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目的利用三维斑点追踪技术(3DSTE)评价控制平稳的2型糖尿病合并和不合并高血压患者的左室功能。方法 82例控制平稳的2型糖尿病患者分为单纯糖尿病组(46例)和糖尿病合并高血压组(36例)。40例年龄、性别匹配的健康体检者作为对照组。采集左室全容积图像分析,计算射血分数(EF)、整体纵向应变(GLS)、圆周应变(GCS)、面积应变(GAS)、径向应变(GRS)。结果单纯糖尿病组仅GLS显著低于对照组(P<0.001),而糖尿病合并高血压组GLS、GCS、GAS和GRS均显著低于对照组和单纯糖尿病组(P<0.001or P<0.05)。空腹血糖(FPG)和左室舒张末期容积(LVEDV)在单纯糖尿病组和糖尿病合并高血压组都是对GLS有意义的影响因素。结论左室射血分数正常的2型糖尿病患者存在收缩期应变下降,合并存在的高血压将加重上述损害,即使血压、血糖控制平稳。而三维斑点追踪技术能够敏感地检测出上述常规超声心动图难以发现的病变。
Objective To evaluate left ventricular function in patients with stable type 2 diabetes mellitus and those without hypertension by 3D speckle tracking (3DSTE). Methods 82 patients with stable type 2 diabetes mellitus were divided into simple diabetic group (n = 46) and diabetes mellitus combined hypertension group (n = 36). 40 cases of age, gender-matched healthy subjects as control group. Left ventricular total volume images were collected for analysis of ejection fraction (EF), global longitudinal strain (GLS), circumferential strain (GCS), area strain (GAS) and radial strain (GRS). Results Only GLS in diabetic group was significantly lower than that in control group (P <0.001), but GLS, GCS, GAS and GRS in diabetic patients with hypertension were significantly lower than those in control group and simple diabetic group (P <0.001or P <0.05). Fasting plasma glucose (FPG) and left ventricular end-diastolic volume (LVEDV) were both significant contributors to GLS in both diabetic and hypertensive diabetic patients. Conclusions Systolic strain decreases in type 2 diabetic patients with normal left ventricular ejection fraction (LVEF), and the combination of hypertension may aggravate the above impairment even though blood pressure and blood glucose control are stable. The three-dimensional speckle tracking technique can sensitively detect the above echocardiography hard to find lesions.