三维超声心动图评价肥厚型心肌病患者左心房功能及其影响因素的临床研究  

Evaluation of left atrial function and its determinants by three-dimensional echocardiography in patients with hypertrophic cardiomyopathy

作　　者：高一鸣[1] 段福建[1] 吕秀章[1,2] 

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外心血管病医院超声科,100037 [2]首都医科大学附属北京朝阳医院心脏中心心脏超声科

出　　处：《中华医学超声杂志（电子版）》2013年第6期455-460,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的应用三维超声心动图(3DE)评价肥厚型心肌病(HCM)患者左心房的功能,并探讨导致左心房功能改变的影响因素。方法 46例HCM患者(梗阻性HCM组25例,非梗阻性HCM组21例)与46名健康对照者(健康对照组)入选此研究。应用3DE获得2组受检者的左心房时间-容积曲线,测量左心房最大容积(LAVmax)、左心房最小容积(LAVmin)及左心房收缩前容积(LAVp),计算左心房容积指数(LAVI)、左心房扩张指数(LAEI)、左心房排空分数(LAEF)、左心房被动排空分数(LAPEF)及左心房主动排空分数(LAAEF),2组间进行对比分析。并对所有入选者的室间隔厚度(IVSd)、左心室流出道峰值压差(LVOT-PG)、二尖瓣反流(MI)量、左心室舒张功能(LVDF)与LAVI进行Spearman线性相关分析及多元线性回归分析。结果健康对照组LAVmax(45.67±11.96)ml、LAVmin(20.48±6.80)ml、LAVp(24.48±9.31)ml、LAVI 25.63±6.52、LAEI(1.32±0.49)%、LAEF(55.25±8.06)%、LAPEF(35.90±7.00)%、LAAEF(30.20±10.13)%,HCM组LAVmax(81.45±24.24)ml、LAVmin(44.60±18.96)ml、LAVp(61.00±21.64)ml、LAVI 45.39±14.17,与健康对照组比较均明显增高,2组间差异有统计学意义(t=8.978、8.123、9.227、8.436,P均<0.01);HCM组LAEI(0.95±0.43)%、LAEF(46.15±11.12)%、LAPEF(25.64±9.09)%,与健康对照组比较明显减低,2组间差异亦有统计学意义(t=-3.865、-4.493、-6.504,P均<0.01);HCM组LAAEF(28.20±9.26)%,与健康对照组比较仅轻度减低,2组间差异无统计学意义(t=-0.656,P>0.01)。IVSd、LVOT-PG、MI、LVDF均与LAVI在0.01水平上呈显著正相关(r=0.704、0.517、0.640、0.701,P均<0.01),多元回归分析得出IVSd、LVOT-PG、MI、LVDF均为LAVI的影响因素(标准回归系数绝对值分别为0.264、0.515、0.614、0.341,P均<0.05)。结论 3DE能够评估HCM患者左心房的容积及功能,主要表现为各时相左心房容积显著增加,而储蓄功能、管道功能、辅泵功能减低。HCM患者的二尖瓣反流、左心室流出道梗阻、左心室舒张�Objective To evaluate the left atrial function and to explore its determinants in patients with hypertrophic cardiomyopathy by three-dimensional echocardiography(3DE).Methods 46 patients with HCM(obstructive HCM:25 cases,nonobstructive HCM:21 cases) and 46 healthy cases(controls) were enrolled in this study.Time-volume curve of left atrium was acquired by 3DE in all subjects.Left atrial maximal volume(LAVmax),left atrial minimal volume(LAVmin) and left atrial presystolic volume(LAVp) were acquaired.Left atrial volume index(LAVI),left atrial expansion index(LAEI),left atrium emptying fraction(LAEF),left atrium passive emptying fraction(LAPEF) and 1eft atrium active emptying fraction(LAAEF) were calculated.Comparative analysis between two groups was taken.The Spearman correlation analysis and multiple linear regression analysis between left atrial volume index(LAVI) with interventricular septal thickness(IVSd),left ventricular outflow tract peak gradient(LVOT-PG),mitral regurgitation(MI), left ventricular diastolic function(LVDF) were analyzed respectively.Results Compared to the controls LAVmax(45.67±11.96)ml,LAVmin(20.48±6.80)ml,LAVp(24.48±9.31)ml,LAVI 25.63±6.52,LAEI(1.32±0.49)%,LAEF(55.25±8.06)%,LAPEF(35.90±7.00)% and LAAEF(30.20±10.13)%,the patient with HCM had a significantly larger LAVmax(81.45±24.24)ml,LAVmin(44.60±18.96)ml,LAVp(61.00±21.64)ml and LAVI 45.39±14.17,there were significant differences among the groups(t=8.978,8.123,9.227,8.436,all P<0.01),lower LAEI(0.95±0.43)%,LAEF(46.15±11.12)%,LAPEF(25.64±9.09)%,there were significant differences among the groups(t=-3.865,-4.493,-6.504,all P<0.01),and slightly lower LAAEF(28.20±9.26)%,there were no significant differences among the groups(t=-0.656,P>0.01).There were significant positive correlation between LAVI and IVSd,LVOT-PG,MI,LVDF respectively(r=0.704,0.517,0.640,0.701,all P<0.01).Multiple linear regression analysis demonstrated that IVSd,LVOT-PG,MI and LVDF were correlated factors of LAVI(absolute standardized coeffients=0.264,0.515,0.

关 键 词：超声心动描记术 心肌病 肥厚性 心房功能 左 

分 类 号：R445.1[医药卫生—影像医学与核医学] R542.2[医药卫生—诊断学]