实时三维超声心动图对2型糖尿病患者左心房功能的临床研究

发布时间：2018-03-22 22:05

本文选题：实时三维超声心动图　切入点：2型糖尿病　出处：《山西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:应用实时三维超声心动图(RT-3DE)技术对伴或不伴高血压(HT)的2型糖尿病(T2DM)患者的左心房功能进行研究。方法:将确诊的2型糖尿病患者62例,根据有无高血压分为单纯糖尿病组(B组)和糖尿病伴高血压组(C组),另外设30例健康志愿者为对照组(A组)。各组受检者均行常规二维超声、M型超声、脉冲多普勒超声、组织多普勒超声及RT-3DE检查:在常规二维超声模式下用辛普森法测得左心室射血分数(LVEF);在M型超声模式下测得左心房前后内径(LAd)、室间隔厚度(IVS)、左心室后壁厚度(LVPW)及左心室舒张末期内径(LVEDD);用脉冲多普勒超声测量经二尖瓣口舒张早期血流峰值速度(VE);用组织多普勒超声测量二尖瓣环室间隔侧舒张早期峰值速度(Ve),计算E/e值。用RT-3DE技术测得左心房最大容积、左心房主动收缩前容积及左心房最小容积,再通过体表面积标准化,得到左心房最大容积指数(LAVImax),左心房主动收缩前容积指数(LAVIpreA)及左心房最小容积指数(LAVImin);最后计算得到左心房总排空分数(LATEF)、左心房被动排空分数(LAPEF)以及左心房主动排空分数(LAAEF)。将RT-3DE获得的糖尿病组左心房容积参数与E/e值做相关性分析。结果:1.常规二维及M型超声测量参数比较:LVEF测值:各组间无统计学差异(P0.05)。LAd、IVS、LVPW、LVEDD测值:糖尿病伴高血压组(C组)高于其他两组(P0.05或P0.001)。2.脉冲多普勒及组织多普勒超声测量参数比较:糖尿病伴高血压组(C组)的Ve测值显著低于其他两组,而E/e值高于其他两组,且均有统计学意义(P0.001);而C组的VE测值仅高于正常对照组(A组)(P0.05)。B组与A组相比,仅E/e值有统计学差异(P0.001)。3.RT-3DE测量参数比较:T2DM组(B组、C组)的LAVImax、LAVIpreA、LAVImin测值均高于正常对照组(A组),而C组高于B组,且差异均有统计学意义(P0.05或P0.01或P0.001);而LATEF、LAPEF测值:B、C组均低于A组,C组低于B组,差异均有统计学意义(P0.05或P0.01或P0.001);LAAEF测值:各组之间无统计学差异(P0.05)。4.相关性分析:糖尿病组的LAVImax、LAVIpreA、LAVImin及LAAEF测值均与E/e值呈显著正相关(P0.01或P0.001),LATEF、LAPEF测值均与E/e值呈显著负相关(P0.001)。结论:单纯T2DM患者的左心房功能已经发生改变,若伴有高血压,则异常改变更明显。在常规超声测得左心室收缩功能正常的T2DM患者可能已经出现左心室舒张功能减低。通过RT-3DE测得的左心房容积参数不仅能够发现T2DM患者左心房功能的异常,还可以间接评价左心室舒张功能,为患者的心脏损害提供更多评估依据。
[Abstract]:Objective: to study the left atrial function of type 2 diabetes mellitus (T2DM) with or without hypertension by real-time three-dimensional echocardiography (RT-3DE). According to whether hypertension was divided into simple diabetes group (group B) and diabetes with hypertension group (group C), another 30 healthy volunteers were selected as control group A, the subjects in each group were treated with conventional two-dimensional ultrasound M-mode ultrasound and pulsed Doppler ultrasound. Tissue Doppler echocardiography and RT-3DE: left ventricular ejection fraction was measured by Simpson method in conventional two-dimensional mode; left atrial anterior and posterior diameter, ventricular septal thickness and left ventricular posterior wall thickness were measured in M-mode echocardiography. Left ventricular end-diastolic diameter (LVEDDN); early diastolic peak velocities through mitral orifice and mitral annulus septum were measured by pulsed Doppler ultrasound (PPD); mitral annular septal septal diastolic peak velocities were measured by tissue Doppler echocardiography (TDI), and E _ (p _ (e)) values were calculated by RT-3DE. The technique measured the maximum volume of the left atrium, The left atrial volume before active contraction and the minimum volume of the left atrium were standardized through the body surface area. The left atrial maximal volume index (LAVImaxa), the left atrial active presystolic volume index (LAVIpreA) and the left atrial minimum volume index (LAVImina) were obtained, and the total left atrial emptying fraction (LATEFF), the left atrial passive emptying fraction (LAPEFF) and the left atrial active emptying were calculated. Analysis of the correlation between left atrial volume parameters and E / e values obtained by RT-3DE. Results: 1. Routine two-dimensional and M-mode ultrasound measurements were compared: there was no statistical difference among the groups (P0.05, LAdIVSV, LVPWV, LVEDD: diabetes mellitus with high blood level). Compared with the other two groups (P 0.05 or P 0.001U 路2.Compared with the parameters of pulsed Doppler and tissue Doppler ultrasound: group C of diabetes mellitus with hypertension), the value of ve was significantly lower than that of the other two groups. The E / e value of group C was significantly higher than that of group A (P 0.001), while the value of VE in group C was only higher than that in group A (P 0.05) and group B (P < 0.05), and that in group B was significantly higher than that in group A (P < 0.05). There was significant difference in E / E value only. 3.The parameters measured by RT-3DE were higher than those in normal control group (P 0.001) and C group (P < 0.05), but in C group was higher than that in B group (P < 0.05), but that in C group was higher than that in B group (P < 0.05), but that in C group was higher than that in B group (P < 0.05). There was significant difference between two groups (P0.05 or P0.01 or P0.001), and the value of LATEFL LAPEF in group C was lower than that in group A and group C was lower than that in group B, and the value of LAPEF in group C was lower than that in group B. There were significant differences between P 0.05 or P 0.01 or P 0.001L LAAEF: there was no significant difference among the groups (P 0.05). Correlation analysis: there was a significant positive correlation between LAVImax1 LAVIpreA LAVImin and E / E values in diabetic group (P0.01 or P0.001LATEFLAPEF) and significant negative correlation with E / e value (P0.001e). Conclusion: left atrial function has been changed in patients with T2DM alone. In the case of high blood pressure, In patients with normal left ventricular systolic function measured by conventional ultrasound, left ventricular diastolic function may have decreased. Left atrial volume parameters measured by RT-3DE can not only find abnormal left atrial function in T2DM patients. The left ventricular diastolic function can also be evaluated indirectly, providing more evidence for evaluating cardiac damage.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2;R540.45

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