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目的运用心肌综合指数量化分析2型糖尿病患者左心室心肌的功能,评价其对判别左心室心肌功能异常的价值。方法选取2型糖尿病患者73例,依据糖化血红蛋白(HbA1c)水平分为A组(HbA1c<7%,n=38)和B组(HbA1c≥7%,n=35),入选31例健康志愿者为对照组。使用3D-STI技术测定左心室收缩期整体峰值环向应变(GCS)、收缩期整体峰值径向应变(GRS)、收缩期整体峰值纵向应变(GLS)、收缩期整体峰值面积应变(GAS)及左心室扭转(LVtw),计算左心室心肌综合指数(SMI),比较各组间参数是否有统计学差异,运用Pearson相关分析各参数同HbA1c的相关性,并利用ROC曲线筛选各参数对2型糖尿病患者心肌损害的诊断价值。结果与对照组相比,2型糖尿病组的GLS、GAS及SMI均小于对照组,而B组同A组相比,GAS、LVtw及SMI亦均减低,差异有统计学意义(P<0.05)。糖尿病组的SMI、GLS和GAS同HbA1c呈明显负相关,相关系数分别为-0.722、-0.594和-0.677(P均<0.001)。SMI的曲线下面积(AUC)为0.859,SMI以-275.7(%×°)为糖尿病患者的截断点时,其敏感性为83.4%,特异性为78.3%。结论 3D-STI诊断2型糖尿病的所有参数中,SMI敏感度和特异度均最高,可监测早期2型糖尿病患者左心室整体收缩功能的变化。
Objective To quantitatively analyze the function of left ventricular myocardium in patients with type 2 diabetes mellitus by using the myocardial composite index to evaluate the value of discriminating left ventricular dysfunction. Methods Totally 73 patients with type 2 diabetes were enrolled and divided into group A (HbA1c <7%, n = 38) and group B (HbA1c≥7%, n = 35) according to the level of HbA1c. 31 healthy volunteers For the control group. The global peak systolic strain (GCS), systolic global peak radial strain (GRS), systolic global peak longitudinal strain (GLS) and systolic global peak area strain (GAS) were measured by 3D-STI Left ventricular diastolic pressure (LVtw), left ventricular myocardial composite index (SMI) were calculated, and the parameters between the two groups were compared statistically. The Pearson correlation was used to analyze the correlation between each parameter and HbA1c. Diagnostic value of myocardial damage in diabetic patients. Results Compared with the control group, the GLS, GAS and SMI in type 2 diabetes group were significantly lower than those in control group, while the GAS, LVtw and SMI in group B were also lower than those in control group (P <0.05) . There was a significant negative correlation between SMI, GLS and GAS in diabetic patients and HbA1c, the correlation coefficients were -0.722, -0.594 and -0.677, respectively (all P <0.001). The area under the curve (AUC) for SMI was 0.859 and the cut-off point for SMI at -275.7 (% x °) was 83.4% with a specificity of 78.3%. Conclusions Among all the parameters of type 2 diabetes mellitus diagnosed by 3D-STI, the sensitivity and specificity of SMI are the highest, which can monitor the changes of left ventricular systolic function in patients with early type 2 diabetes mellitus.