三维斑点追踪技术评价2型糖尿病早期左室应变及与HbA1c的相关性研究
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摘要
目的:应用三维斑点追踪技术(three-dimensional speckle tracking imaging,3D-STI)探讨2型糖尿病(type 2 diabetes mellitus,T2DM)患者早期左心室整体纵向应变(global longitudinal strain,GLS)、圆周应变(global circumferential strain,GCS)、径向应变(global radial strain,GRS)及整体扭转角度(global twist angle,GTA)等应变指标变化,评价T2DM患者糖化血红蛋白(glycosylated hemoglobin A 1c,HbA1c)在控制(HbA1c <7%)和非控制(HbA1c≥7%)情况下左室应变以及与HbA1c的相关性。方法:选取在南昌大学第二附属医院内分泌科首次住院诊断为T2DM患者47例,根据HbA1c水平分成A组(HbA1c <7%)、B组(HbA1c≥7%),同期选取健康志愿者27例作为对照组C组。应用3D-STI测量左室纵向应变(GLS)、圆周应变(GCS)、径向应变(GRS)、左室整体扭转角度(GTA)等指标,比较3组间上述参数的差异,并分析其与HbA1c的相关性。结果:二维超声心动图数据:A组、B组、C组3组间LA、LVPWT、LVEDD、LVESD、LVEF差异无统计学意义(P均> 0. 05)。与C组比较,A组、B组室间隔相对增厚,差异有统计学意义(P <0. 05);但A、B两组间比较差异无统计学意义(P> 0. 05)。与C组比较,A组、B组A值均升高,差异有统计学意义(P <0. 05); A组升高较B组更显著,差异有统计学意义(P <0. 05)。与C组比较,A组、B组E、E/A值均下降,差异有统计学意义(P <0. 05);且与A组相比,B组下降更显著,差异有统计学意义(P <0. 05)。3D-STI参数:A组、B组、C组三组间三维所测LVEDV、LVESV、GTA差异均无统计学意义(P> 0. 05)。与C组比较,A组、B组3D-EF、GLS、GCS、GRS均下降,差异有统计学意义(P <0. 05),其中3D-EF、GLS指标B组下降更明显,差异有统计学意义(P <0. 05)。A组、B组之间比较GCS、GRS指标差异无统计学意义(P> 0. 05)。3D-STI参数与HbA1c相关性分析:HbA1c与GLS(r=-0. 46)、GCS(r=-0. 35)、GRS(r=-0. 42)、3D-EF(r=-0. 45)具有相关性(P均<0. 01)。结论:(1) 2型糖尿病患者早期室间隔相对增厚,且舒张功能已有损害,其舒张功能损害程度与血糖控制水平呈正相关。(2)三维斑点追踪技术能对2型糖尿病患者早期左心室功能受损情况进行定量分析,较常规二维超声心动图更敏感、全面地检测出心肌的早期改变,其中GLS是敏感指标。(3) 2型糖尿病患者早期左心室局部收缩功能受损程度与糖化血红蛋白水平呈负相关。
Objective: To quantitatively investigate the changes of left ventricular global longitudinal strain( GLS),global circumferential strain( GCS),global radial strain( GRS) and global twist angle( GTA) by three-dimensional speckle tracking imaging( 3D-STI) in type 2 diabetes mellitus( T2 DM),and to evaluate the changes of left ventricular myocardial strain and the correlation with HbA1c in controlled HbA1c( HbA1c < 7%) and uncontrolled HbA1c( HbA1c≥7%)conditions. Methods: Forty-seven patients diagnosed T2DM in Department of Endocrinology,the Second Affiliated Hospital of Nanchang University were chosed,and they were divided into group A( HbA1c < 7%) and group B( HbA1c≥7%) according to HbA1c levels. Twenty-seven healthy volunteers were selected as the control group C. The left ventricular global longitudinal strain( GLS),global radial strain( GRS),global circumferential strain( GCS) and left ventricular total twist angle( GTA) was analyzed by 3 D-STI,then we compared the difference of left ventricular myocardial strain in different groups,and analyzed the correlation between HbA1c and them. Result: Two-dimensional echocardiographic data shows that LA,LVPWT,LVEDD、LVESD、LVEFwere not statistically significant between group A,group B,and group C( P > 0. 05). Compared with group C,interventricular septal end diastolic thickness( IVST) were significantly thickened in group A and B( P < 0. 05),but there was no significant difference between group A and group B( P > 0. 05). A values were significantly increased in group A and B( P < 0. 05),and group A increased more compared with group B( P< 0. 05). E and E/A values were significantly decreased in group A and B( P < 0. 05),and group B decreased more compared with group A( P < 0. 05). 3D-STI data shows that LVEDV,LVESV and GTA had no significant changes( P >0. 05). Compared with group C,3D-EF、GLS、GCS、GRSwere significantly decreased in group A and B( P < 0. 05),and 3D-EF,GLS decreased more in group B. Also,there was no significant changes of GCS and GRS between group A and B. HbA1c was associated with GLS( r =-0. 46) 、GCS( r =-0. 35) 、GRS( r =-0. 42) 、3D-EF( r =-0. 45)( P <0. 