组织运动二尖瓣环位移技术评价糖尿病合并代谢综合征患者左心室收缩功能的临床研究

Evaluation of left ventricular systolic function in patients with type 2 diabetes mellitus with metabolic syndrome using tissue motion tracking of mitral annular displacement

摘要:

目的采用超声组织运动二尖瓣环位移技术（TMAD） 评价射血分数正常的2型糖尿病（T2DM） 合并代谢综合征（MS）患者的左心室收缩功能。方法收集左心室射血分数保留的T2DM患者（T2DM组）94 例，根据是否合并MS，将T2DM组分为合并MS组（CMS组）与不合并MS组（NMS组），同期收集年龄、性别 相匹配的50例志愿者作为对照组。采用超声心动图测量左心室舒张期容积（LVEDV）、左心室射血分数（LVEF） 及二尖瓣血流速度等常规参数。采用二维斑点追踪技术（2D STE）测量TMAD参数：二尖瓣环室间隔位点位移 （TMAD1）、侧壁位点位移（TMAD2）、平均位移（TMADmid）及平均位移率（TMADmid%），比较各组各参数 的差异。结果T2DM组患者和对照组的常规超声心动图参数结果比较，差异有统计学意义（P <0.05）；与对照 组相比，T2DM患者的LVEDV增加（P <0.05），Mitral E/A减低（P <0.05）；而LVEDD及LVEF比较，差异无统 计学意义（P >0.05）。对照组、CMS组及NMS组TMAD参数比较，差异有统计学意义（P <0.05）；与对照组比 较，CMS 组及NMS 组患者TMAD1、TMAD2、TMADmid 及TMADmid%均降低（P <0.05），且CMS 组患者 TMAD参数均低于NMS组（P <0.05）。结论射血分数保留的T2DM患者左心室收缩功能仍降低，且合并MS 的T2DM患者左心室收缩功能降低更显著。TMAD参数可作为临床评价左心室收缩功能的新参数，具有操作简 单，准确、灵敏等优点。

Abstract:

Objective To evaluate left ventricular systolic function in patients with type 2 diabetes (T2DM) with preserved left ventricular ejection fraction (LVEF) using tissue mitral valve annulus displacement (TMAD) and the effects of metabolic syndrome (MS) on left ventricular systolic function in patients with T2DM. Methods A total of 94 T2DM patients with preserved LVEF were collected as the case group. According to whether the patients were combined with MS, the T2DM patients were divided into the combined MS group (CMS group) and the noncombined MS group (NMS group), and 50 healthy people with matching age and sex were collected during the same period as control group. Echocardiography was used to measure conventional parameters such as left ventricular diastolic volume (LVEDV), LVEF, and mitral velocity, and we used two-dimensional speckle tracking echocardiography to measure TMAD parameters such as mitral annulus septal site displacement (TMAD1), lateral site displacement (TMAD2), average The displacement (TMADmid), and the average displacement rate (TMADmid%). Then, we compared the differences of parameters between each group. Results The comparison of the results of conventional echocardiography parameters between the T2DM group and the control group was statistically significant (P < 0.05); compared with the control group, the LVEDV of T2DM patients was increased, and the Mitral E/A was decreased (P < 0.05), and there was no significant difference in LVEF between the groups (P > 0.05). The comparisons of the TMAD parameter results among the control group, CMS group, and NMS group were statistically significant (P < 0.05); compared with the control group, the TMAD parameters (including TMAD1, TMAD2, TMADmid, TMADmid%) of patients in the CMS group and NMS group were reduced (P < 0.05), and the TMAD parameters of the patients in the CMS group were lower than those in the NMS group (P < 0.05). Conclusions Left ventricular systolic function in patients with T2DM with LVEF preserved still decreases, and the decrease of the left ventricular systolic function in T2DM patients with MS is more significant. The TMAD parameter can be used as a new parameter for clinical evaluation of left ventricular systolic function, and has the advantages in simple operation, accuracy, and sensitivity.