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背景与糖尿病肾病、糖尿病视网膜病变等其他并发症相比,糖尿病心肌病提出较晚,研究不够深入,发病隐匿,早期诊断方法不够完善,临床重视程度不够。目的利用多普勒组织成像评价糖尿病心肌病左室功能障碍特点。设计完全随机分组设计,对照实验。单位解放军成都军区总医院超声科。材料实验于2002-03/06在解放军成都军区总医院超声科完成。选用健康新西兰大白兔56只,雌雄不拘。方法①随机于56只实验兔中抽出10只作为对照组(不造成糖尿病模型),其余46只进行糖尿病模型复制(家兔禁食18h,按65m L/kg耳缘静脉一次注射链脲佐菌素溶液。将造模成功40只兔随机分成4组,即造模后2,4,6,8周组,每组10只。②采用全身数字化超声心动图仪检查造模后2,4,6,8周及对照组兔心脏二尖瓣环处室壁运动频谱。超声检测指标收缩期峰速度、射血前时间、局部射血时间、二尖瓣环4个不同部位平均收缩速度值、舒张早期速度、舒张晚期速度以及两者比值。③采用单因素方差分析进行组间差异比较。主要观察指标各组兔二尖瓣环后间隔和侧壁处的多普勒组织成像指标比较。结果纳入兔56只,造模失败6只,进入结果分析50只。糖尿病心肌病收缩功能障碍出现在模型成功复制6周,表现为后间隔和侧壁收缩期峰速度显著降低(P<0.05),二尖瓣环水平4个不同部位平均收缩速度值减小(P<0.05)。造模后8周组兔后间隔处射血前时间明显长于对照组和造模后2周组(P<0.05),侧壁处局部射血时间明显长于对照组、造模后2周组及造模后4周组(P<0.05)。从而导致左室壁收缩的不同步。左室舒张功能障碍出现在模型成功复制后4周,随实验时间延长而加重,表现为二尖瓣环后间隔和侧壁处的舒张早期速度逐渐减低(P<0.05),舒张早期速度/舒张晚期速度显著减小(P<0.05)。结论①糖尿病心肌病左室舒张功能障碍以舒张早期峰速度降低、舒张早期速度/舒张晚期速度减小为特点。②糖尿病心肌病收缩功能障碍以局部组织收缩速度降低,部分节段射血前时间的延长以及部分节段射血时间延长为特点。
Background Compared with other complications such as diabetic nephropathy and diabetic retinopathy, diabetic cardiomyopathy was proposed late, the research is not deep enough, the occult onset is occult, the methods of early diagnosis are not perfect, and the clinical importance is not enough. Objective To evaluate the characteristics of left ventricular dysfunction in diabetic cardiomyopathy by Doppler tissue imaging. Design completely randomized block design, control experiment. Unit PLA Chengdu Military Region General Hospital ultrasound. Material experiment was performed at the Department of Ultrasound, Chengdu Military Region General Hospital, People’s Liberation Army from March to June 06, 2002. 56 healthy New Zealand white rabbits were chosen, both male and female. Methods ① A total of 10 rabbits were randomly divided into control group (no diabetic model) and control group (56 rabbits). Rabbits were fasted for 18 hours and then injected with streptozotocin Superabsorption of 40 rabbits were randomly divided into 4 groups, that is, 2, 4, 6, 8 weeks after the model group, 10 in each group.②Using whole body digital echocardiography to check the model after 2,4, 6, 8 weeks and control group, the mitral valve annulus at the wall motion spectrum of the rabbit were measured.The systolic peak velocity, ejection time, local ejection time, the mean systolic velocities of four different sites of mitral annulus, Early diastolic velocity, late diastolic velocity, and the ratio between the two groups.③The differences between groups were compared by one-way analysis of variance.MAIN OUTCOME MEASURES: Comparison of Doppler tissue imaging indices of posterior septum and lateral wall of mitral annulus in each group.Results Fifty-six rabbits were included in the study, and six of the rabbits were model-failed, and 50 of them were analyzed.Results: The systolic dysfunction of diabetic cardiomyopathy was successfully replicated in the model for 6 weeks, showing a significant decrease in the peak velocity at the posterior septum and lateral systolic phase (P <0.05) Mitral annulus level 4 different parts of the average rate of contraction (P0.05) .After 8 weeks, the ejection time of rabbits in rabbits after rabbits was significantly longer than those in control group and 2 weeks after model rabbits (P <0.05), and the ejection time of rabbits in rabbits was longer than that of control Group, 2 weeks after modeling and 4 weeks after modeling (P <0.05), which led to the asynchronous left ventricular wall contraction. Left ventricular diastolic dysfunction appeared 4 weeks after model successful replication. With the prolongation of experimental time (P <0.05), and the early diastolic / diastolic velocity was significantly decreased (P <0.05) .Conclusion ① Diastolic left ventricular diastolic velocity Dysfunction was characterized by decreased early peak diastolic velocity and early diastolic velocity / late diastolic velocity.②Conclusion Dysfunction of diabetic cardiomyopathy is characterized by decreased local tissue contractility, prolongation of partial segment ejection duration, and partial segment ejection Extended time is characterized.