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摘要: 目的 本研究旨在探讨心肌做功在糖尿病(DM)伴有左室重构患者早期左心室功能障碍中的应用价值。方法 本研究最终纳入45例健康受试者作为正常对照组，51例DM患者为DM组。DM组被进一步分为左室几何构型正常组(RWT < 0.42，25例)和左室重构组(RWT≥0.42，26例)。所有研究对象均接受常规超声心动图和二维斑点追踪超声心动图检查，并使用GE Echo PAC分析软件获取左心室常规超声参数、应变参数及心肌做功参数：整体有效做功(GCW)、整体做功指数(GWI)、整体无效做功(GWW)、整体做功效率(GWE)等。结果 与正常对照组比较，DM组GCW、GWI、GWW、GWE、整体纵向应变(GLS)、峰值应变离散度(PSD)均受损(P< 0.05)。与正常对照组比较，左室几何构型正常组和左室重构组的GCW、GWI均减低，且在左室重构组受损明显(P< 0.05)。GWW、GWE、GLS、PSD在左室几何构型正常组与正常对照组之间差异无统计学意义，而与正常对照组相比，左室重构组的GCW、GWI、GWW、GWE、GLS、PSD受损(P< 0.05)。结论 左室心肌做功可以用于评估伴有左室重构的DM患者的左室心肌功能障碍，其能够为DM患者的亚临床左室收缩功能的评估提供更准确、更敏感的新指标。Abstract: Objective The purpose of this study was to investigate the value of myocardial work in early left ventricular dysfunction in patients with diabetes mellitus (DM) and left ventricular remodeling.Methods This study included 51 DM patients and 45 healthy group. DM patients were divided into normal LV geometry(RWT < 0.42,n=25) and LV remodeling(RWT≥0.42,n=26) subgroups. All patients underwent conventional echocardiography and two-dimensional speckle tracking echocardiography, which were analyzed by GE Echo PAC analysis software to obtain conventional ultrasound parameters of left ventricle, strain parameters and myocardial work parameters (GCW, GWI, GWW, GWE).Results Compared with healthy group, GCW, GWI, GWW, GWE, GLS, and PSD were all impaired in the DM group (P< 0.05). Compared with the normal control group, the GCW and GWI of the normal LV geometry subgroup and the LV remodeling subgroup were decreased, and the damage was obvious in the LV remodeling subgroup(P< 0.05). There was no significant difference in GWW, GWE, GLS, PSD between the normal LV geometry subgroup and the healthy control group. However, only the LV remodeling subgroup had impaired GCW, GWI, GWW, GWE, GLS, and PSD compared with the normal control group (P< 0.05).Conclusion Left ventricular myocardial work can be used to evaluate left ventricular myocardial dysfunction in patients with diabetes mellitus and left ventricular remodeling, which may provide a more accurate and sensitive new index for the evaluation of subclinical left ventricular systolic function in patients with diabetes mellitus.
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Key words:
- type 2 diabetes /
- myocardial work /
- left ventricular remodeling /
- echocardiography
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表 1 入组患者的基线资料和常规超声参数比较
Table 1. Baseline characteristics and conventional echocardiographic parameters of enrolled patients
X±S 项目 正常对照组
(45例)DM组
(51例)左室几何构型正常组
(25例)左室重构组
(26例)年龄/岁 54.33±9.94 52.27±11.09 51.88±11.93 52.65±10.44 男/女/例 22/23 24/27 12/13 12/14 病程/年 NA 6.53±1.73 6.20±1.58 6.85±1.87 HbA1c/% NA 6.96±2.41 6.37±3.12 8.16±2.822) LVEDD/mm 46.26±2.93 47.04±2.90 47.12±2.57 46.96±3.24 PWDD/mm 8.76±0.89 9.61±0.961) 9.12±0.671) 10.08±0.981)2) RWT 0.38±0.04 0.41±0.051) 0.39±0.03 0.43±0.051)2) LVEDV/mL 107.76±9.47 109.84±8.18 114.28±7.57 108.46±8.64 LVEF /% 66.60±4.11 64.14±3.78 63.92±3.17 64.27±3.67 LVMI/(g·m-2) 95.80±7.51 102.53±8.271) 98.84±6.881) 106.08±8.041)2) E/Em 8.29±1.80 10.26±2.971) 8.87±2.13 11.59±3.091)2) 与正常对照组比较，1)P < 0.05；与左室几何构型正常组比较，2)P < 0.05。 
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表 2 DM组和正常对照组LVMW及GLS、PSD参数比较
Table 2. LVMW、GLS and PSD parameters of enrolled patients
X±S 参数 正常对照组
(45例)DM组
(51例)左室正常几何构型组
(25例)左室重构组
(26例)GCW/mmHg% 2011.36±308.85 1630.59±306.901) 1855.16±209.581) 1414.65±217.451) GWW/mmHg% 85.29±47.36 128.61±48.871) 101.04±42.59 155.12±39.301) GWE/% 95.88±2.40 92.33±3.571) 94.79±2.29 89.97±2.921) GWI/mmHg% 1776.33±316.44 1554.76±244.061) 1637.68±280.421) 1475.04±173.661) GLS/% -20.02±2.23 -18.65±3.011) -19.36±3.10 -17.96±2.811) PSD/ms 33.45±5.27 41.89±10.031) 36.77±6.07 46.82±10.681) 与正常对照组比较，1)P < 0.05；与左室几何构型正常组比较，2)P < 0.05。
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