【作者】 谢锋；

【导师】 周启昌；

【作者基本信息】 中南大学 ， 影像医学与核医学， 2009， 硕士

【摘要】 研究背景糖尿病是一种以长期高血糖为特征的慢性代谢综合征,近年来全球性糖尿病的患病率及死亡率逐年增加,且发病年龄逐渐年轻化,糖尿病性心肌病是糖尿病的主要并发症之一,最终将发展为充血性心力衰竭(CHF)。因此糖尿病患者早期心脏功能不全的评价具有重要的临床意义。Isomaa等报道显示:成人隐匿型自身免疫性糖尿病(LADA)患者大血管并发症(冠心病等)患病率高于类似病程下的经典1型糖尿病,与2型糖尿病相似,且LADA患者血糖控制水平与冠心病的发病关系较2型糖尿病密切。以往研究发现2型糖尿病患者在无明显临床症状的情况下,心脏舒张早期及收缩期功能已发生改变。但到目前为止国内外仅有少量关于成人隐匿性自身免疫性糖尿病(LADA)患者心脏长轴方向整体或局部功能的研究报道。目的探讨速度矢量显像(velocity vector imaging、VVI)定量检测无明显临床症状的LADA患者左室心肌长轴节段收缩功能和舒张功能,并与正常人比较观察其变化特点。应用VVI技术探讨LADA患者亚临床左心收缩和舒张功能不全的临床价值。对象及方法LADA组:2005—2007年在本院内分泌研究所经过严格筛选,完全符合诊断标准且追踪观察与治疗的单纯LADA患者60例,男32例,女28例,年龄32—75岁,平均(51.833±12.073岁);所有患者均有3年以上病史,患者空腹血糖(FBS)在4.34-21.98mmol/L之间。入选者均排除下列情况:①既往有心脏病、高血压病史;②甲状腺疾病;③糖尿病肾病;④糖尿病视网膜病;⑤糖尿病足;⑥外周血管病变;⑦出现过心肌缺血症状;⑧心电图检查异常;⑨常规超声心动图检查异常;EF＜55%。对照组:按性别、年龄与LADA患者相匹配的正常人60例,男32例,女28例,年龄32—75岁,平均(51.467±12.170岁),无心血管病史,心电图、超声心动图、X线、生化检查均正常,体检排除各种器质性疾病。利用声学采集动态图像,获得16个节段长轴方向的心肌峰值速度(SVmax)、应变峰值(Smax)、应变率峰值(SRmax)及其达峰时间进行分析。每一指标均取3个心动周期的平均值。结果正常组收缩期和舒张期心肌长轴方向的峰值运动速度在基底段、中间段、心尖段呈现减小趋势,峰值应变及应变率在基底段、中间段、心尖段无显著性差异,在LADA组中也有相同改变趋势,但各节段测值均显著减低,差异有极显著性意义(p＜0.01)。LADA组收缩期和舒张期心肌峰值速度、应变率及收缩期、舒张早期心肌应变明显低于对照组(P＜0.01)。舒张晚期应变两组比较无统计学意义(P＞0.05)。速度、应变、应变率的达峰时间比较,LADA组呈延长趋势,但差异无统计学意义(P＞0.05)。结论无明显临床状态的LADA患者心脏长轴方向收缩和舒张功能已发生减退。VVI技术可无创性定量分析LADA患者心肌收缩、舒张功能,为早期评价LADA患者的亚临床左室功能不全提供了一种新的方法。更多还原

【Abstract】 Backgroud: Diabetes mellitus (DM) is a chronic metabolic syndrome characterized by long-term persistent hyperglycemia. Recently, morbidity and mortality of DM are increasing progressively all over the world, and average onset age is gradually decreasing. Diabetic myocardiopathy is a common complication of DM and can lead to congestive heart failure. Thus, it is clinically important to evaluate cardiac function at early stage in patients with DM. Isomaa et al reported that morbidity of major vascular complication in latent autoimmune diabetes in adults (LADA) is higher than those in classic type 1 DM with same courses of disease, similar with type 2 DM. The relationship between blood sugar level and morbidity of coronary artery disease in LADA is closer than in type 2 DM. Studies indicated that cardiac systolic and diastolic function changed prior to presence of clinical symptoms in type 2 DM. Whereas few studies about cardiac longitudial globle and regional function in LADA have been reported so long.Objectives: To assess subclinical left ventricular systolic and diastolic function in normotensive LADA patients with normal ejection fraction and fractional shortening using velocity vector imaging (VVI), and observe the cardiac function changes compared with healthy subjects. Evaluate clinical uses of VVI to detect subclinical left ventricular systolic and diastolic function in LADA patients. Subjects and methods: LADA group: 60 LADA patients who visited Endocrine Research Institute in our hospital from 2005-2007. All the patients were diagnosed LADA and underwent observation and treatment. Among those patients, 32 were male and 28 female, between 32-75 years old, average age (51.833±12.073); All of the enrolled patients had history of disease more than 3 years, and fasting blood sugar (FBS) level were 4.34-21.98mmol/L. Exclusive criteria included:①had history of heart disease and hypertension;②presence of thyroid disease;③diabetic renal disease;④diabetic disease;⑤diabetic feet;⑥periphery vascular disease;⑦presence of myocardial ischemic symptom;⑧abnormal echocardiogram (ECG);⑨abnormal echocardiography in routine tests; EF<55%.Control group: 60 healthy subjects matched with LADA patients in terms of sexy and age. 32 were male and 28 female, between 32-75 years age, average age (51.467±12.170) . All of the subjects had no history of cardiovascular diseases or other organic diseases, with normal ECG, echocardiography, X-ray and biochemical tests. Digital dynamic imagings were collected and myocardial longitudinal velocity (SVmax), strain(Smax), strain rate (SRmax) and time to peak velocity, strain and strain rate of 16 segments were analyzed. Each parameter were measured 3 times and average values were obtained.Results: Myocardial longitudinal peek velocity in both systolic and diastolic period tended to decrease from basal, middle and apical segment in control group, whereas strain and strain rate had no significant differences. The same change tendency was observed in LADA group, but all the measured parameters were lower than those in control group with statistically differences (p<0.01). Myocardial velocity and strain in systolic and diastolic period, myocardial strain in systolic and early diastolic period in LADA group were significantly lower in comparison with control group (P <0.01) . Myocardial strain in late diastolic period had no differences between two groups. Time to peak velocity, strain and strain rate were longer in LADA group, but with no statistically significance (P >0.05) .Conclusion: Cardiac abnormal longitudinal systolic and diastolic function exists in subclinical LADA patients. VVI is a novel and noninvasive tool to quantitatively and objectively assess left ventricular regional systolic and diastolic function in the LADA patients; it can make trustworthy early diagnose of abnormal left ventricle myocardial performance in patients with subclinical LADA. It is prospective that VVI will be widely used with progressive development and more attention to early detect diabetic myocardiopathy.更多还原