超声心动图Tei指数评价妊娠期糖尿病孕妇胎儿心脏功能的价值
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摘要
目的探讨妊娠期糖尿病(GDM)孕妇胎儿心脏功能的变化及超声心动图Tei指数对胎儿心脏功能的评价作用。方法选取GDM孕妇108例,根据血糖控制情况分为血糖控制理想56例(GDM1组)和血糖控制不良52例(GDM2组);选取年龄、孕周及BMI相匹配的正常妊娠孕妇50例作为对照组。测量三组空腹血糖(FPG)、餐后2 h血糖(2 h PG)及糖化血红蛋白(GHb A_(1c))。应用多普勒超声心动图测定三组胎儿心脏结构、功能指标及左、右心室的Tei指数。结果 GDM2组FPG、2 h PG及GHb A_(1c)均高于GDM1组和对照组(P均<0.05)。GDM2组胎儿左室壁厚度、右室壁厚度、右室舒张末期内径(RVDd)、左室短轴缩短率(LVFS)、右室短轴缩短率及左室射血分数(LVEF)均高于对照组(P均<0.05),GDM2组的RVDd、右室收缩末期内径、LVFS及LVEF均高于GDM1组(P均<0.05),GDM1组LVFS高于对照组(P<0.05)。GDM1及GDM2组胎儿左、右心室Tei指数均高于对照组(P均<0.05),GDM2组胎儿左、右心室Tei指数高于GDM1组和对照组(P均<0.05)。结论 Tei指数与GDM孕妇胎儿心脏功能变化相关,可作为临床综合评估GDM胎儿心肌受累的一项简单可靠指标。
Objective To investigate the changes of fetal cardiac function and the function of echocardiographic Tei index in evaluation of fetal cardiac function of pregnant women with gestational diabetes mellitus( GDM). Methods Totally 108 cases of pregnant women with GDM were divided into the well-controlled group( GDM1 group,56 cases) and poorly-controlled group( GDM2 group,52 cases) according to their blood glucose levels. Meanwhile,we selected 50 cases of age,gestational age and BMI-matched normal pregnant women as the controls( control group). The fasting plasma glucose( FPG),postprandial glucose( 2 h PG) and glycosylated hemoglobin( Hb A_(1c)) were measured in these three groups.The fetal cardiac structure,left and right ventricular Tei indexes in each group were measured by Doppler echocardiography. Results FPG,2 h PG and Hb A1 cof the GDM2 group were higher than those of the GDM1 group and control group( all P < 0. 05). The fetal left ventricular wall thickness( LVWT),right ventricular wall thickness( RVWT),right ventricular end-diastolic diameter( RVDd),left ventricular fractional shortening( LVFS),right ventricular fractional shortening( RVFS) and left ventricular ejection fraction( LVEF) of GDM2 group were significantly higher than those of the control group( all P < 0. 05). The fetal RVDd,right ventricular end-systolic diameter,LVFS and LVEF of the GDM2 group were higher than those of the GDM1 group( all P < 0. 05). The GDM1 group's fetal LVFS was higher than that of the control group( P < 0. 05). The Tei index of fetal left and right ventricular of GDM2 group and GDM1 group was significantly higher than that of the control group,and the difference was statistically significant( all P < 0. 05). The average Tei index of fetal left and right ventricular of GDM2 group was higher than that of the GDM1 group and control group( all P < 0. 05). Conclusions Tei index,which is associated with fetal cardiac function in GDM pregnant women,can be used as a simple and reliable indicator in the clinical comprehensive evaluation of fetal cardiac involvement.
Objective To investigate the changes of fetal cardiac function and the function of echocardiographic Tei index in evaluation of fetal cardiac function of pregnant women with gestational diabetes mellitus( GDM). Methods Totally 108 cases of pregnant women with GDM were divided into the well-controlled group( GDM1 group,56 cases) and poorly-controlled group( GDM2 group,52 cases) according to their blood glucose levels. Meanwhile,we selected 50 cases of age,gestational age and BMI-matched normal pregnant women as the controls( control group). The fasting plasma glucose( FPG),postprandial glucose( 2 h PG) and glycosylated hemoglobin( Hb A_(1c)) were measured in these three groups.The fetal cardiac structure,left and right ventricular Tei indexes in each group were measured by Doppler echocardiography. Results FPG,2 h PG and Hb A1 cof the GDM2 group were higher than those of the GDM1 group and control group( all P < 0. 05). The fetal left ventricular wall thickness( LVWT),right ventricular wall thickness( RVWT),right ventricular end-diastolic diameter( RVDd),left ventricular fractional shortening( LVFS),right ventricular fractional shortening( RVFS) and left ventricular ejection fraction( LVEF) of GDM2 group were significantly higher than those of the control group( all P < 0. 05). The fetal RVDd,right ventricular end-systolic diameter,LVFS and LVEF of the GDM2 group were higher than those of the GDM1 group( all P < 0. 05). The GDM1 group's fetal LVFS was higher than that of the control group( P < 0. 05). The Tei index of fetal left and right ventricular of GDM2 group and GDM1 group was significantly higher than that of the control group,and the difference was statistically significant( all P < 0. 05). The average Tei index of fetal left and right ventricular of GDM2 group was higher than that of the GDM1 group and control group( all P < 0. 05). Conclusions Tei index,which is associated with fetal cardiac function in GDM pregnant women,can be used as a simple and reliable indicator in the clinical comprehensive evaluation of fetal cardiac involvement.
引文
[1]Tei C,Dujardin KS,Hodge DO,et al.Doppler index combining systolic and diastolic myocardial performance:clinical value in cardiac amyloidosis[J].Am Coll Cardiol,1996,28(3):658-664.
