二维斑点追踪技术对糖尿病患者亚临床左心室收缩功能障碍的临床研究
发布时间：2018-10-13 15:05
【摘要】：1目的使用常规超声心动图及二维斑点追踪成像(Two-dimensional speckle tracking imaging, 2D-STI)技术评估糖尿病患者左心室早期收缩功能的受损程度,并将两种检查技术进行比较,为临床探寻糖尿病患者亚临床左心室收缩功能受损的可靠评价指标,用于评估亚临床左心室收缩功能受损程度,为临床治疗方案提供参考。2方法本研究选取健康对照组(n=35)、2型糖尿病组(n=32)、合并高血压的2型糖尿病组(n=35)的三组研究对象,三组均进行标准常规经胸超声心动图、组织多普勒成像技术(Tissue doppler imaging, TDI)及 2D-STI。2.1左心室舒张功能的评估:采用频谱多普勒测量二尖瓣口 E峰、A峰,自动计算E/A值,采用组织多普勒成像测量二尖瓣环E'、A',计算出E'/A'值,并将上述数据进行x2检验,以对三组研究对象的左心室舒张功能进行评估。2.2左心室收缩功能的评估:采用常规二维超声心动图测量左心室舒张末期容积(Left ventricular end-diastolic volume,LVEDV)、左心室收缩末期容积(Left ventricular end-systolic volume, LVESV)、左室射血分数(Left ventricular ejection fraction,LVEF)分别评估三组研究对象左心室收缩功能;与此同时,通过二维斑点追踪成像技术采集左心室心尖四腔观、心尖两腔观以及心尖三腔观连续3个心动周期的高帧频二维动态图,存盘后通过GLAB软件进行脱机分析,获得心尖三切面的收缩期左心室峰值纵向应变(Longitudinal strain, LS)及左心室的收缩期峰值整体纵向应变(Global longitudinal strain, GLS),评估三组研究对象的左心室收缩功能。将以上两种不同超声检查技术获得的数据进行单因素方差分析,综合评估研究对象的心脏收缩功能的受损程度,以探讨糖尿病患者亚临床左心室功能受损的可靠评价指标。3结果(1)2型糖尿病组、合并高血压2型糖尿病组与健康对照组比较,研究对象之间E/A及E'/A'组均具有统计学意义(p0.05),提示2型糖尿病(Type2 diabetes mellitus, T2DM)和/高血压均可引起左室舒张功能减低;(2)健康对照组、2型糖尿病组、合并高血压的2型糖尿病组研究对象之间的LVEDV、LVESV、LVEF差异无统计学意义(p0.05),阐述了常规超声心动图认为2型糖尿病组、合并高血压2型糖尿病组研究对象较正常对照组相比左心室收缩功能并未发生改变;(3)健康对照组、2型糖尿病组、合并高血压2型糖尿病组受试者在心尖四腔心、心尖三腔心、心尖两腔心切面的收缩期左心室峰值纵向应变及左室整体应变两两组间均存在具有统计学意义的差异(p0.05),提示二维斑点追踪技术发现2型糖尿病组、合并高血压2型糖尿病组研究对象较正常对照组相比收缩功能发生了一定程度的改变,同时发现高血压可能对左心室的亚临床收缩功能损害有一定的叠加作用。4结论(1)本次研究显示糖尿病患者亚临床期大部分左心室舒张已存在障碍;(2)常规超声心动图测量LVEF评估左心室收缩功能,不易发现早期存在左心室亚临床收缩功能障碍,二维斑点追踪技术较常规超声相比能够更早的准确发现亚临床收缩功能障碍,在临床工作中应用价值更高,是临床评估糖尿病亚临床左心室收缩功能的可靠方法;(3)糖尿病患者合并高血压时对左心室的亚临床收缩功能损害有一定的叠加作用;(4)在糖尿病患者中,亚临床型收缩功能的减低可以与舒张功能障碍同时发生,或者甚至有可能在舒张功能障碍之前发生。
[Abstract]:Objective To evaluate the severity of left ventricular early systolic function in diabetic patients using conventional echocardiography and two-dimensional speckle tracking imaging (2D-STI). In order to evaluate the impairment of subclinical left ventricular systolic function in patients with diabetes mellitus, this study was used to assess the degree of impairment of subclinical left ventricular systolic function and to provide a reference for the clinical treatment regimen. Three groups of subjects with type 2 diabetes mellitus complicated with hypertension (n = 35) were divided into three groups: standard conventional transthoracic echocardiography, tissue Doppler imaging (TDI) and 2D-STI. Automatically calculate the E/ A value and use tissue Doppler imaging to measure the mitral annulus E ',A' Calculate E '/ A The values were measured and the above data were x2 tested to assess the left ventricular diastolic function of the three study subjects. 2. 2 Assessment of left ventricular systolic function: Left ventricular end diastolic volume (LVEDV) was measured using conventional two-dimensional echocardiography. Left ventricular systolic volume (LVESV), left ventricular ejection fraction (LVESV), left ventricular ejection fraction (left ventricular ejection fraction) were used to evaluate left ventricular systolic function in three groups, while left ventricular apex four-lumen view was acquired by two-dimensional speckle tracking imaging technique. high frame rate two-dimensional dynamic map of apical two-cavity view and apical three-cavity view continuous three cardiac cycles, which are taken offline through GLAB software to obtain systolic left ventricular peak longitudinal strain of apical three-section, LS) and left ventricular systolic peak overall longitudinal strain (GLS) were used to evaluate left ventricular systolic function in three groups of study subjects. A single-factor analysis of variance of the data obtained from the two different ultrasound examination techniques was performed to evaluate the degree of impairment of the cardiac systolic function of the study subject in order to investigate the reliable evaluation index of sub-clinical left ventricular function impairment in patients with diabetes. The E/ A and E'/ A 'between subjects with type 2 diabetes mellitus and healthy control group were compared. Both groups were statistically significant (P 0.05), suggesting that type 2 diabetes mellitus (T2DM) and/ or hypertension could induce a decrease in left ventricular diastolic function; (2) LVEDV, LVESV between subjects with type 2 diabetes mellitus in healthy controls, type 2 diabetes mellitus, and hypertension. Compared with the control group, the systolic function of the left ventricle was not changed compared with the control group (3) the healthy control group and the type 2 diabetes group. There was a statistically significant difference between the left ventricular peak longitudinal strain and the left ventricular mass strain between the two groups of systolic left ventricular peak longitudinal strain and left ventricular mass strain in patients with type 2 diabetes mellitus complicated with hypertension (P0.05). It was suggested that the two-dimensional speckle tracking technique was found to have a certain degree of change compared with the normal control group compared with the normal control group. Conclusion (1) This study shows that most of the left ventricular diastolic dysfunction in the sub-clinical phase of diabetic patients is impaired, and (2) conventional echocardiographic measurements have been used to evaluate left ventricular systolic function. It is not easy to find the early left ventricular subclinical contraction dysfunction, the two-dimensional speckle tracking technique can more accurately find the sub-clinical shrinkage dysfunction compared with the conventional ultrasound, and the application value is higher in clinical work, is a reliable method for clinically evaluating the systolic function of a diabetic sub-clinical left ventricle; (3) the diabetes patient has a certain superimposed effect on the sub-clinical contraction function of the left ventricle when the diabetes is combined with hypertension; and (4) in the diabetic patient, a reduction in the subclinical contraction function may occur simultaneously with diastolic dysfunction or may even occur prior to diastolic dysfunction.
