左心房、左心耳自发声学显影影响因素的对比研究  

Influence factors of left atrial and left atrial appendage spontaneous echo contrast in patients with nonalvular atrial fibrillation

作　　者：张薇[1] 张运[1] 杨贵荣[1] 朱慧[1] 苗雅[1] 钟明[1] 皮延生[1] 

机构地区：[1]山东大学齐鲁医院心内科,山东济南250012

出　　处：《山东大学学报（医学版）》2004年第3期280-283,共4页Journal of Shandong University:Health Sciences

基　　金：山东省科委基金资助项目(2000BB1CJA2)

摘　　要：目的:对比研究慢性非瓣膜性心房颤动患者(房颤)左房?左心耳入口和左心耳尖部自发声学显影(SEC)的影响因素?方法:非瓣膜性房颤患者23例,测定其外周静脉血凝血标记物;经胸超声心动图测量左房内径?左室壁厚度等;经食管超声心动图测量左心耳和肺静脉血流速度;应用背向散射积分(IBS)技术定量测定左心房?左心耳入口和左心耳尖部SEC?结果:左心房IBS值与左室壁厚度呈正相关,与左心耳血流流速积分(AVi)和肺静脉血流平均流速(PVDm)呈负相关;左心耳入口IBS与左心耳血流峰值流速(AVp)?平均流速(AVm)?AVi呈负相关,与肺静脉血流D波峰值流速(PVDp)?PVDm呈负相关;左心耳尖部IBS值与左房内径?左室壁厚度呈正相关,与肺静脉血流S波峰值流速(PVSp)?PVSm和PVDm呈负相关,与血浆纤维蛋白原呈正相关?结论:左心房?左心耳入口SEC主要受局部血流动力学异常的影响,左心耳尖部SEC与血流动力学和血浆纤维蛋白原异常有关;定量分析左心耳入口处和左心耳近尖部SEC可能对预测血栓前状态和栓塞事件更有价值?Objective: To evaluate the influence factors of left atrial (LA) and left atrial appendage (LAA) spontaneous echo contrast (SEC) in patients with nonalvular atrial fibrillation. Methods: Twenty-three patients with atrial fibrillation (13 men, 10 women, mean age 58±12 years ) underwent transthoracic and transeosophageal echocardiography. The integrated backscatter intensity (IBS) were measured with the regions of interest placed in the LA cavity, LAA orifice and LAA apex respectively. Plasma fibrinogen, vov Willebrand factor, D-dimer, P-selectin,thrombin-antithrombin complexes and plasminogen activator inhibitor-1 were assayed. Left atrial appendage flow and pulmonary venou flow velocity were detected by pulsed wave Doppler. Results: The left atrial IBS was positively correlated with left ventricular wall thickness, and inversely correlated with the LAA and pulmonary venou flow velocity. The LAA orifice IBS was inversely correlated with the LAA and pulmonary venou flow velocity. The LAA apex IBS was positively correlated with LA diameter, left ventricular wall thickness and plasma fibrinogen, and inversely correlated with pulmonary venou flow velocity. Conclusions: The intensity of SEC in LA, LAA orifice are associated with haemodynamic abnormalities, and SEC in LAA apex are influenced by haemodynamic and haemostatic abnormalities. Quantitation of SEC in the appendage, rather than main LA, is more valuable for assessing embolic potential. [

关 键 词：心房颤动 自发声学显影 背向散射积分 

分 类 号：R543.3[医药卫生—心血管疾病]