摘要
[目的]应用分层应变技术分析糖尿病合并微血管病变患者左心室收缩期心内膜下、中层及心外膜下心肌纵向峰值应变(LPS),以评估糖尿病合并微血管病变患者的心肌功能。[方法]收集2型糖尿病(T2DM)患者40例,分为T2DM组20例、T2DM微血管病变组20例,选择健康志愿者20例设为对照组,进行常规超声心动图测量,采集并储存二维动态图像,导入脱机分析软件QLab13.0中,描记得到左心室收缩期整体纵向应变(GLS);通过分层应变描记左心室三层心肌,得到心内膜心肌纵向峰值应变(LPSendo)、中层心肌纵向峰值应变(LPSmid)以及心外膜下心肌纵向峰值应变(LPSepi),之后通过LPSendo-LPSepi得到左心室跨壁应变压差(ΔLS)。[结果]与对照组相比,T2DM微血管病变组GLS减低2.15%(P<0.05),而T2DM组GLS不存在显著性差异(P>0.05);与T2DM组相比,T2DM微血管病变组GLS减低1.79%(P<0.05)。与对照组相比,T2DM组LPSendo减低3.09%(P<0.05),而LPSmid、LPSepi不存在显著性差异(P>0.05),T2DM微血管病变组LPSendo、LPSmid、LPSepi分别减低4.20%、3.38%及3.16%(P<0.05);与T2DM组相比,T2DM微血管病变组LPSendo、LPSmid、LPSepi分别减低1.11%、2.68%、3.19%(P<0.05)。与对照组相比,T2DM组ΔLS减低2.59%(P<0.05),而T2DM微血管病变组ΔLS不存在显著性差异(P>0.05);与T2DM微血管病变组相比,T2DM组ΔLS减低1.89%(P<0.05)。相关性分析显示,GLS、LPSendo、LPSmid及LPSepi与糖尿病病程均呈负相关(r=-0.491、-0.546、-0.578和-0.592,均P<0.001),ΔLS与糖尿病病程之间不存在线性相关(r=0.305,P>0.05)。[结论]应用分层应变技术可以敏感地发现糖尿病患者心内膜心肌损害及糖尿病合并微血管病变患者不同层次心肌的损害,有助于病情的分析与判断。
Aim To analyze the longitudinal peak strain(LPS)of left ventricular subendocardial myocardium,middle myocardium and subepicardial myocardium in patients with diabetes mellitus complicated with microangiopathy by speckle tracking stratified strain technique,so as to evaluate the myocardial function in patients with diabetes mellitus complicated with microangiopathy.Methods 40 patients with type 2 diabetes mellitus(T2DM)were collected and classified according to whether they had microvascular disease:20 cases of T2DM group,20 cases of T2DM microangiopathy group.20 cases of healthy volunteers were collected as control group.All subjects underwent conventional echocardiographic examination,and the two-dimensional echocardiographic images of at least three cardiac cycles were collected and stored.The collected two-dimensional dynamic images were imported into the offline analysis software QLab13.0.The global longitudinal strain(GLS)of the left ventricle during systole was obtained by recording the endocardium and epicardium.After that,the left ventricular three-layer myocardium was recorded by stratified strain mapping,and the endocardial longitudinal peak strain(LPSendo),middle myocardial longitudinal peak strain(LPSmid)and epicardial longitudinal peak strain(LPSepi)were obtained.Then the transmural strain pressure difference of left ventricle was obtained from the LPS difference between subendocardial and subepicardial myocardium.Results Compared with control group,GLS in T2DM microangiopathy group significantly decreased by 2.15%(P<0.05),but there was no significant difference in GLS in T2DM group.Compared with T2DM group,GLS in T2DM microangiopathy group significantly decreased by 1.79%(P<0.05).Compared with control group,the LPSendo in T2DM group significantly decreased by 3.09%(P<0.05),but there was no significant difference in the LPSmid and LPSepi in T2DM group(P>0.05),and LPSendo,LPSmid and LPSepi in T2DM microangiopathy group significantly decreased by 4.20%,3.38%and 3.16%.Compared with T2DM group,LPSendo,LPSmid and LPSepi in T2DM microangiopathy group respectively decreased by 1.11%,2.68%and 3.19%(P<0.05).Compared with control group,ΔLS in T2DM group decreased by 2.59%(P<0.05),but there was no significant difference inΔLS in T2DM microangiopathy group,and compared with T2DM microangiopathy group,ΔLS in T2DM group was significantly decreased by 1.89%(P<0.05).Correlation analysis showed that GLS,LPSendo,LPSmid and LPSepi were negatively correlated with diabetic course(r=-0.491,-0.546,-0.578 and-0.592,all P<0.001),there was no linear correlation betweenΔLS and diabetic course(r=0.305,P>0.05).Conclusion The application of stratified strain technique can sensitively detect the damage of endocardium in diabetic patients and different levels of myocardium in diabetic patients with microangiopathy,which can provide clinical diagnostic basis.
作者
李晓美
侯志敏
乔英艳
杨慧娟
毛荔
张敏
LI Xiaomei;HOU Zhimin;QIAO Yingyan;YANG Huijuan;MAO Li;ZHANG Min(Shanxi Medical University,Taiyuan,Shanxi 030001,China;Second Hospital of Shanxi Medical University,Taiyuan,Shanxi 030001,China;Xi an Honghui Hospital,Xi an,Shaanxi 710054,China;Shanxi Coal Central Hospital,Taiyuan,Shanxi 030001,China)
出处
《中国动脉硬化杂志》
CAS
2022年第8期699-704,共6页
Chinese Journal of Arteriosclerosis
基金
山西省卫生健康委科研课题(2021118)。
关键词
糖尿病
微血管病变
左心室
分层应变技术
纵向峰值应变
diabetes mellitus
microvascular disease
left ventricle
stratified strain technique
longitudinal peak strain
