二維斑點(diǎn)追蹤技術(shù)對糖尿病患者亞臨床左心室收縮功能障礙的臨床研究
發(fā)布時間：2018-10-13 15:05
【摘要】：1目的使用常規(guī)超聲心動圖及二維斑點(diǎn)追蹤成像(Two-dimensional speckle tracking imaging, 2D-STI)技術(shù)評估糖尿病患者左心室早期收縮功能的受損程度,并將兩種檢查技術(shù)進(jìn)行比較,為臨床探尋糖尿病患者亞臨床左心室收縮功能受損的可靠評價指標(biāo),用于評估亞臨床左心室收縮功能受損程度,為臨床治療方案提供參考。2方法本研究選取健康對照組(n=35)、2型糖尿病組(n=32)、合并高血壓的2型糖尿病組(n=35)的三組研究對象,三組均進(jìn)行標(biāo)準(zhǔn)常規(guī)經(jīng)胸超聲心動圖、組織多普勒成像技術(shù)(Tissue doppler imaging, TDI)及 2D-STI。2.1左心室舒張功能的評估:采用頻譜多普勒測量二尖瓣口 E峰、A峰,自動計算E/A值,采用組織多普勒成像測量二尖瓣環(huán)E'、A',計算出E'/A'值,并將上述數(shù)據(jù)進(jìn)行x2檢驗(yàn),以對三組研究對象的左心室舒張功能進(jìn)行評估。2.2左心室收縮功能的評估:采用常規(guī)二維超聲心動圖測量左心室舒張末期容積(Left ventricular end-diastolic volume,LVEDV)、左心室收縮末期容積(Left ventricular end-systolic volume, LVESV)、左室射血分?jǐn)?shù)(Left ventricular ejection fraction,LVEF)分別評估三組研究對象左心室收縮功能;與此同時,通過二維斑點(diǎn)追蹤成像技術(shù)采集左心室心尖四腔觀、心尖兩腔觀以及心尖三腔觀連續(xù)3個心動周期的高幀頻二維動態(tài)圖,存盤后通過GLAB軟件進(jìn)行脫機(jī)分析,獲得心尖三切面的收縮期左心室峰值縱向應(yīng)變(Longitudinal strain, LS)及左心室的收縮期峰值整體縱向應(yīng)變(Global longitudinal strain, GLS),評估三組研究對象的左心室收縮功能。將以上兩種不同超聲檢查技術(shù)獲得的數(shù)據(jù)進(jìn)行單因素方差分析,綜合評估研究對象的心臟收縮功能的受損程度,以探討糖尿病患者亞臨床左心室功能受損的可靠評價指標(biāo)。3結(jié)果(1)2型糖尿病組、合并高血壓2型糖尿病組與健康對照組比較,研究對象之間E/A及E'/A'組均具有統(tǒng)計學(xué)意義(p0.05),提示2型糖尿病(Type2 diabetes mellitus, T2DM)和/高血壓均可引起左室舒張功能減低;(2)健康對照組、2型糖尿病組、合并高血壓的2型糖尿病組研究對象之間的LVEDV、LVESV、LVEF差異無統(tǒng)計學(xué)意義(p0.05),闡述了常規(guī)超聲心動圖認(rèn)為2型糖尿病組、合并高血壓2型糖尿病組研究對象較正常對照組相比左心室收縮功能并未發(fā)生改變;(3)健康對照組、2型糖尿病組、合并高血壓2型糖尿病組受試者在心尖四腔心、心尖三腔心、心尖兩腔心切面的收縮期左心室峰值縱向應(yīng)變及左室整體應(yīng)變兩兩組間均存在具有統(tǒng)計學(xué)意義的差異(p0.05),提示二維斑點(diǎn)追蹤技術(shù)發(fā)現(xiàn)2型糖尿病組、合并高血壓2型糖尿病組研究對象較正常對照組相比收縮功能發(fā)生了一定程度的改變,同時發(fā)現(xiàn)高血壓可能對左心室的亞臨床收縮功能損害有一定的疊加作用。4結(jié)論(1)本次研究顯示糖尿病患者亞臨床期大部分左心室舒張已存在障礙;(2)常規(guī)超聲心動圖測量LVEF評估左心室收縮功能,不易發(fā)現(xiàn)早期存在左心室亞臨床收縮功能障礙,二維斑點(diǎn)追蹤技術(shù)較常規(guī)超聲相比能夠更早的準(zhǔn)確發(fā)現(xiàn)亞臨床收縮功能障礙,在臨床工作中應(yīng)用價值更高,是臨床評估糖尿病亞臨床左心室收縮功能的可靠方法;(3)糖尿病患者合并高血壓時對左心室的亞臨床收縮功能損害有一定的疊加作用;(4)在糖尿病患者中,亞臨床型收縮功能的減低可以與舒張功能障礙同時發(fā)生,或者甚至有可能在舒張功能障礙之前發(fā)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.
【學(xué)位授予單位】：安徽中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R540.45;R587.2
本文編號：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.
【學(xué)位授予單位】：安徽中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R540.45;R587.2
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