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目的:应用超声心动图分析老年冠心病合并糖代谢异常患者左心功能。方法:选取经冠脉造影确诊但未发生心肌梗死的老年冠心病患者87例,依据糖尿病诊断标准,分为糖尿病(DM)组、糖调节受损(IGR)组和正常(NGT)组。各组患者的血压值没有统计学差异。应用二维超声测量左室射血分数(LVEF)与左房容积指数(LAVI),彩色M型测量舒张期左室内血流传播速度(Vp),脉冲多普勒记录二尖瓣及主动脉瓣口血流频谱、测量二尖瓣口舒张早期与晚期血流峰值的比值(E/A),组织多普勒(DTI)测量二尖瓣环舒张早期运动速度(Em),计算E/Em及左室Tei指数以评估患者的左心功能。结果:与NGT组比较,DM组及IGR组患者的左室Tei指数(LV-tTei)[(0.59±0.09),(0.57±0.07)vs(0.52±0.06)]、E/Em比值[(12.61±1.41),(11.22±1.94)vs(9.85±1.93)]及LAVI[(29.22±3.41),(29.22±3.41)vs(27.24±3.35)]增大,Vp减小,差异有统计学意义。且上述4个超声指标有较好的相关性。结论:E/Em、LAVI、LV-tTei及Vp较传统测量的EF及E/A更早地反映了糖代谢异常对老年冠心病患者左心功能的影响。
Objective: To analyze left heart function in elderly patients with coronary heart disease complicated with abnormal glucose metabolism by echocardiography. Methods: Eighty-seven elderly patients with coronary heart disease confirmed by coronary angiography but without myocardial infarction were divided into diabetic group (DM), impaired glucose regulation (IGR) group and normal (NGT) group according to the diagnostic criteria of diabetes. There was no significant difference in blood pressure among patients in each group. Left ventricular ejection fraction (LVEF) and left atrium volume index (LAVI) were measured by two-dimensional echocardiography, left ventricular blood flow velocity (Vp) was measured by color M mode, and mitral and aortic valves were recorded by pulsed Doppler (E / A), mitral annular early diastolic velocity (E / A), tissue Doppler (DTI) measurement of mitral annular early diastolic velocity (Em) and E / Em and Left ventricular Tei index to assess patient’s left ventricular function. RESULTS: Compared with NGT group, LV Tei index (0.59 ± 0.09), (0.57 ± 0.07) vs (0.52 ± 0.06) vs EGR ratio [(12.61 ± 1.41), (11.22 ± 1.94) vs (9.85 ± 1.93), LAVI (29.22 ± 3.41), (29.22 ± 3.41) vs (27.24 ± 3.35)], respectively. There was a significant difference between the two groups. And the above four ultrasound indicators have a good correlation. Conclusion: E / Em, LAVI, LV-tTei and Vp reflect the effect of abnormal glucose metabolism on left ventricular function in elderly patients with coronary heart disease earlier than EF and E / A.