机分析,获得各个节段的心肌最大收缩速度 Vs)、应变 ε)、应变率 SR).结果对照组和DM组组内比较,自基底段至心尖段Vs、ε、SR均呈递减趋势.对照组和DM组间比较,静息状态下,DM组心尖段SR较对照组显著减低 P＜0.05),其余各指标与对照组的差异均无统计学意义；10 μg·kg-1·min-1多巴酚丁胺负荷后,DM组中间段和心尖段的SR均较对照组显著减低 P＜0.05)；心尖段的Vs和ε亦较对照组显著减低(P＜0.05);20μg·kg-1·min-多巴酚丁胺负荷后,DM组基底段、中间段和心尖段的SR均较对照组显著减低(P＜0.05)；中间段和心尖段的Vs和ε亦较对照组显著减低(P＜0.05).多巴酚丁胺最大负荷后,DM组各指标均较对照组显著减低(P＜0.05).结论 DM患者早期收缩功能的减退最早表现在心尖段的心肌组织；SR比Vs、ε更为敏感；多巴酚丁胺负荷试验与速度向量成像相结合,可以明显增加各指标检出糖尿病心肌收缩功能障碍的敏感性.
목적 응용속도향량성상결합다파분정알부하시험평개사혈분수(EF)정상적당뇨병 DM)환자좌실단축수축공능.방법 30례배제관심병、고혈압、판막성심장병、선천성심장병,병차경상규적초성심동도검사EF치＞50％적DM환자,령선20례성별、년령상필배적건강지원자작위대조,분별재정식상태、다파분정알부하(10、20、30、40μg·kg-1·min 1)상태존저흉골방좌실단축기저단、중간단급심첨단동태이유도상.응용Sygno VVI연건진행탈궤분석,획득각개절단적심기최대수축속도 Vs)、응변 ε)、응변솔 SR).결과 대조조화DM조조내비교,자기저단지심첨단Vs、ε、SR균정체감추세.대조조화DM조간비교,정식상태하,DM조심첨단SR교대조조현저감저 P＜0.05),기여각지표여대조조적차이균무통계학의의；10 μg·kg-1·min-1다파분정알부하후,DM조중간단화심첨단적SR균교대조조현저감저 P＜0.05)；심첨단적Vs화ε역교대조조현저감저(P＜0.05);20μg·kg-1·min-다파분정알부하후,DM조기저단、중간단화심첨단적SR균교대조조현저감저(P＜0.05)；중간단화심첨단적Vs화ε역교대조조현저감저(P＜0.05).다파분정알최대부하후,DM조각지표균교대조조현저감저(P＜0.05).결론 DM환자조기수축공능적감퇴최조표현재심첨단적심기조직；SR비Vs、ε경위민감；다파분정알부하시험여속도향량성상상결합,가이명현증가각지표검출당뇨병심기수축공능장애적민감성.
Objective To evaluate the systolic function of left ventricle(LV) in the short axis views in diabetic patients with ejection fraction (EF) value ＞ 50％ with velocity vector imaging (VVI) and dobutamine stress echocardiography (DSE).Methods 30 diabetic patients,which were excluded from coronary artery disease,hypertension,valvular heart diseases,congenital heart diseases,and EF value ＞50 ％by echocardiography,and 20 volunteers with age and sex matched were involved in the study.Twodimensional VVI echocardiographic cine loops were stored at baseline and dobutamine stress (10,20,30 and 40 μg · kg-1 · min-1) in the basal,middle and apical short axis views of LV.The maximum systolic velocity (Vs),strain (ε) and strain rate (SR) were obtained from sygno VVI software.Results The Vs,ε and SR showed decrement tendency from basal to apical short axis view whether in the control group or in the DM group.At baseline,the SR in the apical view decreased significantly in the DM group than that in the control group (P ＜0.05),other parameters were comparable between the two groups.After 10 μg· kg-1 · min-1 dobutamine stress,the SR in the middle and apical views and Vs,ε in the apical view decreased significantly in the DM group than those in the control group (all P ＜ 0.05).After 20μg· kg-1 · min-1 dobutamine stress,the SR in the basal,middle and apical views and Vs,ε in the middle and apical views decreased significantly in the DM group than those in the control group (all P ＜0.05).After the maximum dobutamine stress,all parameters decreased significantly in the DM group than those in the control group (all P ＜0.05).Conclusions The systolic function impairment of DM patients appeared first in the apical tissue of LV,SR was more sensitive index than velocity arnd strain,DSE could increase the sensitivity of VVI parameters in detecting the myocardial systolic function impairment in the earlier stage.