妊娠期糖尿病孕妇妊娠中期胎儿心脏功能超声评估
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摘要
目的评估妊娠期糖尿病孕妇对妊娠中期胎儿心功能的影响以及血糖控制与心脏功能的关系。方法选择2015年3月至2017年2月西安市中心医院收治的72例胎龄在24～28周单胎妊娠的妊娠期糖尿病(GDM)孕妇为研究对象(GDM组),同时选取胎龄在24～28周单胎妊娠超声心动图正常的72例孕妇作为对照组。采用超声心动图测量两组胎儿心脏各参数。结果 GDM组在等容舒张时间[(44.7±7.1) ms vs (41.2±6.1) ms]和收缩时间[(43.1±8.1) ms vs (39.7±8.7) ms]以及心肌做功指数[(0.55±0.08) vs (0.51±0.07)]和二尖瓣E/A比值(0.61±0.05 vs 0.64±0.08)与对照组比较差异均具有统计学意义(P<0.05)。GDM组二尖瓣环平面收缩期位移明显降低[(4.5±1.2) mm vs(4.9±1.0) mm,P<0.05],差异具有统计学意义。结论妊娠期糖尿病孕妇的胎儿具有较高的心脏结构及功能异常的风险,超声心动图可以检测妊娠期糖尿病孕妇妊娠中期胎儿功能性心脏异常。
Objective To assess the effect of gestational diabetes mellitus(GDM) on fetal cardiac function in the second trimester of pregnancy, and to analyze the relationship between glycemic control and cardiac function.Methods Seventy-two GDM pregnant women with singleton pregnancy of 24-28 weeks gestational age admitted to Xi'an Central Hospital from March 2015 to February 2017 were included(GDM group). Seventy-two pregnant women with singleton pregnancy and gestational age between 24 and 28 weeks with normal echocardiogram in the hospital were included as control group. The parameters of the two groups of fetal heart were measured by echocardiography.Results Functional cardiac variables in GDM group showed a statistically difference in isovolumetric relaxation, contraction times, the myocardial performance index, and mitral E/A ratios compared with normal control group(all P<0.05):(44.7±7.1) ms vs(41.2±6.1) ms,(43.1±8.1) ms vs(39.7±8.7) ms,(0.55±0.08) vs(0.51±0.07),(0.61±0.05) mm vs(0.64±0.08) mm, respectively. Conclusion GDM puts the fetus at risk of structural and functional cardiac abnormalities.Echocardiography can be used to detect functional cardiac abnormalities during the second trimester in fetuses of GDM.
Objective To assess the effect of gestational diabetes mellitus(GDM) on fetal cardiac function in the second trimester of pregnancy, and to analyze the relationship between glycemic control and cardiac function.Methods Seventy-two GDM pregnant women with singleton pregnancy of 24-28 weeks gestational age admitted to Xi'an Central Hospital from March 2015 to February 2017 were included(GDM group). Seventy-two pregnant women with singleton pregnancy and gestational age between 24 and 28 weeks with normal echocardiogram in the hospital were included as control group. The parameters of the two groups of fetal heart were measured by echocardiography.Results Functional cardiac variables in GDM group showed a statistically difference in isovolumetric relaxation, contraction times, the myocardial performance index, and mitral E/A ratios compared with normal control group(all P<0.05):(44.7±7.1) ms vs(41.2±6.1) ms,(43.1±8.1) ms vs(39.7±8.7) ms,(0.55±0.08) vs(0.51±0.07),(0.61±0.05) mm vs(0.64±0.08) mm, respectively. Conclusion GDM puts the fetus at risk of structural and functional cardiac abnormalities.Echocardiography can be used to detect functional cardiac abnormalities during the second trimester in fetuses of GDM.
引文
[1]沈红霞.妊娠期糖尿病对胎儿心功能影响的超声研究进展[J].临床超声医学杂志, 2016, 18(8):542-544.
[2] FOUDA UM, ABOUELKASSEM MM, HEFNY SM, et al. Role of fetal echocardiography in the evaluation of structure and function of fetal heart in diabetic pregnancies[J]. J Matern Fetal Neonatal Med,2013, 26(6):571-575.
[3] ICHIZUKA K, MATSUOKA R, HASEGAWA J, et al. The Tei index for evaluation of fetal myocardial performance in sick fetuses[J].Early Hum Dev, 2005, 81(3):273-279.
[4] MIYAKE T. Doppler echocardiographic studies of diastolic cardiac function in the human fetal heart[J]. Kurume Med J, 2001, 48(1):59-64.
[5] BALLI S, PAC FA, ECE?, et al. Assessment of cardiac functions in fetuses of gestational diabetic mothers[J]. Pediatr Cardiol, 2014, 35(1):30-37.
[6] DIABETES IAO, PANEL PSGC. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy:comment to the international association of diabetes and pregnancy study groups consensus panel[J]. Diabetes Care, 2010, 33(3):676-682.
[7]庞敏,厉志洪,赵金侠,等.评价结合组织多普勒(TDI)的Tei指数检测胎儿先天性心脏病早期心功能变化的价值[J].齐齐哈尔医学院学报, 2013, 34(23):3452-3453.
[8] KEW S, YE C, SERMER M, et al. Postpartum metabolic function in women delivering a macrosomic infant in the absence of gestational diabetes mellitus[J]. Diabetes Care, 2011, 34(12):2608-2613.
