单心动周期实时三维超声心动图评价糖尿病肾病患者左室功能及同步性的研究

发布时间：2018-02-25 15:29

  本文关键词： 糖尿病 糖尿病肾病 单心动周期实时三维超声 左心室收缩功能 左心室舒张功能 左室机械同步性　出处：《河北医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的:探讨单心动周期实时三维超声心动图（Single-beatreal-time three-dimensional echocardiography, sRT-3DE）在评价糖尿病肾病（diabetes nephropathy DN）患者左室功能及其16节段收缩、舒张同步性中的应用价值。 方法：糖尿病和糖尿病肾病组：根据1999WHO糖尿病诊断标准，并排除1型糖尿病、泌尿系感染、原发性肾病及同时患有其它心脏病的患者。糖尿病肾损害的发生、发展分为五期，本研究选择的是早期糖尿病肾病患者,即出现微量蛋白尿,UAER持续在20-200μg/min.选择2013年1月至2013年12月在我院内分泌科或肾病科就诊的糖尿病和糖尿病肾病患者作为研究对象，其中糖尿病组40例，男性25例，女性15例，年龄38-69岁，平均年龄为（54.4±7.7）岁；糖尿病肾病组30例，男性20例，，女性10例，年龄29-74岁，平均年龄为（53.8±9.7）岁。排除以下情况：近期有手术或创伤的患者；进行过透析治疗的患者；合并肿瘤的患者；非窦性心律患者、图像质量不佳者，所有入选者均为窦性心律。 正常对照组：随机收集门诊普通健康人30例，男18例，女12例，年龄29-69岁，平均年龄约（51.3±12）岁。既往均体健，无糖尿病、高血压、冠心病等病史，肝、肾功能正常，体格检查、X一线、心电图及超声心动图均无异常。与病例组间患者年龄、性别、身高、心率的差异均无统计学意义。 仪器设备：单心动周期三维全容积图像采集使用SIEMENS ACUSONSC2000超声诊断仪，4Z1c全容积探头，探头频率2.8MHz，扫描角度90°×90°，容积帧频≥12容积/s，同步心电图导联。图像处理使用设备内置的TOMTEC成像系统及实时左心容积自动分析软件（LVA）。 实时三维超声图像采集方法和指标：首先嘱患者放松，连接同步导联心电图，取左侧卧位，待心电图出现连续规律的QRS波群后将超声诊断仪系统设置为左心容积分析模式，将4Z1c全容积探头放置于患者左侧胸壁心尖部位，显示标准的二维四腔心切面，并适度调整深度及增益至图像清晰度最佳，启动4D键后开始实时三维全容积扫描，在获得标准、稳定、清晰的左心室三维全容积图像后，冻结图像，按下动态存储键，仪器自动选择单个心动周期的动态三维图像进行存储。糖尿病组和糖尿病肾病组与正常对照组均留取三个到五个完整的单心动周期的动态图像并存储。进入LVA分析软件进行分析，系统自动识别心内膜边界，计算出16节段收缩不同步指数（Systolic dyssynchrony index, SDI）、16节段舒张不同步指数（Diastolic dyssynchrony index, DDI），左室16节段收缩后容积及收缩前收缩容积（Postcontr；Precontr），左室舒张末容积(Leftventricular end-diastolic volume, LVEDV)、左室收缩末容积（Leftventricular end-systolic volume, LVESV）、左室射血分数（Leftventricular ejection fraction, LVEF）、左室16节段收缩末及舒张末的离散度（Dispersion end-systole, DISPES; Dispersion end-diastole,DISPED），所得数据均用心率校正，以心动周期百分比的形式表示，同时软件将自动显示左室整体时间-容积曲线和左室16节段时间-容积曲线。 统计分析：各参数均取3个心动周期的平均值，计量资料各参数用均数±标准差表示，多组间计量资料比较用方差分析，进一步两两比较用q检验，两个指标间的相关分析采用直线相关分析，数据统计分析采用SPSS13.0统计学软件分析， P＜0.01差异有统计学意义。 结果： 1糖尿病肾病组和糖尿病组患者左室16节段SDI、DDI、DISPES、DISPED与对照组比较，其差异均有统计学意义（P＜0.01），糖尿病肾病组与糖尿病组比较，其差异有统计学意义（P＜0.01），病例组患者16节段时间-容积曲线走形紊乱，同步性差，且糖尿病肾病组较糖尿病组更显著，而对照组16节段时间-容积曲线走形规则、平滑，同步性好； 2糖尿病肾病组和糖尿病组患者左室16节段Postcontr及Precontr之和与正常对照组比较，其差异均有统计学意义（P＜0.01），糖尿病肾病组与糖尿病组比较，其差异无统计学意义（P＞0.01），病例组收缩后容积及收缩前容积之和大于正常组； 3糖尿病和糖尿病肾病组患者LVEF与正常对照组比较，三组间差异均有统计学意义（P＜0.01），病例组收缩功能均低于正常组；4糖尿病肾病组患者左室射血分数与左室的收缩不同步指数呈负性相关（r值=-0.599，P值＜0.01）； 结论： 1糖尿病肾病患者左室16节段收缩同步性及舒张同步性较单纯糖尿病患者和正常人差； 2糖尿病肾病组和糖尿病组患者左室16节段收缩后容积及收缩前容积之和指数更进一步提示左室收缩同步性比正常人差；且左室16节段收缩末和舒张末的离散度均较正常人大； 3糖尿病肾病患者左室收缩功能低于正常人； 4糖尿病肾病患者左室收缩功能减低与左室收缩不同步有关； 5sRT-3DE是一种临床评价糖尿病肾病患者左室功能及同步性的直观、简便、有效的新方法。
[Abstract]:Objective: To explore the application value of Single-beatreal-time three-dimensional echocardiography (sRT-3DE) in evaluating the left ventricular function and the 16 segments of systolic and diastolic synchrony in patients with diabetic nephropathy (diabetes nephropathy DN).
Methods: diabetic nephropathy group and diabetes: according to 1999WHO diagnostic criteria for diabetes, and the exclusion of type 1 diabetes, urinary tract infection, primary nephrotic and with other heart disease. Diabetic renal damage, development is divided into five phases, were selected in this study of patients with early diabetic nephropathy, namely, microalbuminuria in 20-200, g/min. from January 2013 to December 2013 in patients with diabetes mellitus and diabetic nephropathy in our hospital department of Endocrinology and Department of nephropathy in our hospital as the research object for UAER, of which 40 patients with diabetes mellitus, 25 males, 15 females, age 38-69 years old, the average age was (54.4 + 7.7); diabetic nephropathy group 30 cases, 20 cases male, 10 female, age 29-74 years old, the average age was (53.8 + 9.7) years old. To exclude the following cases: recent surgery or trauma patients; for dialysis patients with tumor patients; In patients with non sinus rhythm and poor image quality, all the participants were sinus rhythm.