【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R540.45;R587.2
本文编号：2269048
[Abstract]:Objective To evaluate the severity of left ventricular early systolic function in diabetic patients using conventional echocardiography and two-dimensional speckle tracking imaging (2D-STI). In order to evaluate the impairment of subclinical left ventricular systolic function in patients with diabetes mellitus, this study was used to assess the degree of impairment of subclinical left ventricular systolic function and to provide a reference for the clinical treatment regimen. Three groups of subjects with type 2 diabetes mellitus complicated with hypertension (n = 35) were divided into three groups: standard conventional transthoracic echocardiography, tissue Doppler imaging (TDI) and 2D-STI. Automatically calculate the E/ A value and use tissue Doppler imaging to measure the mitral annulus E ',A' Calculate E '/ A The values were measured and the above data were x2 tested to assess the left ventricular diastolic function of the three study subjects. 2. 2 Assessment of left ventricular systolic function: Left ventricular end diastolic volume (LVEDV) was measured using conventional two-dimensional echocardiography. Left ventricular systolic volume (LVESV), left ventricular ejection fraction (LVESV), left ventricular ejection fraction (left ventricular ejection fraction) were used to evaluate left ventricular systolic function in three groups, while left ventricular apex four-lumen view was acquired by two-dimensional speckle tracking imaging technique. high frame rate two-dimensional dynamic map of apical two-cavity view and apical three-cavity view continuous three cardiac cycles, which are taken offline through GLAB software to obtain systolic left ventricular peak longitudinal strain of apical three-section, LS) and left ventricular systolic peak overall longitudinal strain (GLS) were used to evaluate left ventricular systolic function in three groups of study subjects. A single-factor analysis of variance of the data obtained from the two different ultrasound examination techniques was performed to evaluate the degree of impairment of the cardiac systolic function of the study subject in order to investigate the reliable evaluation index of sub-clinical left ventricular function impairment in patients with diabetes. The E/ A and E'/ A 'between subjects with type 2 diabetes mellitus and healthy control group were compared. Both groups were statistically significant (P 0.05), suggesting that type 2 diabetes mellitus (T2DM) and/ or hypertension could induce a decrease in left ventricular diastolic function; (2) LVEDV, LVESV between subjects with type 2 diabetes mellitus in healthy controls, type 2 diabetes mellitus, and hypertension. Compared with the control group, the systolic function of the left ventricle was not changed compared with the control group (3) the healthy control group and the type 2 diabetes group. There was a statistically significant difference between the left ventricular peak longitudinal strain and the left ventricular mass strain between the two groups of systolic left ventricular peak longitudinal strain and left ventricular mass strain in patients with type 2 diabetes mellitus complicated with hypertension (P0.05). It was suggested that the two-dimensional speckle tracking technique was found to have a certain degree of change compared with the normal control group compared with the normal control group. Conclusion (1) This study shows that most of the left ventricular diastolic dysfunction in the sub-clinical phase of diabetic patients is impaired, and (2) conventional echocardiographic measurements have been used to evaluate left ventricular systolic function. It is not easy to find the early left ventricular subclinical contraction dysfunction, the two-dimensional speckle tracking technique can more accurately find the sub-clinical shrinkage dysfunction compared with the conventional ultrasound, and the application value is higher in clinical work, is a reliable method for clinically evaluating the systolic function of a diabetic sub-clinical left ventricle; (3) the diabetes patient has a certain superimposed effect on the sub-clinical contraction function of the left ventricle when the diabetes is combined with hypertension; and (4) in the diabetic patient, a reduction in the subclinical contraction function may occur simultaneously with diastolic dysfunction or may even occur prior to diastolic dysfunction.
【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R540.45;R587.2
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