| Objective:To investigate the two-dimensional speckle tracking imaging technique to evaluate the application value of left atrial function in patients with type2diabetes.Method:1.subjects Study of100cases selected packet as follows:1.12diabetes mellitus group:60patients with type2diabetes were collected from2013April to2013September in our hospital for treatment of patients with. Met the diagnostic criteria of type2diabetes in2006WHO:fasting blood glucose of7.0mmol/l or2hour postprandial blood glucose greater than or equal to11.1mmol/1; the male27cases, female33cases, age33-66years, mean age45.3±6.3years old; hypertension, coronary heart disease were excluded, valvular heart disease, cardiac disease, thyroid disease, acute and chronic nephropathy, immune system disease, arrhythmia and other organic heart disease. Left ventricular ejection fraction (EF)>55%, without left ventricular diameter. According to the tissue Doppler imaging (TDI) measurement of left ventricular wall mitral annular early diastolic peak velocity (Ve) and the average peak velocity, late diastolic (Va) ratio (Ve/Va) as a judge of the left ventricular diastolic function in patients with type2diabetes mellitus standard, will be divided into left ventricular diastolic function in normal group (group A, Ve/Va>1), decrease of left ventricular diastolic function group (group B, Ve/Va<1). A group of34cases, male15cases, female19cases, age33-63years, mean age44.7±6.4years old; B group26patients, male14cases, female12cases, age38-66years, mean age46.3±5.9years old.1.2in the control group (C group):30cases, healthy volunteers, male12cases, female18cases, age18～61years, mean age42.8±6.1years old; regular measurement of blood pressure and blood and urine routine examination, liver and kidney function, electrolyte, blood examination examination examination, routine ECG examination, ultrasound Beckoning graph examination, X-ray examination, excluding diabetes, thyroid disease, hypertension, coronary heart disease, valvular heart disease, cardiac disease, acute and chronic kidney disease, immune system disease, arrhythmia and other organic heart disease.2. instruments and equipmentThe Philips electronics company production of the world’s most high-end cardiovascular special color Doppler ultrasonic diagnostic instruments Philips IE33, X5-1probe, probe frequency of1～5MHz, equipped with tissue Doppler imaging (TDI), the two-dimensional speckle tracking imaging (STI), ultrasonic technology of real-time three-dimensional ultrasound and other advanced, and is equipped with QLAB offline analysis software after weaning, can be used for the quantitative analysis of myocardial segments.3. research methodsAll of the subjects were the routine ultrasound Beckoning graph examination, application of M ultrasound, color Doppler ultrasound, Doppler ultrasound spectrum calculated the left atrial diameter, maximal left atrial volume, the minimum left atrial volume, left atrial contraction of volume, the maximum volume index, left atrium and left atrial ejection force. Strain rate and then using two-dimensional speckle tracking front wall, left atrium imaging measurement under the wall, posterior wall, side wall, the atrial septum (SR).4.statistical analysisAll data are used SPSS17software was used for statistical analysis, measurement data to mean+standard deviation said (±s); between the two groups were compared by two independent samples t test. Analysis of application of partial clinical factors and left ventricular diastolic function of left atrial function; multiple regression analysis was used to screen factors significantly influence of left atrial function; area of application of ROC curve and the curve of STI to determine the sensitivity of the left atrium in patients with type2diabetes function.(P<0.05had statistical significance)Result:1.general clinical data (Table1)1.1A group compared with C group:A group of glycosylated hemoglobin, cholesterol, glycerin three fat, low density lipoprotein were increased (P<0.05); high density lipoprotein and serum insulin were decreased (P<0.05); impaired fasting blood glucose and postprandial2hour blood glucose slightly higher. But the difference was not statistically significant (P>0.05)1.2B group compared with C group:B group of glycosylated hemoglobin, cholesterol, glycerin three fat, low density lipoprotein were significantly increased (P<0.001); high density lipoprotein and serum insulin were significantly decreased (P<0.001); fasting blood glucose and postprandial2hour blood glucose was significantly increased (P<0.05)2.general ultrasonic Beckoning graph data comparison (Table2)2.1A group compared with C group:A group of left atrial diameter, maximal left atrial volume, the minimum left atrial volume, left atrial initiative systolic left atrial ejection force volume, maximum volume index, left atrial ago were slightly increased, but the difference is not statistically significant (P>0.05)2.2B group compared with C group:B group of left atrial diameter, maximal left atrial volume, the minimum left atrial volume, left atrial initiative systolic left atrial ejection force volume, maximum volume index, left atrium before the