脓毒症大鼠心肌功能障碍的常规超声心动图与组织多普勒成像分析  

Assessment of myocardial dysfunction in septic rats with conventional echocardiography and tissue Doppler imaging

作　　者：单光华[1] 徐雅倩 唐翔诩 李红梅 王彦平 黎凯颖 邢云 戴晓萌 杨多猛 吕秀秀 陆大祥 王华东 SHAN Guang-hua;XU Ya-qian;TANG Xiang-xu;LI Hong-mei;WANG Yan-ping;LI Kai-ying;XING Yun;DAI Xiao-meng;YANG Duo-meng;LÜ Xiu-xiu;LU Da-xiang;WANG Hua-dong(Department of Cardiovascular Medicine,The First Affiliated Hospital of Jinan University,School of Medicine,Jinan University,Guangzhou 510632,China;Department of Pathophysiology,Key Laboratory of Pathophysiology of National Administration of Traditional Chinese Medicine,School of Medicine,Jinan University,Guangzhou 510632,China)

机构地区：[1]暨南大学附属第一医院心血管内科,国家中医药管理局病理生理学重点实验室,广东广州510632 [2]暨南大学基础医学院病理生理学系,国家中医药管理局病理生理学重点实验室,广东广州510632

出　　处：《中国病理生理杂志》2020年第7期1243-1248,共6页Chinese Journal of Pathophysiology

基　　金：国家自然科学基金资助项目(No.81372028,No.81670359);广州市科技计划项目(No.201508020005)。

摘　　要：目的:利用脓毒症大鼠模型,比较常规超声和组织多普勒超声指标在早期诊断脓毒症大鼠心肌内在收缩与舒张功能障碍中的价值。方法:利用盲肠结扎穿孔(CLP)建立脓毒症大鼠模型,22只大鼠随机分成CLP组与假手术组,每组11只。利用ELISA和Western blot检测肿瘤坏死因子α(TNF-α)、细胞间黏附分子1(ICAM-1)和血管细胞黏附分子1(VCAM-1)的表达水平;离体心脏灌流、常规超声心动图和心脏组织多普勒成像测定心脏收缩与舒张功能。结果:与假手术组比较,CLP术后6 h,大鼠血清中TNF-α水平及左心室ICAM-1和VCAM-1表达显著升高,左心室±dp/dtmax显著降低,左心室每搏输出量与舒张末期容积显著降低,但左室射血分数的差异没有统计学显著性,二尖瓣血流速度E波峰值和A波峰值显著降低,二尖瓣环舒张早期运动速度E’波峰值和二尖瓣环舒张晚期运动速度A’波峰值显著降低,而E/E’比值的差异没有统计学显著性。相关分析显示,E’波峰值和A’波峰值分别与-dp/dtmax呈正相关(r分别为0.460和0.520,P<0.05)。结论:组织多普勒成像可以有效评价脓毒症早期心肌内在舒张功能障碍,E’与A’峰值可以作为检测左室心肌舒张功能障碍的指标。AIM:To compare various conventional and tissue Doppler echocardiographic indexes to assess their accuracy to detect left ventricular(LV)intrinsic systolic and diastolic dysfunction in septic rats.METHODS:Twenty-two SD rats were randomly divided into 2 groups:sham group and sepsis group,with 11 rats in each group.A model of sepsis was established by cecal ligation and puncture(CLP).Serum tumor necrosis factor-α(TNF-α)level,and myocardial intercellular adhesion molecule-1(ICAM-1)and vascular cell adhesion molecule-1(VCAM-1)expression were determined by ELISA and Western blot.The LV systolic and diastolic functions were analyzed by isolated heart Langendorff perfusion technique,conventional echocardiography and tissue Doppler imaging.RESULTS:Compared with sham group,the serum TNF-αlevel,and LV ICAM-1 and VCAM-1 expression were increased significantly,while LV±dp/dtmax,stroke volume and LV end-diastolic volume were markedly decreased at 6 h after CLP.Moreover,compared with sham group,mitral inflow peak E and A wave velocities as well as early-diastolic peak velocities(E’wave)and late-diastolic peak velocities(A’wave)of the mitral annulus were reduced significantly in sepsis group at 6 h after CLP.In contrast,no significant difference in LV ejection fraction and E/E’ratio between sham group and sepsis group was observed.Further investigation revealed that peak E’wave and A’wave velocities were positively correlated with-dp/dtmax(r=0.460 and r=0.520,P<0.05).CONCLUSION:At the early stage of sepsis,tissue Doppler echocardiography is a useful technique to assess LV diastolic dysfunction,and peak E’and A’wave velocities may be the sensitive indexes to detect LV intrinsic diastolic dysfunction.

关 键 词：脓毒症 心肌功能障碍 离体心脏灌流 组织多普勒成像 

分 类 号：R515.3[医药卫生—内科学] R363.2[医药卫生—临床医学]