不同分期妊娠期高血压疾病患者左心房与左心室舒张功能评价  

Evaluation of diastolic function of left atrium and left ventricle in patients with gestational hypertension by two-dimensional speckle tracking imaging technique

作　　者：丁岚[1] 刘影[2] 白传明[3] 姚彦 

机构地区：[1]河北省沧州市中心医院产科,061000 [2]河北省石家庄市第四医院产科 [3]河北省沧州市中心医院心血管外科,061000 [4]河北省沧州市中心医院神经内科,061000

出　　处：《河北医药》2018年第1期120-123,共4页Hebei Medical Journal

基　　金：沧州市科学技术研究与发展支撑计划项目(编号:162302036)

摘　　要：目的探讨利用二维斑点追踪技术评价不同分期妊娠高血压疾病患者左心室舒张功能与左心房功能水平变化。方法选择诊断为妊娠期高血压疾病患者120例,依据《妇产科学》诊断分型标准,入选患者分为妊娠期高血压患者80例和子痫前期患者40例,取同期门诊检查健康孕产妇40例为对照组。二维超声心动图心尖四腔心切面Simpson’s测量舒张末期左心室容积(LVEDV)、收缩末期左心室容积(LVESV)、左心室射血分数(LVEF)、左心房容积,计算左心房容积指数(LAVI),血流多普勒测量二尖瓣口舒张早期血流速度峰值(E峰),左心房舒张晚期血流速度峰值(A峰),组织多谱勒测量收缩期二尖瓣环侧壁根部运动速度峰值(Ea值),计算E/A,E/Ea比值。二维斑点追踪技术测量左心房整体纵向应变峰值(LA-GLPS)、收缩期左心房应变率(LASRs)、舒张早期左心房应变率(LASRe)、左心室整体纵向应变峰值(LV-GLPS),左心室基底部、心尖部收缩期整体峰值旋转角度(BRmax,ARmax),计算左心室收缩期峰值心肌扭转角度(Twistmax),检测3组血浆氨基末端脑钠肽前体水平(NT-proBNP),Pearson相关分析LAVI、LA-GLPS、LASRs、LASRe与E/Ea、NT-proBNP水平。结果对照组、妊娠高血压组、子痫前期组患者LVEDV、LVESV、LAVI、E/Ea逐渐增加,E/A比值减小,3组差异有统计学意义(P<0.05),LVEF值比较差异无统计学意义(P>0.05)。子痫前期组、妊娠高血压组、对照组患者LA-GLPS、LV-GLPS、LASRs、LASRe逐渐增加,3组差异有统计学意义(P<0.05)。子痫前期组、妊娠高血压组患者Twistmax轻度增加,但与对照组比较差异无统计学意义(P>0.05)。LAVI、LA-GLPS、LASRs、LASRe与E/Ea、NT-proBNP水平呈正相关关系(r E/Ea=0.876,0.604,0.598,0.532,r BNP=0.902,0.766,0.617,0.589,P<0.05)。结论不同临床分期妊娠期高血压病患者心脏功能损伤存在差异,其中以子痫前期患者损害较明显,心脏功能损伤主要表现为左心室舒�Objective To investigate the changes of diastolic function of left atrium and left ventricle in patients with gestational hypertension at different stages by two-dimensional speckle tracking imaging technique（ 2 D-STI）. Methods A total of 120 patients with gestational hypertension who were treated in our hospital from January 2016 to June 2017 were enrolled in the study. According to the diagnostic and typing criteria of《The Eighth Edition of Obstetrics and Gynecology》,these patients were divided into gestational hypertension group（ n = 80）,preeclampsia group（ n = 40）,at the same time,the other 40 pregnant women were served as control group. The left ventricular end diastolic volume（ LVEDV）,left ventricular end systolic volume（ LVESV）, left ventricular objection fraction（ LVEF）, left atrial volume were examined by two-dimensional echocardiogram,and left atrial volume index（ LAVI） was calculated. The early diastolic blood flow velocity（ E） of mitral valve and the peak velocity of left atrial late diastolic blood flow（ A） were detected by flow Doppler. The peak velocity of mitral annular root velocity（ Ea） was measured by tissue Doppler imaging,and the ratios of E/A and E/Ea were calculated. The left atrial global longitudinal peak strain（ LA-GLPS）,left atrial strain rate of systolic period（ LASRs）,left atrial strain rate of early diastole（ LASRe）,left ventricular global longitudinal peak strain（ LV-GLPS）,left ventricular base and apical peak rotation（ BRmax,ARmax） were measured by 2 D-STI,and left ventricular systole Twistmax was calculated.Moreover the levels of NT-proBNP were detected. In addition,the correlation between LAVI,LA-GLPS,LASRs,LASRe and E/Ea,NT-proBNP was analyzed by means of Pearson correlation analysis. Results The levels of LVEDV,LVESV,LAVI and E/Ea were gradually increased in order of control group,gestational hypertension group,preeclampsia group,but the ratio of E/A was decreased,there were significant differences among the three

关 键 词：妊娠期高血压 超声心动描计术 二维斑点追踪术 

分 类 号：R714.246[医药卫生—妇产科学]