三维斑点追踪技术在诊断左心室射血分数正常的轻链型心肌淀粉样变中的应用研究  

The role of three-dimensional speckle tracking imaging in the diagnosis of immunoglobulin light-chain cardiac amyloidosis with normal left ventricular ejection fraction

作　　者：雷常慧 左蕾 王妍 朱晓丽 周梦垚 杨倩利 徐浛兮 刘丽文 Lei Changhui;Zuo Lei;Wang Yan;Zhu Xiaoli;Zhou Mengyao;Yang Qianli;Xu Hanxi;Liu Liwen(Department of Ultrasound,Xijing Hospital,Air Force Medical University,Xi′an 710032,China;Department of Nephrology,Xijing Hospital,Air Force Medical University,Xi′an 710032,China)

机构地区：[1]空军军医大学西京医院超声医学科,西安710032 [2]空军军医大学西京医院肾脏内科,西安710032

出　　处：《中华超声影像学杂志》2020年第3期213-218,共6页Chinese Journal of Ultrasonography

基　　金：国家科技部国际合作专项(2014DFA31980);国家自然科学基金(81671693,81600562);陕西省重点项目(2017ZDXM-SF-058,2019KW-076);西京医院新技术、新业务资助项(417432A);陕西省重点科技创新团队(2014KCT-20)。

摘　　要：目的应用三维斑点追踪(3D-STI)技术评估左室射血分数(LVEF)正常的免疫球蛋白轻链型心肌淀粉样变(AL-CA)患者的左室心肌应变,探讨3D-STI在诊断AL-CA中的应用价值。方法连续纳入2014年10月至2019年1月在空军军医大学西京医院确诊为系统性免疫球蛋白轻链型淀粉样变(sAL)且LVEF正常的患者92例,依据心脏受累的诊断标准分为AL-CA组(52例)和免疫球蛋白轻链型淀粉样变(AL)组(40例)。收集患者的临床资料和血清学指标;采集患者的常规超声心动图和三维全容积动态图像,运用TomTec脱机软件对左室整体纵向应变(GLS)、整体径向应变(GRS)、整体圆周应变(GCS)和整体面积应变(GAS)等三维参数进行分析。比较两组患者临床资料、血清学指标、常规超声心动图和三维应变参数的差异。结果与AL组相比,AL-CA组氨基末端B型前脑钠肽明显增高(P<0.001),其余血清学指标两组间比较差异无统计学意义(均P>0.05)。与AL组相比,AL-CA组左室舒张末期最大室壁厚度、左室质量指数、左房容积指数、二尖瓣口舒张早期血流速度峰值/二尖瓣环舒张早期峰值速度显著增加(均P<0.05),其余常规超声心动图参数LVEF、左室舒张末期容积、左室收缩末期容积两组间比较差异无统计学意义(均P>0.05)。与AL组相比,AL-CA组3D-STI参数GLS、GAS以及GRS明显减低(均P<0.05),而两组间GCS差异无统计学意义(P>0.05)。ROC曲线分析结果显示GLS≤16.09%、GAS≤36.54%、GRS≤31.90%的sAL患者更易出现心肌的受累。结论3D-STI技术可以检测sAL患者的心脏受累,为诊断AL-CA提供了简单、无创的新方法。Objective To explore the value of three-dimensional speckle tracking imaging(3D-STI)in the diagnosis of immunoglobulin light-chain cardiac amyloidosis(AL-CA)patients with normal left ventricular ejection fraction(LVEF).Methods A total of 92 consecutive patients diagnosed with systemic immunoglobulin light chain amyloidosis(sAL)and with normal LVEF from October 2014 to January 2018 in Xijing Hospital were enrolled.Based on the diagnostic criteria of cardiac involvement,the patients were divided into AL-CA group(52 cases)and immunoglobulin light chain amyloidosis(AL)group(40 cases).The clinical data and serological markers of the patients were collected,the conventional echocardiography and full-volume three dimensional dynamic images were acquired,left ventricular global longitudinal strain(GLS),global radial strain(GRS),global circumferential strain(GCS),and global area strain(GAS)were analyzed using off-line TomTec software.The differences between the two groups were compared.Results Compared with the AL group,the NT-proBNP of AL-CA group was significantly higher(P<0.05)and there were no significant differences of the other serological indexes between the two groups(all P>0.05).Compared with the AL group,the maximal left ventricular wall thickness,left ventricular mass index,left atrial volume index,and E/e′in the AL-CA group were significantly increased(all P<0.05).There were no significant differences of other conventional echocardiographic measurements between the two groups(all P>0.05).Compared with the AL group,GLS,GAS,and GRS were significantly lower in AL-CA group(all P<0.05);but there was no significant difference of GCS between the two groups(P>0.05).The ROC curve analysis showed that the cut-off values discriminating cardiac involvement were 16.09%for GLS,36.54%for GAS and 31.90%for GRS.Conclusions 3D-STI measurements of left ventricular myocardial mechanics could detect cardiac involvement in patients with sAL amyloidosis,and provides a new method for diagnosis of AL-CA.

关 键 词：超声心动描记术 三维斑点追踪技术 免疫球蛋白轻链型心肌淀粉样变 应变 

分 类 号：R542.2[医药卫生—心血管疾病]