Normal control group: 30 cases were randomly collected from outpatient general health, male 18 cases, female 12 cases, age 29-69 years, mean age (51.3 + 12) years old. The past are healthy, without diabetes, hypertension, coronary heart disease history, liver, kidney function, physical examination, electrocardiogram and ultrasonic X line echocardiography showed no abnormality. Between the case group and the patients' age, gender, height, heart rate showed no significant differences.
Equipment: single cycle full volume three-dimensional image acquisition using SIEMENS ACUSONSC2000 ultrasonic diagnostic instrument, 4Z1c full volume probe, probe frequency 2.8MHz, scanning angle of 90 * 90 DEG, the volume of more than 12 frame volume /s, synchronouselectrocardiogram. Automatic analysis software for image processing of TOMTEC imaging system using the built-in real-time and left ventricular volume (LVA).
Real time 3D ultrasound image acquisition methods and indicators: first, ask the patient to relax, connected with the synchronous lead ECG, ECG to take a leftlie, consecutive regular QRS wave group after the ultrasound system is provided for the left ventricular volume analysis model, 4Z1c full volume probe placed on the left chest wall in patients with apical parts, display standard two dimensional four chamber view, and appropriately adjust the depth and sharpness of the image to gain best, start the 4D key after the beginning of full volume three-dimensional scanning, stable in standard, full volume three-dimensional images of left ventricle clearly, freeze the image, press the key instrument of dynamic storage, automatic selection of dynamic three-dimensional images of a single cardiac cycle for storage. The diabetic group and diabetic nephropathy group and normal control group were collected three to five complete single cycle dynamic image and stored into the LVA software to analyze, Automatic identification of endocardial boundary system, calculate the 16 segmental systolic dyssynchrony index (Systolic dyssynchrony, index, SDI), 16 segmental diastolic dyssynchrony index (Diastolic dyssynchrony, index, DDI), left ventricular systolic volume after 16 and systolic systolic volume (Postcontr; Precontr), left ventricular end diastolic volume (Leftventricular end-diastolic volume, LVEDV), left ventricular end systolic volume (Leftventricular end-systolic, volume, LVESV), left ventricular ejection fraction (Leftventricular ejection, fraction, LVEF), left ventricular end systolic 16 segment and end diastolic dispersion (Dispersion end-systole, DISPES Dispersion; end-diastole, DISPED), heart rate data are obtained the correction, with the heartbeat cycle percentage is expressed in the form, and the software will automatically display the left ventricular volume time curve and left ventricular volume time curves of 16 segments.
Statistical analysis: all parameters were taken 3 average values of the cardiac cycle, the parameters of measurement data with the mean standard deviation of that number of measurement data among groups were compared by analysis of variance, a further 22 compared with the Q test, correlation analysis between two indexes using linear correlation analysis, analysis using SPSS13.0 statistical software for statistical analysis of data there was statistical significance, P < 0.01 difference.
Result锛

本文编号：1534113