本文選題：實時三維超聲心動圖　切入點：2型糖尿病　出處：《山西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:應(yīng)用實時三維超聲心動圖(RT-3DE)技術(shù)對伴或不伴高血壓(HT)的2型糖尿病(T2DM)患者的左心房功能進行研究。方法:將確診的2型糖尿病患者62例,根據(jù)有無高血壓分為單純糖尿病組(B組)和糖尿病伴高血壓組(C組),另外設(shè)30例健康志愿者為對照組(A組)。各組受檢者均行常規(guī)二維超聲、M型超聲、脈沖多普勒超聲、組織多普勒超聲及RT-3DE檢查:在常規(guī)二維超聲模式下用辛普森法測得左心室射血分?jǐn)?shù)(LVEF);在M型超聲模式下測得左心房前后內(nèi)徑(LAd)、室間隔厚度(IVS)、左心室后壁厚度(LVPW)及左心室舒張末期內(nèi)徑(LVEDD);用脈沖多普勒超聲測量經(jīng)二尖瓣口舒張早期血流峰值速度(VE);用組織多普勒超聲測量二尖瓣環(huán)室間隔側(cè)舒張早期峰值速度(Ve),計算E/e值。用RT-3DE技術(shù)測得左心房最大容積、左心房主動收縮前容積及左心房最小容積,再通過體表面積標(biāo)準(zhǔn)化,得到左心房最大容積指數(shù)(LAVImax),左心房主動收縮前容積指數(shù)(LAVIpreA)及左心房最小容積指數(shù)(LAVImin);最后計算得到左心房總排空分?jǐn)?shù)(LATEF)、左心房被動排空分?jǐn)?shù)(LAPEF)以及左心房主動排空分?jǐn)?shù)(LAAEF)。將RT-3DE獲得的糖尿病組左心房容積參數(shù)與E/e值做相關(guān)性分析。結(jié)果:1.常規(guī)二維及M型超聲測量參數(shù)比較:LVEF測值:各組間無統(tǒng)計學(xué)差異(P0.05)。LAd、IVS、LVPW、LVEDD測值:糖尿病伴高血壓組(C組)高于其他兩組(P0.05或P0.001)。2.脈沖多普勒及組織多普勒超聲測量參數(shù)比較:糖尿病伴高血壓組(C組)的Ve測值顯著低于其他兩組,而E/e值高于其他兩組,且均有統(tǒng)計學(xué)意義(P0.001);而C組的VE測值僅高于正常對照組(A組)(P0.05)。B組與A組相比,僅E/e值有統(tǒng)計學(xué)差異(P0.001)。3.RT-3DE測量參數(shù)比較:T2DM組(B組、C組)的LAVImax、LAVIpreA、LAVImin測值均高于正常對照組(A組),而C組高于B組,且差異均有統(tǒng)計學(xué)意義(P0.05或P0.01或P0.001);而LATEF、LAPEF測值:B、C組均低于A組,C組低于B組,差異均有統(tǒng)計學(xué)意義(P0.05或P0.01或P0.001);LAAEF測值:各組之間無統(tǒng)計學(xué)差異(P0.05)。4.相關(guān)性分析:糖尿病組的LAVImax、LAVIpreA、LAVImin及LAAEF測值均與E/e值呈顯著正相關(guān)(P0.01或P0.001),LATEF、LAPEF測值均與E/e值呈顯著負(fù)相關(guān)(P0.001)。結(jié)論:單純T2DM患者的左心房功能已經(jīng)發(fā)生改變,若伴有高血壓,則異常改變更明顯。在常規(guī)超聲測得左心室收縮功能正常的T2DM患者可能已經(jīng)出現(xiàn)左心室舒張功能減低。通過RT-3DE測得的左心房容積參數(shù)不僅能夠發(fā)現(xiàn)T2DM患者左心房功能的異常,還可以間接評價左心室舒張功能,為患者的心臟損害提供更多評估依據(jù)。
[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.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R587.2;R540.45

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