本文關鍵詞： 糖尿病 糖尿病腎病 單心動周期實時三維超聲 左心室收縮功能 左心室舒張功能 左室機械同步性　出處：《河北醫(yī)科大學》2014年碩士論文　論文類型：學位論文

【摘要】：目的:探討單心動周期實時三維超聲心動圖（Single-beatreal-time three-dimensional echocardiography, sRT-3DE）在評價糖尿病腎病（diabetes nephropathy DN）患者左室功能及其16節(jié)段收縮、舒張同步性中的應用價值。 方法：糖尿病和糖尿病腎病組：根據1999WHO糖尿病診斷標準，并排除1型糖尿病、泌尿系感染、原發(fā)性腎病及同時患有其它心臟病的患者。糖尿病腎損害的發(fā)生、發(fā)展分為五期，本研究選擇的是早期糖尿病腎病患者,即出現微量蛋白尿,UAER持續(xù)在20-200μg/min.選擇2013年1月至2013年12月在我院內分泌科或腎病科就診的糖尿病和糖尿病腎病患者作為研究對象，其中糖尿病組40例，男性25例，女性15例，年齡38-69歲，平均年齡為（54.4±7.7）歲；糖尿病腎病組30例，男性20例，，女性10例，年齡29-74歲，平均年齡為（53.8±9.7）歲。排除以下情況：近期有手術或創(chuàng)傷的患者；進行過透析治療的患者；合并腫瘤的患者；非竇性心律患者、圖像質量不佳者，所有入選者均為竇性心律。 正常對照組：隨機收集門診普通健康人30例，男18例，女12例，年齡29-69歲，平均年齡約（51.3±12）歲。既往均體健，無糖尿病、高血壓、冠心病等病史，肝、腎功能正常，體格檢查、X一線、心電圖及超聲心動圖均無異常。與病例組間患者年齡、性別、身高、心率的差異均無統(tǒng)計學意義。 儀器設備：單心動周期三維全容積圖像采集使用SIEMENS ACUSONSC2000超聲診斷儀，4Z1c全容積探頭，探頭頻率2.8MHz，掃描角度90°×90°，容積幀頻≥12容積/s，同步心電圖導聯。圖像處理使用設備內置的TOMTEC成像系統(tǒng)及實時左心容積自動分析軟件（LVA）。 實時三維超聲圖像采集方法和指標：首先囑患者放松，連接同步導聯心電圖，取左側臥位，待心電圖出現連續(xù)規(guī)律的QRS波群后將超聲診斷儀系統(tǒng)設置為左心容積分析模式，將4Z1c全容積探頭放置于患者左側胸壁心尖部位，顯示標準的二維四腔心切面，并適度調整深度及增益至圖像清晰度最佳，啟動4D鍵后開始實時三維全容積掃描，在獲得標準、穩(wěn)定、清晰的左心室三維全容積圖像后，凍結圖像，按下動態(tài)存儲鍵，儀器自動選擇單個心動周期的動態(tài)三維圖像進行存儲。糖尿病組和糖尿病腎病組與正常對照組均留取三個到五個完整的單心動周期的動態(tài)圖像并存儲。進入LVA分析軟件進行分析，系統(tǒng)自動識別心內膜邊界，計算出16節(jié)段收縮不同步指數（Systolic dyssynchrony index, SDI）、16節(jié)段舒張不同步指數（Diastolic dyssynchrony index, DDI），左室16節(jié)段收縮后容積及收縮前收縮容積（Postcontr；Precontr），左室舒張末容積(Leftventricular end-diastolic volume, LVEDV)、左室收縮末容積（Leftventricular end-systolic volume, LVESV）、左室射血分數（Leftventricular ejection fraction, LVEF）、左室16節(jié)段收縮末及舒張末的離散度（Dispersion end-systole, DISPES; Dispersion end-diastole,DISPED），所得數據均用心率校正，以心動周期百分比的形式表示，同時軟件將自動顯示左室整體時間-容積曲線和左室16節(jié)段時間-容積曲線。 統(tǒng)計分析：各參數均取3個心動周期的平均值，計量資料各參數用均數±標準差表示，多組間計量資料比較用方差分析，進一步兩兩比較用q檢驗，兩個指標間的相關分析采用直線相關分析，數據統(tǒng)計分析采用SPSS13.0統(tǒng)計學軟件分析， P＜0.01差異有統(tǒng)計學意義。 結果： 1糖尿病腎病組和糖尿病組患者左室16節(jié)段SDI、DDI、DISPES、DISPED與對照組比較，其差異均有統(tǒng)計學意義（P＜0.01），糖尿病腎病組與糖尿病組比較，其差異有統(tǒng)計學意義（P＜0.01），病例組患者16節(jié)段時間-容積曲線走形紊亂，同步性差，且糖尿病腎病組較糖尿病組更顯著，而對照組16節(jié)段時間-容積曲線走形規(guī)則、平滑，同步性好； 2糖尿病腎病組和糖尿病組患者左室16節(jié)段Postcontr及Precontr之和與正常對照組比較，其差異均有統(tǒng)計學意義（P＜0.01），糖尿病腎病組與糖尿病組比較，其差異無統(tǒng)計學意義（P＞0.01），病例組收縮后容積及收縮前容積之和大于正常組； 3糖尿病和糖尿病腎病組患者LVEF與正常對照組比較，三組間差異均有統(tǒng)計學意義（P＜0.01），病例組收縮功能均低于正常組；4糖尿病腎病組患者左室射血分數與左室的收縮不同步指數呈負性相關（r值=-0.599，P值＜0.01）； 結論： 1糖尿病腎病患者左室16節(jié)段收縮同步性及舒張同步性較單純糖尿病患者和正常人差； 2糖尿病腎病組和糖尿病組患者左室16節(jié)段收縮后容積及收縮前容積之和指數更進一步提示左室收縮同步性比正常人差；且左室16節(jié)段收縮末和舒張末的離散度均較正常人大； 3糖尿病腎病患者左室收縮功能低于正常人； 4糖尿病腎病患者左室收縮功能減低與左室收縮不同步有關； 5sRT-3DE是一種臨床評價糖尿病腎病患者左室功能及同步性的直觀、簡便、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錛

本文編號：1534113