三维超声心动图评价糖尿病患者左心室功能及其与血清学代谢指标的相关性

Objective To assess the left ventricular dysfunction and the correlation with metabolic indexes in diabetes patients with real-time three-dimensional echocardiography. Methods Totally 90 patients with type 2 diabetes (48 with early-stage diabetes [early diabetes group], 42 with early-stage diabetic nephropathy [early diabetic nephropathy group]) and 47 healthy volunteers (control group) were enrolled. The left ventricular end-diastolic dimension (LVEDd), left ventricular end-systolic diameter (LVESd), two-dimensional left ventricular ejection fraction (2D-LVEF), isovolumic relaxation time (TVRT), early diastolic velocity of mitral valve (Ea), end diastolic velocity of mitral valve (Aa) and E-wave deceleration time (EDT) were measured with two-dimensional echocardiography. E/E' and Tei index were calculated. Real-time three-dimensional ultrasound was used to record the left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), three-dimensional left ventricular ejection fraction (3D-LVEF) and left ventricular myocardium overall longitudinal strain (GLS). The serum cystatin C, β₂ microglobulin, serum creatinine and glycated hemoglobin levels were recorded. The differences of the above indicators were compared among 3 groups, and the correlation between echocardiographic indicators and serological indicators were evaluated. Results Compared with those of control group, LVEDV, E/E', Tei index increased, 3D-LVEF and GLS decreased in early diabetes group (all P<0.05), while LVDd, LVEDV, LVESV, Tei index, E/E', Aa, IVRT and EDT increased, 2D-LVEF, GLS, 3D-LVEF and Ea decreased in early diabetic nephropathy group (all P<0.05). Compared with those of early diabetes group, LVDd, LVEDV, Tei index, E/E' and EDT increased, GLS and 3D-LVEF decreased in patients with early diabetic nephropathy group (all P<0.05). Correlation analysis showed that serum β₂ microglobulin positively correlated with Tei index and LVEDV (r=0.732, 0.604, both P<0.05), and negatively correlated with GLS (r=-0.703, P<0.05). The glycated hemoglobin level positively correlated with LVEDV (r=0.663, P<0.05) and negatively correlated with 3D-LVEF and GLS (r=-0.701, -0.742, both P<0.05). Conclusion The diastolic and systolic function of the left ventricle was impaired in early diabetic patients, and the left ventricular function is correlated with serum β₂ microglobulin and glycosylated hemoglobin level.