彩色多普勒超声评价肥厚型心肌病颈部和颅脑动脉血流动力学改变的临床研究  

Assessment of the hemodynamic changes of carotid and cerebral arteries in hypertrophic cardiomyopathy with color Doppler ultrasound

作　　者：赵永锋 王静 左蕾 康楠 杨帆 刘丽文 ZHAO Yong-feng;WANG Jing;ZUO Lei;KANG Nan;YANG Fan;LIU Li-wen(Department of Ultrasound,Xijing Hospital,Air Force Medical University,Shaanxi Province,Xi′an 710032,China)

机构地区：[1]空军军医大学西京医院超声医学科

出　　处：《河北医科大学学报》2020年第1期61-65,71,共6页Journal of Hebei Medical University

基　　金：国家国际科技合作专项(2014DFA31980);国家自然科学基金青年科学基金(81601498);国家自然科学基金面上项目(81671693);陕西省重点研发项目(2017ZDXM-SF-058)

摘　　要：目的探讨肥厚型心肌病(hypertrophic cardiomyopathy,HCM)患者颈部和颅脑动脉血流动力学变化。方法选择HCM患者40例和正常体检者25例。采用彩色多普勒超声技术对心脏、颈部和颅脑血管超声参数,心脏指标包括左心室最大室壁厚度(maximal left ventricular wall thickness,MLVWT)、左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)、左心室舒张末期容积(left ventricular end-diastolic volume,LVEDV)、左心室收缩末期容积(left ventricular end-systolic volume,LVESV)、左心室射血分数(left ventricular ejection fraction,LVEF)、左心室流出道峰值压力阶差(left ventricular outflow tract pressure gradients,LVOT-PG)、左心房前后径(left atrial diameter,LAD)、二尖瓣口和瓣环舒张早期血流峰速(E峰和e′),颈部和颅脑血管超声参数包括双侧颈总动脉(common carotid artery,CCA)、颈内动脉(internal carotid artery,ICA)、椎动脉(vertebral artery,VA)、双侧大脑中动脉(middle cerebral artery,MCA)、大脑前动脉(anterior cerebral artery,ACA)、大脑后动脉(posterior cerebral artery,PCA)、双侧椎动脉颅内段(vertebral artery-intracranial,VA-IC)和基底动脉(basilar artery,BA)的收缩期最大血流速度(peak systolic velocity,PSV)、舒张末期最大血流速度(maximum end-diastolic velocity,EDV)、舒张末期平均血流速度(average end-diastolic velocity,MDV)、搏动指数(pulsative index,PI)、阻力指数(resistance index,RI)、血流速度时间积分(velocity-time integrals,VTI)、收缩期和舒张期流速比(S/D)和平均血流速度(mean velocity,Mean)。结果HCM组MLVWT、LVOT-PG、LAD、E/e′比值明显均高于对照组(P<0.05);双侧CCA的EDV、MDV和VTI均低于对照组,PI和RI均高于对照组(P<0.05);右侧ICA的PSV、EDV、MDV均低于对照组,PI和RI均高于对照组(P<0.05);左侧ICA的EDV低于对照组,PI和RI均高于对照组(P<0.05);右侧VA的PI和RI均高于对照组(P<0.05);左侧VA的EDV低于对照组,PI和RI均高于对Objective To investigate the hemodynamic changes of carotid and cerebral arteries in hypertrophic cardiomyopathy(HCM).Methods Totally 40 HCM patients and 25 normal controls were enrolled.All of them received echocardiography,carotid and cerebral arteries color Doppler ultrasound.Echocardiographic parameters included maximal left ventricular wall thickness(MLVWT),left ventricular end-diastolic diameter(LVEDD),left ventricular end-diastolic and systolic volume(LVEDV and LVESV),left ventricular ejection fraction(LVEF),left ventricular outflow tract pressure gradients(LVOT-PG),left atrial diameter(LAD),and mitral valve inflow and annular early diastolic velocity(E and e′).Besides,the carotid and cerebral arteries were involved including bilateral common carotid artery(CCA),internal carotid artery(ICA),middle cerebral artery(MCA),vertebral artery(VA),anterior cerebral artery(ACA),posterior cerebral artery(PCA),vertebral artery-intracranial(VA-IC)and basilar artery(BA).The ultrasound parameters of these arteries,such as peak systolic velocity(PSV),maximum end-diastolic velocity(EDV),average end-diastolic velocity(MDV),pulsative index(PI),resistance index(RI),velocity-time integrals(VTI),S/D,mean velocity(Mean)were all measured and compared.Results The ratios of MLVWT,LVOT-PG,LAD,and E/e′in the HCM group were significantly higher than those in the control group;EDV,MDV,and VTI of bilateral CCA were lower than those in the control group,and PI and RI were higher.PSV,EDV and MDV in right ICA were lower than those in the control group,PI and RI were higher.EDV in left ICA was lower than that in the control group,PI and RI were higher.PI and RI of the right VA were higher than the control group.EDV in left VA was lower than that in normal control group,PI and RI were higher.RI and Mean in left MCA were higher than that of the control group.VTI of bilateral PCA and left ACA were higher than that of the control group;PSV,PI,RI and SD of right va-ic were higher than that of the control group,the differences were statistica

关 键 词：心肌病 肥厚型 血流动力学 超声检查 多普勒 彩色 

分 类 号：R542.2[医药卫生—心血管疾病]