01). Conclusion: ⑴Interventricular septum was relatively thickened in early period of T2 DM,and diastolic function has also damaged. The degree of damage is related to the control of blood glucose. ⑵3D-STI can quantitatively analyze the left ventricular systolic dysfunction in T2DM. It is more sensitive and comprehensive than the conventional two-dimensional echocardiography to detect early changes of the myocardium. GLS is a sensitive index. ⑶The degree of early left ventricular regional systolic dysfunction is associated with the level of HbA1c in patients with type 2 diabetes.
Objective: To quantitatively investigate the changes of left ventricular global longitudinal strain( GLS),global circumferential strain( GCS),global radial strain( GRS) and global twist angle( GTA) by three-dimensional speckle tracking imaging( 3D-STI) in type 2 diabetes mellitus( T2 DM),and to evaluate the changes of left ventricular myocardial strain and the correlation with HbA1c in controlled HbA1c( HbA1c < 7%) and uncontrolled HbA1c( HbA1c≥7%)conditions. Methods: Forty-seven patients diagnosed T2DM in Department of Endocrinology,the Second Affiliated Hospital of Nanchang University were chosed,and they were divided into group A( HbA1c < 7%) and group B( HbA1c≥7%) according to HbA1c levels. Twenty-seven healthy volunteers were selected as the control group C. The left ventricular global longitudinal strain( GLS),global radial strain( GRS),global circumferential strain( GCS) and left ventricular total twist angle( GTA) was analyzed by 3 D-STI,then we compared the difference of left ventricular myocardial strain in different groups,and analyzed the correlation between HbA1c and them. Result: Two-dimensional echocardiographic data shows that LA,LVPWT,LVEDD、LVESD、LVEFwere not statistically significant between group A,group B,and group C( P > 0. 05). Compared with group C,interventricular septal end diastolic thickness( IVST) were significantly thickened in group A and B( P < 0. 05),but there was no significant difference between group A and group B( P > 0. 05). A values were significantly increased in group A and B( P < 0. 05),and group A increased more compared with group B( P< 0. 05). E and E/A values were significantly decreased in group A and B( P < 0. 05),and group B decreased more compared with group A( P < 0. 05). 3D-STI data shows that LVEDV,LVESV and GTA had no significant changes( P >0. 05). Compared with group C,3D-EF、GLS、GCS、GRSwere significantly decreased in group A and B( P < 0. 05),and 3D-EF,GLS decreased more in group B. Also,there was no significant changes of GCS and GRS between group A and B. HbA1c was associated with GLS( r =-0. 46) 、GCS( r =-0. 35) 、GRS( r =-0. 42) 、3D-EF( r =-0. 45)( P <0. 01). Conclusion: ⑴Interventricular septum was relatively thickened in early period of T2 DM,and diastolic function has also damaged. The degree of damage is related to the control of blood glucose. ⑵3D-STI can quantitatively analyze the left ventricular systolic dysfunction in T2DM. It is more sensitive and comprehensive than the conventional two-dimensional echocardiography to detect early changes of the myocardium. GLS is a sensitive index. ⑶The degree of early left ventricular regional systolic dysfunction is associated with the level of HbA1c in patients with type 2 diabetes.
引文
[1]汪艳丽.空腹血糖、糖化血清蛋白和糖化血红蛋白在2型糖尿病治疗监测中的应用[J].国际检验医学杂志,2017(16):2320-2322.
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[12]Schulz R,Heusch G.Balance and imbalance of regional myocardial contractile function and blood flow[J].ZKardiol,2001,90(12):964-969.
