二维斑点追踪成像联合实时三维超声心动图评价尿毒症患者左房功能的研究  

Study of left atrial function in uremic patients evaluated by two-dimensional speckle tracking imaging and real-time three-dimensional echocardiography

作　　者：马媛媛[1] 陈金玲[1] 谭团团[1] 宋宏宁[1] 冯闯丽 曹省[1] 周燕翔 郭瑞强[1] MA Yuanyuan;CHEN Jinling;TAN Tuantuan;SONG Hongning;FENG Chuangli;CAO Sheng;ZHOU Yanxiang;GUO Ruiqiang(Department of Ultrasonography,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院超声影像科,武汉市430060

出　　处：《临床超声医学杂志》2018年第10期660-664,共5页Journal of Clinical Ultrasound in Medicine

基　　金：湖北省卫计委青年人才项目(WJ2015Q016)

摘　　要：目的应用二维斑点追踪成像(2D-STI)和实时三维超声心动图(RT-3DE)两种技术分别从心肌应变和容积变化的角度定量评估尿毒症患者左房功能。方法选取69例尿毒症患者,根据左房最大容积指数(LAVI)分为LAVI增高者(ELA组34例,LAVI>34 ml/m2)和LAVI正常者(NLA组35例,LAVI≤34 ml/m2),另选22例正常成人为对照组,应用RT-3DE时间-容积曲线获取各组左房容积指标:最大容积(LAVmax)、最小容积(LAVmin)、收缩前容积(LAVp),计算左房总射血分数(LAEF)、被动射血分数(LAPEF)、主动射血分数(LAAEF);应用2D-STI对各组行心肌应变和应变率曲线分析,获取左房壁舒张早期应变(Se)、舒张晚期应变(Sa)、总应变(Sg)和舒张早期应变率(SRe)、舒张晚期应变率(SRa)、收缩期应变率(SRs),比较3组上述各指标变化情况。采用Pearson线性相关分析左房应变和应变率绝对值与LAPEF、LAEF间的相关性;应用Bland-Altman法分析观察者内和观察者间测量结果的一致性。结果 (1)左房壁平均Sg、SRs、SRa在NLA组与对照组间差异无统计学意义,上述两组均高于ELA组(均P<0.05);NLA组和ELA组左房壁平均Se和SRe均较对照组显著减低;NLA组Sa高于对照组,ELA组Sa低于对照组,差异均有统计学意义(均P<0.05);(2)NLA组LAEF和LAAEF均高于对照组,ELA组低于对照组(均P<0.05);LAPEF在对照组、NLA组和ELA组间依次减低(均P<0.05);(3)LAPEF与SRe呈正相关(r=0.529,P=0.000);LAEF与Sa和SRa均呈正相关(r=0.501、0.498,均P=0.000);(4)Bland-Altman重复性检验显示,左房应变参数在观察者内和观察者间的测量均有良好的一致性,变异系数分别为(6.19±5.04)%和(5.32±4.87)%。结论 2D-STI联合RT-3DE技术可简便、快捷、准确地评价尿毒症患者左房功能,可为临床早期诊疗提供可靠依据。Objective To evaluate the function of left atrium quantitatively in uremic patients by two-dimensional speckle tracking imaging （2D-STI） and real-time three-dimensional echocardiography （RT-3DE ） from the perspective of myocardial strain and volume changes respectively.Methods Sixty-nine patients with uremia and twenty-two healthy volunteers as control group were enrolled.The uremic patients were divided into two groups according to left atrial volume index （LAVI）： enlarged LAVI group（ LAVI 〉34 ml/m2, E LA group） and normal LAVI group（ LAVI -〈 34 ml/m2, NLA group）.From the time-volume curve of RT- 3DE workstation, the maximum volume （LAVmax）, the minimum volume （LAVmin）, the volume before contraction （LAVp） of left atrium were acquired.Accordingly,the total, passive and active ejection fraction of left atrium （LAEF, LAPEF, LAAEF ） were calculated.The mean left atrial strain and strain rate（Sg, Se, Sa, SRs, SRe and SRa） were measured by 2D-STI, the parameters were compared among three groups.The correlation of left atrial strain,strain rate between LAPEF and LAEF were analyzed.The Bland-Altman method was used to analyze the consistency of measurement between interaobserver and intraobserver.Results ①There were no significant differences of the mean Sg,SRs and SRa between NLA group and the control group, but the mean Sg,SRs and SRa of both groups were higher than those of ELA group（all P〈0.05）.The mean Se and SRe of NLA and E LA group decreased significantly compared with those of control group（all P〈0.05）.Moreover,the mean Sa of the control group was higher than that of ELA group but lower than that of NLA group（all P〈0.05）.②LAEF and LAAEF of the control group were higher than those of ELA group but lower than those of NLA group（all P〈0.05 ）.LAPEF reduced gradually among the control, NLA and ELA group（all P〈0.05）.③LAPEF had a positive correlation with $Re（r=0.529, P=0.000）,and LAEF had a significant correlation with Sa and SRa �

关 键 词：超声心动描记术 实时 三维 斑点追踪成像 二维 尿毒症 心房功能 左 

分 类 号：R540.45[医药卫生—心血管疾病]