经胸实时三维超声心动图对比研究不同梗死部位缺血性二尖瓣反流的二尖瓣构型  

Comparative study of mitral valve configuration in patients with ischemic mitral regurgitation in different infarct sites by transthoracic real-time three-dimensional echocardiography

作　　者：陈宇娇 刘昕[1] 薛娜[1] 穆维娜[1] CHEN Yu-jiao;LIU Xin;XUE Na;MU Wei-na(The First Department of Ultrasound, the First Central Hospital of Baoding, Hebei Province, Baoding 071000, China)

机构地区：[1]河北省保定市第一中心医院超声一科,河北保定071000

出　　处：《河北医科大学学报》2021年第5期582-586,共5页Journal of Hebei Medical University

基　　金：河北省研究生创新资助项目(CXZZSS2019139)。

摘　　要：目的应用经胸实时三维超声探讨不同部位缺血性二尖瓣反流(ischemic mitral regurgitation,IMR)患者的二尖瓣构型改变情况,分析反流程度的影响因素,为临床治疗提供参考。方法纳入心肌梗死(myocardial infarction,MI)伴IMR患者64例作为病例组,根据心肌梗死的部位分为前壁MI组40例与下壁MI组24例2个亚组,另纳入健康志愿者45例作为对照组。超声定量参数包括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)、瓣环前后径(anterior-to-posterior diameter,DAP)、瓣环高度(annular height,AH)、联合处直径(commissural diameter,CD)、瓣环三维面积(three-dimensional annular area,A3D)、非平面角度(nonplanar angle,NPA)、幕状区容积(tenting volume,VTent)、幕状区高度(tenting height,HTent)、瓣环周长(three-dimensional annular circumference,AC)、后叶角度(posterior leaflet angle,θPost)。比较各组二尖瓣构型改变情况,并通过多元Logistic回归分析IMR严重程度的影响因素。结果前壁MI组、下壁MI组LVESV、LVEDV明显大于对照组,LVEF明显小于对照组;前壁MI组LVESV、LVEDV明显大于下壁MI组,LVEF明显小于下壁MI组,差异有统计学意义(P<0.05)。前壁MI组和下壁MI组DAP、CD、A3D、NPA、HTent、VTent、AC、θpost大于对照组,AH小于对照组,差异有统计学意义(P<0.05)。前壁MI组CD、A3D、HTent、VTent大于下壁MI组,θpost小于下壁MI组,差异有统计学意义(P<0.05);前壁MI组和下壁MI组DAP、AH、NPA、AC差异无统计学意义(P>0.05)。下壁MI组重度IMR发生率大于前壁MI组,差异有统计学意义(P<0.05)。多元Logistic回归分析结果显示,VTent、θpost是重度IMR的危险因素。结论前壁MI组与下壁MI组IMR形成机制不同,VTent、θpost是重度IMR的危险因素,该结果有益于临床对于术式的选择。Objective To investigate the changes of mitral valve configuration in patients with ischemic mitral regurgitation(IMR)in different infarct sites by transthoracic real-time three-dimensional echocardiography,and to analyze the influencing factors of the degree of regurgitation,so as to provide reference for clinical treatment.Methods A total of 64 patients with myocardial infarction(MI)and IMR were included as the case group.According to the location of MI,the patients were divided into anterior MI subgroup(n=40)and inferior MI subgroup(n=24),and 45 healthy volunteers were included as the control group.The ultrasonic quantitative parameters included left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular ejection fraction(LVEF),anterior-to-posterior diameter(DAP),annular height(AH),commissural diameter(CD),three-dimensional annular area(A3D),non-planar angle(NPA),tenting volume(VTent),tenting height(HTent),three-dimensional annular circumference(AC),and posterior leaflet angle(θPost).The changes of mitral valve configuration between each group were compared and the influencing factors of the degree of IMR were analyzed by multinomial Logistic regression.Results LVESV and LVEDV in anterior MI subgroup and inferior MI subgroup were all higher than those in the control group,while LVEF was significantly lower than that in the control group;LVESV and LVEDV in anterior MI subgroup were larger than those in the inferior MI subgroup,while LVEF was smaller than that in the inferior MI subgroup,and the differences were statistically significant(P<0.05).DAP,CD,A3D,HTent,VTent,AC,NPA andθPost in anterior MI subgroup and inferior MI subgroup were all higher than those in the control group,while AH was lower than that in the control group,and the differences were statistically significant(P<0.05).CD,A3D,VTent and HTent in anterior MI subgroup were larger than those in the inferior MI subgroup,whileθPost was smaller than that in the inferior MI subgroup,and the differences we

关 键 词：二尖瓣闭锁不全 心肌梗死 超声心动描记术 三维 

分 类 号：R542.51[医药卫生—心血管疾病] R542.22[医药卫生—内科学]