斑点追踪技术与实时三维超声心动图评价类风湿性关节炎患者左室收缩同步性的对比研究  

A comparative study of two-dimensional speckle tracking imaging and realtime three-dimensional echocardiography to evaluate left ventricular systolic synchrony in patients with rheumatoid arthritis

作　　者：朱巧玲 郭泰 芦芳[3] ZHU Qiaoling;GUO Tai;LU Fang(Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学,太原市030001 [2]山西白求恩医院骨科 [3]山西医科大学第二医院超声科

出　　处：《临床超声医学杂志》2020年第8期590-595,共6页Journal of Clinical Ultrasound in Medicine

摘　　要：目的应用二维斑点追踪(2D-STI)与实时三维超声心动图(RT-3DE)评价不同病程活动期类风湿性关节炎(RA)患者左室收缩同步性,对比两种方法在评价左室收缩同步性方面的差异。方法选取我院90例活动期RA患者,根据病程将RA患者分为3组,每组各30例:A组,病程1~5年;B组,5年<病程≤10年;C组,病程>10年;另选同期30例健康志愿者作为对照组。应用2D-STI获得各组左室收缩功能参数即左室整体纵向应变(LVGLS)、左室整体环向应变(LVGCS),以及同步性参数即左室纵向应变及环向应变达峰时间标准差(Tls-SD、Tcs-SD);应用RT-3DE获得同步性参数即左室16节段达最小收缩容积时间的标准差(Tmsv-16-SD)及最大时间差(Tmsv-16-Dif)、经R-R间期校正后的左室16节段达最小收缩容积时间的标准差占心动周期的百分比(Tmsv-16-SD%)及最大时间差占心动周期的百分比(Tmsv-16-Dif%);比较各组上述参数差异;分析Tls-SD、Tcs-SD与Tmsv-16-SD、Tmsv-16-Dif的相关性。并对2D-STI与RT-3DE所测同步性参数进行重复性检验。结果 A组、B组、C组两两比较显示,随着病程增加,LVGLS逐渐降低,而Tcs-SD和TIs-SD逐渐延长,差异均有统计学意义(均P<0.05);A、B、C组与对照组比较,Tmsv-16-SD、Tmsv-16-Dif、Tmsv-16-SD%、Tmsv-16-Dif%均逐渐延长,差异均有统计学意义(均P<0.05)。Tls-SD与Tmsv-16-SD、Tmsv-16-Dif均呈正相关(r=0.307、0.345,均P<0.01),Tcs-SD与Tmsv-16-SD、Tmsv-16-Dif均呈正相关(r=0.340、0.359,均P<0.01)。2DSTI与RT-3DE对左室同步性指标的测量均具有较好的一致性,其中Tmsv-16-SD%重复性最好(观察者内ICC=0.985,观察者间ICC=0.977,均P<0.001)。结论 2D-STI与RT-3DE均能够检测出RA患者左室同步性的变化,均可定量评价左室收缩同步性,但是RT-3DE检测左室同步性变化更为敏感。ObjectiveTo evaluate the changes of left ventricular systolic synchronization in patients with rheumatoid arthritis(RA)in different course by two-dimensional speckle tracking imaging(2 D-STI)and real-time three-dimensional echocardiography(RT-3 DE),and to compare the differences between the two methods in evaluating left ventricular systolic synchronization.Methods A total of 90 RA patients in our hospital were selected.According to the course of disease,RA patients were divided into three groups(A,B and C),according to 1~5 years,5~10 years and more than 10 years,with 30 patients in each group.Another 30 healthy volunteers of the same period were selected as the control group.Conventional echocardiography,2 D-STI and RT-3 DE were performed in all subjects.The left ventricular global longitudinal strain(LVGLS),left ventricular global circumferential strain(LVGCS),left ventricular longitudinal strain and circumferential strain reaching peak time standard deviation(Tls-SD,Tcs-SD)were obtained by 2 D-STI.The synchronization parameters were obtained by RT-3 DE,such as left ventricular 16-segment standard deviation(Tmsv-16-SD)and maximum time difference(Tmsv-16-Dif),the percentage of standard deviation(Tmsv-16-SD%)and the percentage of maximum difference(Tmsv-16-Dif%)of the time for the 16 segments of the left ventricle to reach the minimum systolic volume after R-R interval correction.The differences of the above parameters in each group were compared,the correlation analysis of Tls-SD and Tcs-SD with Tmsv-16-SD and Tmsv-16-Dif were carried out and the repeatability tests were performed for Tls-SD,Tcs-SD,Tmsv-16-SD,Tmsv-16-Dif,Tmsv-16-SD% and Tmsv-16-Dif%.Results Pair-wise comparison among group A,group B and group C showed that with course of disease increased,the LVGLS gradually decreased,while Tcs-SD and Tls-SD gradually extended,with statistically significant difference(all P<0.05).Compared with the control group,Tmsv-16-SD,Tmsv-16-Dif,Tmsv-16-SD% and Tmsv-16-Dif% in group A,B and C were gradually extended,and the

关 键 词：超声心动描记术 三维 实时 斑点追踪 二维 类风湿性关节炎 心室 左 同步性 

分 类 号：R540.45[医药卫生—心血管疾病] R593.22[医药卫生—内科学]