超声自动功能成像在轻症病毒性心肌炎诊断中的应用观察  

Application of automatic functional imaging in diagnosis of mild viral myocarditis

作　　者：何倩 张平洋[1] 马小五[1] 冉红[1] 李林[1] 李妙[1] HE Qian;ZHANG Pinyang;MA Xiaowu;RAN Hong;LI Lin;LI Miao(Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院.南京市第一医院,南京210006 [2]南京市江宁区第二人民医院

出　　处：《山东医药》2018年第43期35-38,共4页Shandong Medical Journal

基　　金：南京市科技发展资助计划(医学项目);南京市医学发展重点项目(ZKX17026)

摘　　要：目的探讨超声自动功能成像(AFI)在评价轻症病毒性心肌炎患者心肌损害的诊断效能。方法 36例轻症病毒性心肌炎患者为观察组,正常健康受检者32例为对照组,常规超声心动图测算两组记录左室舒张末期内径(LVEDD)、射血分数(LVEF)、每搏量(SV)、心输出量(CO)和心脏指数(CI)值。应用基于二维斑点追踪显像(2D-STI)的超声自动功能成像(AFI)观察两组收缩期左室长轴纵向峰值应变(LPS)情况,测量左室壁各节段长轴收缩期峰值应变(RLPS)、左室整体长轴收缩峰值应变(GLPS)。收集两组空腹静脉血,检测血清超敏心肌钙蛋白Ⅰ(hs-CTnⅠ)、肌酸激酶同工酶(CK-MB)。Spearman相关分析法分析GLPS与LVEDD、LVEF、SV、CO、CI、hs-CTnⅠ、CK-MB等指标的相关性,ROC曲线分析GLPS对病毒性心肌炎患者心肌损害的诊断效能。结果与对照组比较,观察组血清hs-CtnⅠ水平升高、GLPS减小(P <0. 05)。与对照组比较,观察组左室壁前间隔基底、下壁基底段、后壁基底段、侧壁基底段、前壁中间段、前间隔中段、后间隔中段、后壁中间段、侧壁中间段、前壁心尖段、间隔心尖段、下壁心尖段、心尖部RLPS均降低(P均<0. 05)。病毒性心肌炎患者GLPS与LVEF、SV呈正相关(r=0. 64; 0. 59; P均<0. 01),与血清hs-CtnⅠ呈负相关(r=-0. 73,P <0. 01)。GLPS的绝对值小于17. 72%时,GLPS判断病毒性心肌炎患者心肌损害的敏感度95. 81%,特异度86. 31%,曲线下面积0. 89。结论轻症病毒性心肌炎患者左室GLPS减小,GLPS诊断病毒性心肌炎患者心肌损害的敏感度、特异度均较高。AFI技术可用于病毒性心肌炎的早期诊断。Objective To investigate the diagnostic value of automatic mechanical imaging(AFI)technique in evaluating the myocardial damage of patients with mild viral myocarditis.Methods Thirty-six patients with mild viral myocarditis(observation group)and 32 normal health subjects(control group)were enrolled.We measured the left ventricular end-diastolic diameter(LVEDD),ejection fraction(LVEF),stroke volume(SV),cardiac output(CO),and cardiac index(CI)values by conventional echocardiography.Automated functional imaging(AFI)technique with two-dimensional spot tracking was used to obtain longitudinal peak strain of left ventricular long axis during systolic period in the two groups,measured the regional long-axis systolic peak strain(RLPS)in each segment of the left ventricular wall and global longitudinal peak systolic strain(GLPS)in left ventricular wall.The fasting venous blood was collected in the two groups to measure serum allergen cardiac troponin I(hs-CtnⅠ)and creatine kinase isoenzyme(CK-MB)levels.Correlation of GLPS,LVEDD,LVEF,SV,CO,CI,hs-CTnI,and CK-MB were analyzed by Spearman correlation analysis,and the ROC curve was used to analyze the diagnostic efficacy of GLPS for myocardial damage in patients with viral myocarditis..Results Compared with the control group,hs-CtnⅠlevel increased and GLPS decreased in the observation group(P<0.05).Compared with the control group,RLPS of anterior septal basement,inferior basal segment,posterior basal segment,lateral basal segment,anterior medial segment,middle segment of anterior septum,middle segment of posterior septum,middle segment of posterior wall,middle section of lateral wall,apical segment of anterior wall,septal apical segment,apical segment of inferior wall,and apex of heart in the observation group decreased(P<0.05).There was a positively correlation between GLPS and LVEF,SV in patients with viral myocarditis(r=0.64 and 0.59;P<0.01).When the absolute value of GLPS was less than 17.72%,the sensitivity of hs-CtnⅠin diagnosis of myocardial damage in patients wi

关 键 词：超声自动功能成像 左室壁各节段长轴收缩期峰值应变 左室整体长轴收缩峰值应变 病毒性心肌炎 

分 类 号：R542.21[医药卫生—心血管疾病]