[2]Eidem BW,Tei C,O'Leary PW,et al.Nongeometric quantitative assessment of right and left ventricular function:myocardial performance index in normal children and patients with Ebstein anomaly[J].Am Soc Echocardiography,1998,11(9):849-856.
[3]储晨,桂永浩,施立晔.用脉冲多普勒Tei指数评价正常胎儿心功能价值探讨[J].中国实用儿科杂志,2008,5(23):356.
[4]International Association of Diabetes and Pregnancy Study Groups Consensus Panel,Metzger BE,Gabbe SG,et al.International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy[J].Diabetes Care,2010,33(3):676-682.
[5]庞慧燕,姜志荣.超声心动图对正常胎儿心脏功能研究进展[J].中华临床医师杂志(电子版),2011,5(7):2036-2038.
[6]陆永萍,邓又斌,刘娅妮,等.组织多普勒超声评价妊娠期糖尿病胎儿及婴儿心脏整体作功[J].中华超声影像学杂志,2006,15(10):751-754.
[7]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.
[8]桂永浩.先天性心脏病产前诊断及其临床意义[J].中国小儿急救医学,2006,10(13):399-401.
[9]Zou Y,Ding Y.Effect of hyperglycemia on fetal heart in pregnant rats[J].Cent Southuniv(Med Sci),2009,34(2):139-147.
[10]何萍,陈敏,徐惠英,等.超声心动图评价妊娠期糖尿病胎儿心脏功能[J].中国医学影像学杂志,2012,20(6):441-444.
[11]Turan S,Turan OM,Miller J,et al.Decreased fetal cardiac performance in the first trimester correlates with hyperglycemia in pregestational maternal diabetes[J].Ultrasound Obstet Gynecol,2011,38(3):325-331.
[12]薛静,邓涛,张周龙,等.组织多普勒与脉冲多普勒法Tei指数评价冠心病左心功能的对比研究[J].中国医学影像学杂志,2010,18(4):315-317.
[13]焦荣红,郑瑶,曲艺,等.Tei指数测定在妊娠糖尿病孕妇胎儿心脏功能评价中的应用[J].疑难病杂志,2010,9(12):916-917.
[14]Eidem BW,Edwards JM,Cetta F,et al.Quantitative assessment of fetal ventricular function:establishing normal values of the myocardial performance index in the fetus[J].Echocardiography,2001,18(1):9-13.
[15]Hernandez-Andrade E,Figueroa-Diesel H,Kottman C,et al.Gestational-age-adjusted reference values for the modified myocardial performance index for evaluation of fetal left cardiac function[J].Ultrasound Obstet Gynecol,2007,29(3):321-325.
[16]王小艳,周启昌,蒲大容,等.速度向量成像评价妊娠期糖尿病胎儿左心室扭转运动的研究[J].中华超声影像学杂志,2012,21(4):292-295.
[2]Eidem BW,Tei C,O'Leary PW,et al.Nongeometric quantitative assessment of right and left ventricular function:myocardial performance index in normal children and patients with Ebstein anomaly[J].Am Soc Echocardiography,1998,11(9):849-856.
[3]储晨,桂永浩,施立晔.用脉冲多普勒Tei指数评价正常胎儿心功能价值探讨[J].中国实用儿科杂志,2008,5(23):356.
[4]International Association of Diabetes and Pregnancy Study Groups Consensus Panel,Metzger BE,Gabbe SG,et al.International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy[J].Diabetes Care,2010,33(3):676-682.
[5]庞慧燕,姜志荣.超声心动图对正常胎儿心脏功能研究进展[J].中华临床医师杂志(电子版),2011,5(7):2036-2038.
[6]陆永萍,邓又斌,刘娅妮,等.组织多普勒超声评价妊娠期糖尿病胎儿及婴儿心脏整体作功[J].中华超声影像学杂志,2006,15(10):751-754.
[7]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.
[8]桂永浩.先天性心脏病产前诊断及其临床意义[J].中国小儿急救医学,2006,10(13):399-401.
[9]Zou Y,Ding Y.Effect of hyperglycemia on fetal heart in pregnant rats[J].Cent Southuniv(Med Sci),2009,34(2):139-147.
[10]何萍,陈敏,徐惠英,等.超声心动图评价妊娠期糖尿病胎儿心脏功能[J].中国医学影像学杂志,2012,20(6):441-444.
[11]Turan S,Turan OM,Miller J,et al.Decreased fetal cardiac performance in the first trimester correlates with hyperglycemia in pregestational maternal diabetes[J].Ultrasound Obstet Gynecol,2011,38(3):325-331.
[12]薛静,邓涛,张周龙,等.组织多普勒与脉冲多普勒法Tei指数评价冠心病左心功能的对比研究[J].中国医学影像学杂志,2010,18(4):315-317.
[13]焦荣红,郑瑶,曲艺,等.Tei指数测定在妊娠糖尿病孕妇胎儿心脏功能评价中的应用[J].疑难病杂志,2010,9(12):916-917.
[14]Eidem BW,Edwards JM,Cetta F,et al.Quantitative assessment of fetal ventricular function:establishing normal values of the myocardial performance index in the fetus[J].Echocardiography,2001,18(1):9-13.
[15]Hernandez-Andrade E,Figueroa-Diesel H,Kottman C,et al.Gestational-age-adjusted reference values for the modified myocardial performance index for evaluation of fetal left cardiac function[J].Ultrasound Obstet Gynecol,2007,29(3):321-325.
[16]王小艳,周启昌,蒲大容,等.速度向量成像评价妊娠期糖尿病胎儿左心室扭转运动的研究[J].中华超声影像学杂志,2012,21(4):292-295.