increase (P<0.05)3.Comparison of left atrial wall strain rate detection of3two-dimensional speckle tracking (Table3)3.1A group compared with C group:left atrial systolic strain rate of A group average peak (SSR) lower (P<0.05); left atrial wall early diastolic strain rate (ESR) decreased the average peak (P<0.05), left atrial wall and late diastolic strain rate (ASR) increased the average peak (P<0.05)3.2B group compared with C group:left atrial systolic strain rate of B group average peak (SSR) decreased (P<0.05), left atrial wall early diastolic strain rate (ESR) decreased the average peak (P<0.001), left atrial wall and late diastolic strain rate (ASR) increased the average peak (P<0.05)3.3A group compared with B group:left atrial systolic strain rate of B group average peak (SSR) decreased (P<0.05), left atrial wall early diastolic strain rate (ESR) decreased the average peak (P<0.05), left atrial wall average peak late diastolic strain rate (ASR) difference was not statistically significant (P>0.05)4.Technology assessment and general clinical data of partial correlation between the rate of type2diabetes mellitus group left atrial wall strain4two-dimensional speckle tracking (Table4, Figure1-3)4.1left atrial systolic strain rate average peak (SSR) and fasting blood glucose, glycosylated hemoglobin, glycerin three greases were negatively correlated (r=-0.261,-0.263,-0.218), were positively correlated with high density lipoprotein, insulin levels (r=0.263,0.278).4.2left atrial wall early diastolic strain rate (ESR) and the average peak value of fasting blood glucose, glycosylated hemoglobin, cholesterol, low density lipoprotein were negatively correlated (r=-0.279,-0.602,-0.210,-0.197) were positively correlated with high density lipoprotein, insulin levels (r=0.254,0.491).4.3left atrial wall and late diastolic strain rate average peak (ASR) and fasting blood glucose, glycosylated hemoglobin, cholesterol, glycerin three greases were positively correlated (r=0.269,0.371,0.247,0.251), were negatively correlated with high density lipoprotein, insulin levels (r=-0.261,-0.369).5.To evaluate the left atrial wall strain rate linear numerical and general clinical data regression analysis between5speckle tracking (Table5)5.1fasting blood glucose, postprandial2hour blood glucose, glycosylated hemoglobin, cholesterol, glycerin three fat, insulin levels, high density lipoprotein, low density lipoprotein for left atrial systolic strain rate (SSR) and average peak factor independent effect.5.2fasting blood glucose, postprandial2hour blood glucose, glycosylated hemoglobin, cholesterol, glycerin three fat, insulin levels, high density lipoprotein, low density lipoprotein to left atrial wall early diastolic strain rate (ESR) and average peak factor independent effect.5.3fasting blood glucose, postprandial2hour blood glucose, glycosylated hemoglobin, cholesterol, glycerin three fat, insulin levels, high density lipoprotein, low density lipoprotein to left atrial wall and late diastolic strain rate (ASR) and average peak factor independent effect.6.ROC curves of sensitivity and specificity of STI left atrial wall strain rate in type2diabetic myocardial motion judgment (Figure4-9)The results of this study show the left atrial systolic strain rate average peak (SSR) sensitivity and specificity of type2diabetes mellitus group were0.73and0.81, the area under the ROC curve was0.851; left atrial wall early diastolic strain rate (ESR) and average peak sensitivity and specificity of type2diabetes mellitus group were0.81and0.78, the area under the ROC curve was0.825; left atrial wall average peak late diastolic strain rate (ASR) sensitivity and specificity of type2diabetes mellitus group were0.74and0.83, the area under the ROC curve was0.834.Conclusion:l.The left ventricular diastolic function of type1.2diabetic patients with normal left atrial function has been impaired, mainly as a left atrial reservoir function and conduit function decreases, booster pump function.2.The left ventricular diastolic function of type2.2diabetic patients with mild decreases, left atrial reservoir function and conduit function further reduced, compared with normal function in type2diabetic patients with left ventricular diastolic, booster pump function did not change significantly.3.The2type of left atrial function in patients with diabetes mellitus due to the combined effects of left ventricular function and abnormal glucose metabolism.4.1ndependent risk factors for type4.2diabetes patients with fasting blood glucose, postprandial2hour blood glucose, glycosylated hemoglobin, cholesterol, glycerin three fat, insulin levels, high density lipoprotein, low density lipoprotein were left atrial function.5.two-dimensional speckle tracking strain rate imaging in the evaluation of the sensitivity of2type of left atrial function in patients with diabetes mellitus have higher, diagnostic information for early detection of heart in patients with type2diabetes mellitus provides value to change, to provide objective evidence for clinical judgement of heart function, evaluating prognosis and curative effect of the patients. |
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