实时三维超声心动图评价舒张性心力衰竭患者左房容积及功能变化  

Assessment of Left Atrial Volume and Function in Patients with Diastolic Heart Failure by Real-time 3D Echocardiography

作　　者：陈超容[1] 吴棘[1] 邓晓丽[1] 李蔚[1] 林海红[1] 刘雪玲[2] 郭盛兰[1] 

机构地区：[1]广西医科大学第一附属医院超声科,南宁市530021 [2]广西中医药大学第一附属医院超声科

出　　处：《中国超声医学杂志》2016年第5期421-425,共5页Chinese Journal of Ultrasound in Medicine

基　　金：广西科学研究与技术开发计划项目(No.1298003-3-1);广西自然科学基金项目(No.2013GXNSFAA019173)

摘　　要：目的应用实时三维超声心动图(RT-3DE)评价舒张性心力衰竭(DHF)患者左房容积及功能的变化及其临床应用价值。方法 DHF患者68例。按NYHA分级分为NYHAⅡ级组(33例)、Ⅲ级组(21例)、Ⅳ级组(14例)3个亚组。对照组41例。常规测量二尖瓣口前向峰值流速E和二尖瓣环峰值速度E′,计算E/E′值。采用RT-3DE测量左房最大容积(LAVmax)、最小容积(LAVmin)及收缩前容积(LAVpreA),并用体表面积校正(LAVImax、LAVImin、LAVIpreA),计算左房整体射血分数(LAEF)、被动射血分数(LAPEF)、主动射血分数(LAAEF)。应用ELISA法测量研究对象血浆心房利钠肽(ANP)水平。结果 LAVImax、LAVImin、LAVIpreA、ANP水平在DHF患者中增大,且随着心功能级数的增加而增加(P<0.05);LAEF在DHF患者中减小,且随着心功能级数的增加而降低(P<0.05);LAAEF在NYHAⅡ级组中最大,对照组次之,在NYHAⅣ级组中最小(P<0.05);LAPEF在DHF患者中降低,对照组和DHF各亚组间差异均有统计学意义,在DHF各亚组间差异无统计学意义。DHF患者的LAVImax、LAVImin、LAVIpreA与E/E′、ANP水平分别呈正相关(P<0.05),LAEF、LAPEF、LAAEF与E/E′、ANP水平分别呈负相关(P<0.05)。结论 RT-3DE能有效评价DHF患者左房容积及功能的变化,并间接反映左室舒张功能的改变。Objective Using real-time 3Dechocardiography（RT-3DE）to evaluate the change of left atrial（LA）volume and function and its clinical application value in patients with DHF.Methods 68 cases with DHF.According to the classification of the NYHA,they were divided into NYHA Ⅱ class group（33cases）,NYHA Ⅲ class group（21cases）,NYHA IV class group（14cases）.41 healthy people as a control.The peak flow velocity of mitral valve（E）and mitral annulus（E′）were measured and the ratio E to E′was calculated.The LA maximum volume（LAVmax）,LA minimum volume（LAVmin）,LA volume pre contraction（LAVpreA）were measured by RT-3DE,then adjusted by body surface area（LAVImax、LAVImin、LAVIpreA）.Then LA total ejection fraction（LAEF）,LA passive ejection fraction（LAPEF）,LA active ejection fraction（LAAEF）were calculated.All cases′plasma levels of atrial natriuretic polypeptide（ANP）were measured by enzyme-linked immunosorbent assay.Results The LAVImax,LAVImin,LAVIpreA,ANP level in patients with DHF were larger than those in the normal group,while the LAEF were lower.There were increasing in LAVImax,LAVImin,LAVIpreA,ANP level and decreasing in LAEF with increasing in the grading of the heart function（P〈0.05）.LAAEF in the group of NYHA Ⅱ class was the largest,the normal group followed,and the group of NYHA Ⅳ class was minimum（P〈0.05）.LAPEF in the three subgroups of DHF were lower than that in the normal group（P〈0.05）,while the differences between the three subgroups of DHF had no statistical significance.The LAVImax,LAVImin,LAVIpreA in the group of DHF had positive correlation with E/E′and ANP level（P〈0.05）,the LAEF,LAPEF,LAAEF in the group of DHF had negative correlation with E/E′and ANP level（P〈0.05）.Conclusions RT-3DE can evaluate the change of LA volume and function in patients with DHF,and indirectly reflect the change of left ventricular diastolic function.

关 键 词：超声心动描记术 实时三维 舒张性心力衰竭 左房功能 ANP 

分 类 号：R540.45[医药卫生—心血管疾病]