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目的采用超声心动图评价原发性高血压合并Ⅱ型糖尿病(hypertension and typeⅡdiabetes melllitus,DMTH)患者与健康人群的二尖瓣环与主动脉瓣环平面夹角(Aortomitral angle,AMA)的运动变化及其与左室收缩功能的关系。方法纳入59例DMTH患者及63例性别年龄相匹配的健康人作为对照组,所有参选病例均行常规超声心动图检查,平静状态下采集连续五个心动周期的二维灰阶动态图像,于胸骨旁左室长轴切面上,依次测量等容收缩期起始(Start of isovolume contraction,Sivct-AMA)、S波顶点(S wave peak,Sp-AMA)、等容舒张期起始(Start of isovolume relaxtion,Sivrt-AMA)、舒张期末(End of diastolic,Ed-AMA)对应的AMA,角度差(⊿θ)=AMAmax-AMAmin,角度变化率=⊿θ/AMAmax。使用Philips QLAB 10.3二维斑点追踪定量分析软件获取左室整体纵向应变(The global longitudinal strain,GLS)及整体周向应变(The global circumferntial strain,GCS)。采用Simpson’s双平面法测量左室射血分数(Left ventrical eject fraction,LVEF)。两组间结果的比较采用两独立样本t检验,P<0.001为差异有统计学意义;两参数间的相关性分析采用Pearson相关分析,P<0.05为差异有统计学意义。结果 DMTH组的GLS、GCS较对照组明显减低,差异有统计学意义(P<0.05),LVEF无明显差异(P>0.05);Sp-AMA较对照组明显增大,P<0.05,差异有统计学意义;其余时相的AMA与对照组相比,无统计学差异(P>0.05);⊿θ、⊿θ/AMAmax较对照组明显减小,差异有统计学意义(P<0.05)。正常对照组内⊿θ、⊿θ/AMAmax均与GLS绝对值呈正相关性(r=0.372、P=0.004,r=0.349、P=0.007),而与GCS的绝对值、LVEF均无相关性。与对照组相比,DMTH组患者⊿θ、⊿θ/AMAmax与LVEF均呈正相关(r=0.289、P=0.022,r=0.325、P=0.009),与GLS、GCS均无相关性。结论 DMTH患者AMA的增大可能是瓣环联合体为保持左室有效射血而发生的适应性改变,是心肌间质纤维立体网络重构的一种表现。
Objective To evaluate the changes of Aortomitral angle (AMA) in patients with essential hypertension and type 2 diabetes mellitus (DMTH) and healthy subjects by echocardiography. Its relationship with left ventricular systolic function. Methods Fifty-nine DMTH patients and 63 gender-matched healthy individuals were enrolled as control group. All the patients underwent routine echocardiography. Two-dimensional gray-scale dynamic images of five consecutive cardiac cycles were collected under calm condition. On the long axis of the parasternal side of the sternum, Sivct-AMA, S-wave peak (Sp-AMA), Start of isovolume relaxtion (Sivrt-AMA), AMA corresponding to the end of diastolic (Ed-AMA), angle difference (⊿θ) = AMAmax-AMAmin and rate of change of angle = ⊿θ / AMAmax. The global longitudinal strain (GLS) and global circumferential strain (GCS) were obtained using Philips QLAB 10.3 2D speckle tracking quantitative analysis software. Left ventricular ejection fraction (LVEF) was measured using Simpson’s bi-planar method. The results of two groups were compared using two independent samples t test, P <0.001 for the difference was statistically significant; Pearson correlation analysis between the two parameters, P <0.05 for the difference was statistically significant. Results The levels of GLS and GCS in DMTH group were significantly lower than those in control group (P <0.05), while there was no significant difference in LVEF (P> 0.05). Sp-AMA was significantly higher than that in control group There was no significant difference in the other phases of AMA compared with the control group (P> 0.05); ⊿θ, ⊿θ / AMAmax were significantly decreased compared with the control group (P <0.05). The values of ⊿θ and ⊿θ / AMAmax in normal control group were positively correlated with the absolute value of GLS (r = 0.372, P = 0.004, r = 0.349, P = 0.007), but not with the absolute value of GCS and LVEF. There was a positive correlation between ⊿θ, ⊿θ / AMAmax and LVEF in DMTH group (r = 0.289, P = 0.022, r = 0.325, P = 0.009), but no correlation with GLS and GCS. Conclusions The increase of AMA in patients with DMTH may be the adaptive changes in the annulus to maintain effective left ventricular ejection. It is a manifestation of three-dimensional reconstruction of myocardial interstitial fibroids.