二尖瓣对合面积和对合指数的实验研究  

Experiment Research of Mitral Valve Coaptation Area and Coaptation Index

作　　者：李继勇[1] 何怡华[2] 张健群[1] 王琳琳[2] 张亮[3] 

机构地区：[1]首都医科大学附属北京安贞医院北京市心肺血管疾病研究所心脏外科,北京100029 [2]首都医科大学附属北京安贞医院超声诊断科,北京100029 [3]首都医科大学附属北京安贞医院麻醉科,北京100029

出　　处：《中国胸心血管外科临床杂志》2013年第4期446-450,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金资助项目(30970840)~~

摘　　要：目的通过犬的动物实验来研究二尖瓣出现中度反流的情况下二尖瓣对合面积及对合指数的变化趋势,为预测远期手术效果提供帮助。方法应用飞利浦IE33超声心动图成像仪,对15只犬行经食管实时三维超声心动图(RT-3D-TEE)检查,并建立动物实验模型,在逐渐缩窄升主动脉造成左心室压力升高的情况下获取RT-3D-TEE图像,直至二尖瓣出现中度反流为止。应用飞利浦三维定量Qlab7.0软件的方法对原始数据进行后处理,计算对合面积和对合指数。动物实验后计算心脏标本二尖瓣瓣叶的离体对合指数。通过受试者工作特征曲线(ROC)计算对合指数和左心室压力的截断值。结果 15只犬在无反流和有反流时对合面积[(198±50)mm2vs.(123±36)mm2,P<0.05]和对合指数(0.25±0.06 vs.0.13±0.03,P<0.05)差异均有统计学意义,对合指数和二尖瓣中度以上反流的ROC下面积为0.879±0.019,95%CI(0.843,0.916),截断值为0.213(P<0.05)。左心室压力和二尖瓣中度以上反流的ROC曲线下面积为0.882±0.021,95%CI(0.840,0.923),截断值为225(P<0.05)。离体瓣膜面积与舒张期总面积、离体对合面积与对合面积、离体对合指数与对合指数的差异均无统计学意义(P>0.05)。舒张期总面积和离体瓣膜面积具有良好的相关性(r=0.937,P<0.05),对合面积和离体对合面积具有良好的相关性(r=0.917,P<0.05),对合指数和离体对合指数有良好的相关性(r=0.946,P<0.05)。对合指数和离体对合指数的相关性高于对合面积与离体对合面积、舒张期总面积与离体瓣膜面积的相关性。结论二尖瓣出现反流的情况下对合面积和对合指数有明显下降,对合指数可更精确地反映二尖瓣反流的程度,为二尖瓣成形手术预后提供参考。RT-3D-TEE可以较为准确地测量二尖瓣对合面积和对合指数。Objective To investigate the changing tendency of mitral valve coaptation area and coaptation index of moderate mitral regurgitation （MR） in a dog experiment, and provide evidence for predicting long-term surgical results. Methods Real-time three-dimensional transesophogeal echocardiography （RT-3D-TEE） images were obtained in 15 dogs via Philips IE33 echocardiography system, and animal experiment model was established. RT-3D-TEE images were taken by gradually narrowing the ascending aorta and increasing left ventricular pressure till moderate MR. Original data were analyzed using Philips Qlab 7.0 three-dimensional quantification software, and mitral valve coaptation area and coaptation index were calculated. Specimen coaptation index of the mitral leaflets was calculated after the animal experiment. Cutoff values of coaptation index and left ventricular pressure were calculated by receiver operating characteristic （ROC） curve. Results There was statistical difference in coaptation area （ 198 ±50 ） mm2 vs. （ 123±36） mm2, P 〈 0.05 ） and coaptation index （0.25 ± 0.06 vs. 0.13± 0.03, P 〈 0.05） between non-MR state and MR status of the 15 dogs. The area under the ROC curve of coaptation index and moderate MR was 0.879±0.019 with 95% CI 0.843 to 0.916, and the cutoff value was 0.213 （P 〈 0.05）. The area under the ROC curve of left ventricular pressure and moderate MR was 0.8824-0.021 swith 95% CI 0.840 to 0.923, and the cutoff value was 225 （P 〈 0.05）. There was no statistical difference between specimen mitral valve area and early-diastolic mitral leaflet area, specimen coaptation area and coaptation area, specimen coaptation index and coaptation index （P 〉 0.05 ）. Early-diastolic mitral leaflet area was significantly correlated with specimen mitral valve area （r=-0.937, P 〈 0.05 ）. Coaptation area was significantly correlated with specimen coaptation area （r=0.917, P 〈 0.05 ）. Coaptation index was significantly correlated with specimen coaptation index

关 键 词：对合指数 对合面积 二尖瓣反流 

分 类 号：R654.2[医药卫生—外科学]