目的:使用频谱组织多普勒成像(TDI)和M模式成像来确定1型和2型糖尿病孕妇的血糖控制是否会改变胎儿心功能。
方法:本研究包括68名30-32孕周的孕前糖尿病妇女(DM)。所有参与者分为两组:1型(n=17)和2型(n=51),然后将这些组分为控制良好和控制不良的亚组,根据空腹血糖(FG)和餐后1小时血糖(PPG)值。通过TDI和M模式成像比较了控制良好和不良组的心脏参数。心脏参数与FG的相关性,PPG,和HbA1c值进行评估。还评估了它们在预测新生儿结局中的作用。
结果:厚度测量,舒张早期环形峰值速度(E'),舒张末期环形峰值速度(A'),组织等容弛豫时间(IRT\'),在两个控制不佳的组中,组织心肌性能指标(MPI\')均增加。组织喷射时间(ET')在控制不佳的组中显著减少,而组织等容收缩时间(ICT)在任何组中均无明显变化。三尖瓣,二尖瓣,和间隔环平面偏移(TAPSE,地图,还有SAPSE,分别)在所有控制不佳的亚组中均显着降低。E\',E\'/A\',MPI\',IRT\',ET\',M模式成像参数与FG显著相关。
结论:母体高血糖导致室间隔和心室收缩和舒张功能的细微变化,因此,确保1型和2型糖尿病的血糖控制至关重要。
To determine whether changes in fetal heart function according to glycemic control in pregnant women with Type 1 and Type 2 diabetes using spectral tissue Doppler imaging (TDI) and M-mode imaging.
This study included 68 pregestational diabetic women (DM) at 30-32 gestational weeks. All participants were divided into two groups: type 1(n = 17) and type 2(n = 51), and then these groups were divided into the subgroups as well-controlled and poorly controlled, according to fasting glucose (FG) and 1-h postprandial glucose (PPG) values. Cardiac parameters were compared for well- and poorly-controlled groups with TDI and M-mode imaging. The correlation of cardiac parameters with FG, PPG, and HbA1c values was evaluated. Their roles in predicting neonatal outcomes were also assessed.
Thickness measurements, early diastolic annular peak velocity (E\'), late diastolic annular peak velocity (A\'), tissue isovolumetric relaxation time (IRT\'), and tissue myocardial performance index (MPI\') were increased in both poorly controlled groups. Tissue ejection time (ET\') was significantly reduced in the poorly controlled groups, while tissue isovolumetric contraction time (ICT\') was not significantly changed in any group. Tricuspid, mitral, and septal annular plane excursions (TAPSE, MAPSE, and SAPSE, respectively) were significantly decreased in all poorly controlled subgroups. E\', E\'/A\', MPI\', IRT\', ET\', and M-mode imaging parameters significantly correlated with FG notably.
Maternal hyperglycemia leads to subtle changes in systolic and diastolic functions both in the interventricular septum and ventricles, so it is essential to ensure glycemic control in both Type 1 and Type 2 DM.