三维斑点追踪技术对是否合并肥胖的2型糖尿病患者左心室功能损伤的评价

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摘要目的应用三维斑点追踪技术（3D-STI）对是否合并肥胖的2型糖尿病患者左室功能损伤的评价。方法选取河北北方学院附属第一医院2017年5月~2018年5月诊断为2型糖尿病患者88例，根据是否合并全身性肥胖分为不合并全身性肥胖组[D1组，体重指数（BMI）＜25 kg/m2]与合并全身性肥胖组（D2组，BMI≥25 kg/m2），D1组43例，D2组45例。选取年龄和性别匹配的健康人群40例为对照组。D2组测量腰围（WC）后判断其是否合并腹型肥胖，并将其分为非腹型肥胖组（D2WC1组，男性WC＜90 cm，女性WC＜80 cm）和腹型肥胖组（D2WC2组，男性WC≥90 cm，女性WC≥80 cm），D2WC1组20例，D2WC2组25例。应用3D-STI得到左室整体收缩期纵向应变（GLS）、圆周应变（GCS）、面积应变（GAS）及径向应变（GRS），并收集其他临床指标，分析比较各组患者的各指标的差异。结果与对照组比较，D1组GLS显著降低（P ＜ 0.05），D2组所有方向的整体应变严重降低（P ＜ 0.001）；与D1组比较，D2组所有应变指标显著降低（P ＜ 0.05）；D2WC2组中所有应变指标均显著低于D2WC1组（P ＜ 0.05）。结论糖尿病患者在左室射血分数正常的情况下已有心肌功能受损，合并肥胖可使心肌功能障碍进一步加重，3D-STI则可早期敏感发现肥胖糖尿病患者的左室功能变化，为临床干预提供参考依据。

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	温德惠1 徐乐1 郑英娟1 刘俊峰1 谷君2 王义成1 孙晨曦1

关键词 ：三维斑点追踪技术, 糖尿病, 肥胖, 左室功能

Abstract：Objective To evaluate the left ventricular function of patients with type 2 diabetes mellitus with obesity using three-dimensional speckle tracking technology (3D-STI). Methods A total of 88 patients with type 2 diabetes diagnosed in the First Affiliated Hospital of Hebei North University from May 2017 to May 2018 were divided into the non-systemic obesity group(D1 group, BMI<25 kg/m2) and the systemic obesity group (D2 group, BMI≥25 kg/m2) according to whether they had systemic obesity, and there were 43 cases in D1 group and 45 cases in D2 group. Forty healthy people with age and gender matching were selected as the control group. The waist circumference (WC) of D2 group was measured to determine whether abdominal obesity was associated with abdominal obesity. The patients were divided into non-abdominal obesity group (D2WC1 group, male WC < 90 cm, female WC < 80 cm) and abdominal obesity group (D2WC2 group, male WC < 90 cm, female WC < 80 cm), 20 cases in D2WC1 group and 25 cases in D2WC2 group. Left ventricular systolic longitudinal strain (GLS), circumferential strain (GCS), area strain (GAS) and radial strain (GRS) were obtained by 3D-STI, and other clinical indicators were collected to analyze and compare the differences between the indicators among each group. Results Compared with the control group, GLS in D1 group was significantly lower (P < 0.05), global strain in all directions in D2 group was significantly lower (P < 0.001), all strain indices in D2 group were significantly lower than those in D1 group (P < 0.05), and all strain indices in D2WC2 group were significantly lower than those in D2WC1 group (P < 0.05). Conclusion Diabetic patients with normal left ventricular ejection fraction have impaired myocardial function. Obesity can further aggravate myocardial dysfunction. 3D-STI can detect early changes of left ventricular function in obese diabetic patients and provide reference for clinical intervention.

Key words： Three dimensional speckle tracking technique Diabetes Obesity Left ventricular function

基金资助:河北省科技计划项目（17277772D）。

引用本文:

温德惠1 徐乐1 郑英娟1 刘俊峰1 谷君2 王义成1 孙晨曦1. 三维斑点追踪技术对是否合并肥胖的2型糖尿病患者左心室功能损伤的评价[J]. 中国医药导报, 2018, 15(36): 162-165.
WEN Dehui1 XU Le1 ZHENG Yingjuan1 LIU Junfeng1 GU Jun2 WANG Yicheng1 SUN Chenxi1. Evaluation of subclinical left ventricular function injury in type 2 diabetic patients whether with obesity by three-dimensional speckle tracking. 中国医药导报, 2018, 15(36): 162-165.

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