[9] HERNANDEZANDRADE E, BENAVIDESSERRALDE JA, CRUZMARTINEZ R, et al. Evaluation of conventional Doppler fetal cardiac function parameters:E/A ratios, outflow tracts, and myocardial performance index[J]. Fetal Diagn Ther, 2012, 32(1-2):22-29.
[10] WONG ML, WONG WHS, CHEUNG YF. Fetal myocardial performance in pregnancies complicated by gestational impaired glucose tolerance[J]. Ultrasound Obstet Gynecol, 2007, 29(4):395-400.
[11]刘颖.妊娠糖尿病各时期胎儿心脏结构及心功能分析[J].中国医药导报, 2014, 11(22):20-23.
[12] MIEGHEM TV, HODGES R, JAEGGI E, et al. Functional echocardiography in the fetus with non-cardiac disease[J]. Prenat Diagn,2014, 34(1):23-32.
[13] RUSSELL NE, FOLEY M, KINSLEY BT, et al. Effect of pregestational diabetes mellitus on fetal cardiac function and structure[J].Am J Obstet Gynecol, 2008, 199(3):312.e311.
[14]陆永萍,邓又斌,刘娅妮,等.组织多普勒超声对妊娠期糖尿病胎儿心肌功能的研究[J].中国超声医学杂志, 2006, 22(2):137-139.
[15]张秀丽,韦德湛,邓璐莎,等.应用Tei指数测定妊娠期糖尿病孕妇胎儿心功能的研究[J].中国医药导报, 2012, 9(17):57-58.
[16]何萍,张玉奇,陆彧,等.妊娠期糖尿病胎儿心脏功能与室间隔厚度的相关性[J].中国医学影像学杂志, 2013, 21(10):771-774.
[17] RUSSELL NE, HOLLOWAY P, QUINN S, et al. Cardiomyopathy and cardiomegaly in stillborn infants of diabetic mothers[J]. Pediatr Dev Pathol, 2008, 11(1):10-14.
[2] FOUDA UM, ABOUELKASSEM MM, HEFNY SM, et al. Role of fetal echocardiography in the evaluation of structure and function of fetal heart in diabetic pregnancies[J]. J Matern Fetal Neonatal Med,2013, 26(6):571-575.
[3] ICHIZUKA K, MATSUOKA R, HASEGAWA J, et al. The Tei index for evaluation of fetal myocardial performance in sick fetuses[J].Early Hum Dev, 2005, 81(3):273-279.
[4] MIYAKE T. Doppler echocardiographic studies of diastolic cardiac function in the human fetal heart[J]. Kurume Med J, 2001, 48(1):59-64.
[5] BALLI S, PAC FA, ECE?, et al. Assessment of cardiac functions in fetuses of gestational diabetic mothers[J]. Pediatr Cardiol, 2014, 35(1):30-37.
[6] DIABETES IAO, PANEL PSGC. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy:comment to the international association of diabetes and pregnancy study groups consensus panel[J]. Diabetes Care, 2010, 33(3):676-682.
[7]庞敏,厉志洪,赵金侠,等.评价结合组织多普勒(TDI)的Tei指数检测胎儿先天性心脏病早期心功能变化的价值[J].齐齐哈尔医学院学报, 2013, 34(23):3452-3453.
[8] KEW S, YE C, SERMER M, et al. Postpartum metabolic function in women delivering a macrosomic infant in the absence of gestational diabetes mellitus[J]. Diabetes Care, 2011, 34(12):2608-2613.
[9] HERNANDEZANDRADE E, BENAVIDESSERRALDE JA, CRUZMARTINEZ R, et al. Evaluation of conventional Doppler fetal cardiac function parameters:E/A ratios, outflow tracts, and myocardial performance index[J]. Fetal Diagn Ther, 2012, 32(1-2):22-29.
[10] WONG ML, WONG WHS, CHEUNG YF. Fetal myocardial performance in pregnancies complicated by gestational impaired glucose tolerance[J]. Ultrasound Obstet Gynecol, 2007, 29(4):395-400.
[11]刘颖.妊娠糖尿病各时期胎儿心脏结构及心功能分析[J].中国医药导报, 2014, 11(22):20-23.
[12] MIEGHEM TV, HODGES R, JAEGGI E, et al. Functional echocardiography in the fetus with non-cardiac disease[J]. Prenat Diagn,2014, 34(1):23-32.
[13] RUSSELL NE, FOLEY M, KINSLEY BT, et al. Effect of pregestational diabetes mellitus on fetal cardiac function and structure[J].Am J Obstet Gynecol, 2008, 199(3):312.e311.
[14]陆永萍,邓又斌,刘娅妮,等.组织多普勒超声对妊娠期糖尿病胎儿心肌功能的研究[J].中国超声医学杂志, 2006, 22(2):137-139.
[15]张秀丽,韦德湛,邓璐莎,等.应用Tei指数测定妊娠期糖尿病孕妇胎儿心功能的研究[J].中国医药导报, 2012, 9(17):57-58.
[16]何萍,张玉奇,陆彧,等.妊娠期糖尿病胎儿心脏功能与室间隔厚度的相关性[J].中国医学影像学杂志, 2013, 21(10):771-774.
[17] RUSSELL NE, HOLLOWAY P, QUINN S, et al. Cardiomyopathy and cardiomegaly in stillborn infants of diabetic mothers[J]. Pediatr Dev Pathol, 2008, 11(1):10-14.