[13]Bulbul S B,Ekiz O,Rifaioglu E N,et al.Assessment of subclinical left ventricular dysfunction in patients with psoriasis by speckle tracking echocardiography:ASpeckle Tracking Study[J].Int J Dermatol,2016,55(2):158-164.
[14]王全江,张煜华,孙延河,等.空腹血糖受损切点下调后不同血糖水平对心脏结构及左室功能的影响[J].中国超声医学杂志,2013(11):987-990.
[15]Sun JP,Xu TY.early diastolic dyssynchrony in relation to left ventricular remodeling and funtiong in hypertension[J].Int J Cardiol,2015,179(1):195-200.
[16]刘丽华,欧阳璐,李舒梅.糖化血红蛋白在2型糖尿病诊断中的应用[J].赣南医学院学报,2014,34(6):978-982.
[17]Sun J P,Xu T Y,Lee A P,et al.Early diastolic dyssynchrony in relation to left ventricular remodeling and function in hypertension[J].Int J Cardiol,2015,179:195-200.
[2]Alonso N,Moliner P,Mauricio D.Pathogenesis,Clinical Features and Treatment of Diabetic Cardiomyopathy[J].Adv Exp Med Biol,2018,1067:197-217.
[3]Thorstensen A,Dalen H,Hala P,et al.Three-dimensional echocardiography in the evaluation of global and regional function in patients with recent myocardial infarction:a comparison with magnetic resonance imaging[J].Echocardiography,2013,30(6):682-692.
[4]Lang R M,Bierig M,Devereux R B,et al.Recommendations for chamber quantification:a report from the A-merican Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group,developed in conjunction with the European Association of Echocardiography,a branch of the European Society of Cardiology[J].J Am Soc Echocardiogr,2005,18(12):1440-1463.
[5]杨跃进,王红,宋光远.糖尿病心肌病[J].中国糖尿病杂志,2012,20(10):794-796.
[6]Yilmaz S,Canpolat U,Aydogdu S,et al.Diabetic Cardiomyopathy;Summary of 41 Years[J].Korean Circ J,2015,45(4):266-272.
[7]王玲,潘小凤,储全根.糖尿病心肌病发病机制的研究进展[J].山西中医学院学报,2016(4):72-74.
[8]Xu Y,Wang L,He J,et al.Prevalence and control of diabetes in Chinese adults[J].JAMA,2013,310(9):948-959.
[9]Torrent-Guasp F,Ballester M,Buckberg G D,et al.Spatial orientation of the ventricular muscle band:physiologic contribution and surgical implications[J].J Thorac Cardiovasc Surg,2001,122(2):389-392.
[10]Sengupta P P,Krishnamoorthy V K,Korinek J,et al.Left ventricular form and function revisited:applied translational science to cardiovascular ultrasound imaging[J].J Am Soc Echocardiogr,2007,20(5):539-551.
[11]Oner F A,Yurdakul S,Oner E,et al.Evaluation of the effect of L-thyroxin therapy on cardiac functions by using novel tissue Doppler-derived indices in patients with subclinical hypothyroidism[J].Acta Cardiol,2011,66(1):47-55.
[12]Schulz R,Heusch G.Balance and imbalance of regional myocardial contractile function and blood flow[J].ZKardiol,2001,90(12):964-969.
[13]Bulbul S B,Ekiz O,Rifaioglu E N,et al.Assessment of subclinical left ventricular dysfunction in patients with psoriasis by speckle tracking echocardiography:ASpeckle Tracking Study[J].Int J Dermatol,2016,55(2):158-164.
[14]王全江,张煜华,孙延河,等.空腹血糖受损切点下调后不同血糖水平对心脏结构及左室功能的影响[J].中国超声医学杂志,2013(11):987-990.
[15]Sun JP,Xu TY.early diastolic dyssynchrony in relation to left ventricular remodeling and funtiong in hypertension[J].Int J Cardiol,2015,179(1):195-200.
[16]刘丽华,欧阳璐,李舒梅.糖化血红蛋白在2型糖尿病诊断中的应用[J].赣南医学院学报,2014,34(6):978-982.
[17]Sun J P,Xu T Y,Lee A P,et al.Early diastolic dyssynchrony in relation to left ventricular remodeling and function in hypertension[J].Int J Cardiol,2015,179:195-200.