【作者】 张华；

【导师】 姜志荣；

【作者基本信息】 青岛大学 ， 内科学， 2003， 硕士

【摘要】 目的 本研究应用超声背向散射积分技术研究糖尿病患者的心肌超声组织特征，旨在探讨超声背向散射积分(Integrated Backscatter，IBS)参数测定在评价糖尿病患者心肌病变方面的临床应用价值。 方法 采用HP SONOS 5500型超声诊断仪，该机配置声学密度定量-背向散射积分(AD-IBS)联机采样分析软件，检测了17例无微血管并发症的2型糖尿病患者(Ⅰ组)和17例有微血管并发症的糖尿病患者(Ⅱ组)以及16例正常人(对照组)心肌的心动周期时间平均背向散射积分(IBS)、背向散射积分标化值(IBS％)、背向散射积分周期变异幅度(CVIB)、背向散射积分跨壁梯度(TGIB)等超声背向散射积分参数，采样部位为胸骨旁左室长轴切面室间隔及左室后壁心肌的中间段。同时测定糖尿病患者的糖化血红蛋白(HbAlc)水平。运用t检验进行三组受检者心肌超声背向散射积分参数的显著性检验，对糖尿病患者的TGIB与HbAlc进行相关性分析，P＜0.05定义为有统计学意义。 结果 1．糖尿病Ⅰ组室间隔及左室后壁心肌的IBS％均明显高于对照组(P＜0.05)；糖尿病Ⅱ组室间隔及左室后壁心肌的IBS％均显著高于对照组(P＜0.01)。2．糖尿病Ⅰ组室间隔及左室后壁心肌的CVIB均明显低于对照组(P＜0.05)；糖尿病Ⅱ组室间隔及左室后壁心肌的CVIB均显著低于对照组(P＜0.01)。3．糖尿病Ⅰ组室间隔及左室后壁心肌的TGIB均显著高于对照组(P＜0.01)；糖尿病Ⅱ组室间隔及左室后壁心肌的TGIB均显著高于对照组(P＜0.001)。4．糖尿病Ⅱ组室间隔及左室后壁心肌的IBS％均明显高于糖尿病Ⅰ组(P＜0.05，P＜0.01)。5．糖尿病Ⅱ组室间隔及左室后壁心肌的CVIB均明显低于糖尿病Ⅰ组(P＜0.05)。6．糖尿病Ⅱ组室间隔及左室后壁心肌的TGIB均显著高于糖尿病Ⅰ组(P＜0.01)。7．糖尿病组(Ⅰ组、Ⅱ组)室间隔及左室后壁心肌的TGIB与糖化血红蛋白(HbAlc)水平之间呈较高的相关性，相关系数有统计学意义(相关系数分别为0.481，0.642，P＜0.01，P＜0.001)。 结论 心肌超声背向散射积分参数测定可敏感地早期检测糖尿病患者的心肌病变，协助判断心肌病变的程度，揭示其内在进展，作为一种无创、安全、费用低的检查值得临床推广和应用。更多还原

【Abstract】 Objective To evaluate the diagnostic value of ultrasonic integratedbackscatter (IBS) technique in detecting myocardial damage in patients with type 2 Diabetes Mellitus .Methods Seventeen type 2 Diabetes Mellitus patients without noncardiacdiabetic complications, seventeen type 2 Diabetes Mellitus patients with noncardiac diabetic complications and sixteen normal subjects were studied by Hewlett Packard SONOS echocardiographic system with AD-IBS. The time averaged value of IB(IBS),the calibrated time-averaged value of IB(IBS% ) , the magnitude of the cyclic variation of IB(CVIB),and the transmural gradient of IBS%(TGIB) were detected. The area of interest for backscatter measurements was placed in the septum wall and in the left ventricular posterior wall(parasternal long-axis view ).Glycosylated hemoglobin (HbAlc) was measured in the patients with type 2 Diabetes Mellitus .Intergroup differences were tested for significance by means of Student’s t tests.The correlation between TGffi and HbAlc was analyzed.Resu Its 1 .The IBS% of the septum and left ventricular posterior wall wassignificantly higher in diabetic patients than in the control group(P<0.05).2.The CVIB of the septum and left ventricular posterior wall was significantly lower in diabetic patients than in the control group(P<0.05).3.The TGIB values increased significantly in the patients group (P<0.01).4. Integrated backscatter parameters of patients with noncardiac diabetic complications had significant difference from those of patients without noncardiac diabetic complications (P<0.05) .5.Indiabetic patients ,there was a significant correlation between glycosylated hemoglobin (HbAlc) and TGIB(r=0.481,0.642,P<0.01,P<0.001).Conlusions Ultrasonic integrated backscatter parameters are helpful inassessing myocardial damage sensitively and determining of the degrees of myocardium injury of type 2 Diabetes Mellitus patients.更多还原