超声心动图Tei指数对不同血糖控制水平妊娠期糖尿病孕妇胎儿心功能及出生后整体心功能的评估价值

目的:探讨超声心动图Tei指数对不同血糖控制水平妊娠期糖尿病(GDM)孕妇胎儿心功能及出生后整体心功能的评估价值。方法:选择2017年2月至2019年10月期间我院产科接诊的134例GDM患者,根据血糖控制水平将其分为良好组(餐前空腹血糖≤5.3 mmol/L,餐后2 h血糖≤6.7 mmol/L,睡前血糖>3.3 mmol/L,妊娠期糖化血红蛋白<5.5%,65例)和不良组(餐前空腹血糖>5.3 mmol/L,餐后2 h血糖>6.7 mmol/L,睡前血糖≤3.3 mmol/L,妊娠期糖化血红蛋白≥5.5%,69例),另选择50例正常妊娠孕妇为对照组。分别于妊娠3238周、新生儿出生后17 d采用超声心动图测量胎儿、新生儿心功能和Tei指数。比较胎儿、新生儿心功能、Tei指数的差异。结果:不良组胎儿左室射血分数(LVEF)、二尖瓣E/A峰的速度比值(E/AMV)、右室舒张末期内径(RVDd)、右室收缩末期内径(RVDs)、左室短轴缩短率(LVFS)、左心室Tei指数、右心室Tei指数均高于良好组和对照组(P<0.05),三尖瓣E/A峰速度比值(E/ATV)低于良好组和对照组(P<0.05)。良好组LVFS高于对照组(P<0.05),良好组LVEF、E/AMV、E/ATV、RVDd、RVDs、左心室Tei指数、右心室Tei指数与对照组比较无统计学差异(P>0.05)。不良组新生儿LVEF、E/AMV、RVDd、RVDs、LVFS、左心室Tei指数、右心室Tei指数均高于良好组和对照组(P<0.05),E/ATV低于良好组和对照组(P<0.05)。良好组LVFS高于对照组(P<0.05),良好组LVEF、E/AMV、E/ATV、RVDd、RVDs、左心室Tei指数、右心室Tei指数与对照组比较无统计学差异(P>0.05)。结论:超声心动图Tei指数可敏感地反映GDM孕妇胎儿以及新生儿心功能损伤,妊娠期有效控制血糖水平有助于保护胎儿心功能。

The Value of Echocardiography Tei Index in Evaluating Fetuses Cardiac Function and Overall Cardiac Function after Birth in Pregnant Women with Gestational Diabetes at Different Blood Glucose Control Levels

Objective:To investigate the value of echocardiography Tei index in evaluating fetuses cardiac function and overall cardiac function after birth in pregnant women with gestational diabetes(GDM)at different blood glucose control levels.Methods:From February 2017 to October 2019,134 patients with GDM who were admitted to the obstetrics department of our hospital were selected,and divided into good group(Fasting blood glucose before meals≤5.3 mmol/L,blood glucose 2 h after meals≤6.7 mmol/L,blood glucose before going to bed>3.3 mmol/L,hemoglobin a1 c during pregnancy<5.5%,65 cases)and bad group(Fasting blood glucose before meal>5.3 mmol/L,blood glucose 2 h after meals>6.7 mmol/L,blood glucose before going to bed≤3.3 mmol/L,hemoglobin a1 c during pregnancy≥5.5%,69 cases)according to the blood glucose control level during pregnancy,and 50 normal pregnant women were selected as the control group.Echocardiography was used to measure fetuses and newborns cardiac function and Tei index at 3238 weeks gestation and 17 days after birth respectively.The differences of fetuses and newborns cardiac function and Tei index were compared.Results:Left ventricular ejection fraction(LVEF),velocity ratio of the mitral valve E/A peak(E/AMV),right ventricular end-diastolic diameter(RVDd),right ventricular end-systolic(RVDs),left ventricular fraction shortening(LVFS),left ventricular Tei index and right ventricular Tei index of fetuses in bad group were higher than those in good group and the control group(P<0.05),tricuspid valve E/A peak velocity ratio(E/ATV)was lower than that in the good group and the control group(P<0.05).LVFS in the good group was higher than that in the control group(P<0.05),LVEF,E/AMV,E/ATV,RVDd,RVDs,left ventricular and right ventricular Tei index compared between the control group and good group were no statistical difference(P>0.05).LVEF,E/AMV,RVDd,RVDs,LVFS,left ventricular and right ventricular Tei index of newborns in bad group were higher than those in good group and the control group(P<0.05),E/ATV was lower than that in the good group and the control group(P<0.05).LVFS in the good group was higher than that in the control group(P<0.05),LVEF,E/AMV,E/ATV,RVDd,RVDs,left ventricular and right ventricular Tei index compared between the control group and good group were no statistical difference(P>0.05).Conclusion:Echocardiography Tei index can be sensitive to evaluate the damage of cardiac function in fetuses and neonates in pregnant women with GDM.Effective control of blood glucose level during pregnancy is helpful to protect fetuses cardiac function.