经胸与经食管三维超声评估健康人二尖瓣构型的研究  

Study on the mitral valve geometry of the healthy subjects assessed by real-time three-dimensional transthoracic echocardiography and real-time three-dimensional transesophageal echocardiography

作　　者：薛继平[1] 吕虹[1] 康春松[1] 雒珉[2] 陈晓燕[1] 苗俊旺[1] 

机构地区：[1]山西医学科学院山西医科大学附属大医院超声科,太原030032 [2]山西医学科学院山西医科大学附属大医院麻醉科,太原030032

出　　处：《中华超声影像学杂志》2016年第12期1013-1020,共8页Chinese Journal of Ultrasonography

摘　　要：目的探讨经胸实时三维超声（RT-3D-TTE）与经食管实时三维超声（RT-3I）_TEE）评价健康人二尖瓣参数的相关性和-致性。方法对29例健康志愿者在清醒和全身麻醉状态下分别行RT-3D-TTE和RT-3D-TEE检查，应用TomTec二尖瓣分析软件获取收缩中期二尖瓣瓣环及瓣叶参数。对RT-3D-TTE所获二尖瓣参数进行可重复性研究；对两种方法所获二尖瓣参数进行相关性和-致性检验，并比较两种方法所获二尖瓣参数的差异。本研究获山西大医院伦理委员会批准（批件号：YXLL-2015-040）。结果①RT-3D-TTE重复性检验结果显示观察者间和观察者内各参数组内相关参数（ICC）均〉0．8，Blant—Altman图显示瓣环前后直径（AP）、前外侧至后内侧直径（ALPM）、瓣环周长（AC）、瓣环三维面积（AA3D）观察者内平均差异分别为0．009±0．11、-0．008±0．10、-0．036±0．32、0．030±0．36，观察者间平均差异分别为-0．018±0．09、0．087±0．20、-0．037±0．44、-0．016±0．62，显示观察者内及观察者间重复性好；②RT-3D-TTE与RT-3D-TEE所获二尖瓣各参数均显著相关（r=0．566～0．870，P〈0．01），-致性好（ICC=0．719～0．931，P〈0．01）；③两种方法所获二尖瓣参数测值相近，其中AP、瓣环二维面积（AA：。）、瓣环高度（AH）、幕状区容积（Tv）、前小叶长度（ALL）、后小叶长度（PLL）两种方法测值比较差异无统计学意义（P〉0．05），余参数ALPM、球度指数（SPI）、连合处直径（cD）、AC、AAm非平面角度（NPA）、幕状区高度（TH）、瓣环最大位移（ADmax）、瓣环最大位移速率（ADVmax）测值两种方法间比较差异均有统计学意义（P〈0．05）。结论应用RT-3D-TTE测量二尖瓣参数的可重复性很好，RT-3D-TTE与RT-3D-TEE两种方法所获二尖瓣参数测值相近，相关性和-致性好。因此，RT-3D-TTE在评价二尖瓣构型中有较高的潜在临Objective To assess the correlation and agreement of the mitral valve geometry parameters obtained by real-time three-dimensional transthoracic echocardiography （RT-3D-TTE） and real- time three-dimensional transesophageal echocardiography （RT-3D-TEE）. Methods RT-3D-TTE and RT- 3D-TEE were performed on 29 healthy volunteers under conscious state and general anesthesia respectively. The mid-systole mitral valve parameters were analyzed by TomTec Imaging Systems. The repeatability test of the mitral valve parameters obtained by RT-3D-TTE was performed. The correlation and agreement of the mitral valve parameters obtained by RT-3D-TTE and RT-3D-TEE were assessed, and then the differences of mitral valve parameters between the two methods were compared. The study was approved by the Shanxi Dayi Hospital Ethics Committee （Approval no. YXLL-2015-040）. Results OThe mitral valve parameters obtained by RT-3D-TTE showed excellent intra- and interobserver reproducibility, in intra- observer and inter-observer with ICC〉0.8 for all the parameters, and the Bland-Airman plots displayed the average differences of anterior-posterior （AP）, anterolateral-posteromedial （ALPM）, annular circumference（AC）, three-dimensional annular area （AA3D） for intra- and interobserver were 0. 009 ± 0.11, -0. 008 ± 0.10,-0.036±0.32,0.030±0.36 in intra-observer and -0.018±0.09,0.087±0.20, -0.037±0.44, -0. 016 ± 0.62 in inter-observers, respectively. （2）There were close correlations （ r = 0. 566- 0. 870, P 〈 0.01） and good agreement （ICC = 0. 719- 0.931, P G0.01） between the mitral valve parameters obtained by RT-3D-TTE and RT-3D-TEE. QThe mitral valve parameters obtained by RT-3D-TTE were similar to those obtained by RT-3D-TEE. Among the parameters, AP, two-dimensional annular area （AA2D）, annular height （AH）, tenting volume （TV）, anterior leaflet length （ALL） and posterior leaflet length （PLL） had no statistically significant differences between the two methods （ P 〉0.05）.

关 键 词：超声心动描记术 实时三维 二尖瓣 

分 类 号：R540.45[医药卫生—心血管疾病]