三维斑点追踪成像评价慢性阻塞性肺疾病患者左心室功能早期变化  

Early changes in left ventricular function assessed by three-dimensional speckle tracking imaging in patients with chronic obstructive pulmonary diseases

作　　者：王璆 孙终霞 余蕾 蒋天安[1] WANG Qiu;SUN Zhongxia;YU Lei;JIANG Tian'an(Department of Ultrasound Medicine,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China)

机构地区：[1]浙江大学医学院附属第一医院超声医学科,杭州310003

出　　处：《浙江医学》2021年第13期1395-1399,I0004,共6页Zhejiang Medical Journal

摘　　要：目的探讨三维斑点追踪成像(3D-STI)评价慢性阻塞性肺疾病(COPD)患者左心室功能早期变化的临床意义。方法选取2019年3月至2020年7月浙江大学医学院附属第一医院诊断为COPD的患者52例,根据肺动脉收缩压(PASP)分级标准将COPD患者分为无肺动脉高压(NPAH)组(PASP<40 mmHg)27例和轻度肺动脉高压(MPAH)组(PASP为40~50 mmHg)25例。另选取同期本院排除心肺疾患的志愿者30例作为对照组。常规超声心动图测得左心室舒张功能指标,采集三维全容积图像,采用EchoPAC 201工作站脱机分析,获取3D-STI参数,包括左心室三维整体纵向应变(3D-GLS)、三维整体圆周应变(3D-GCS)、三维整体径向应变(3D-GRS)及三维整体面积应变(3D-GAS),进行分析和组间比较。结果3组患者左心室舒张末期容积、每搏量、舒张早期二尖瓣峰值流速E峰(Mitral E)与舒张晚期二尖瓣峰值流速A峰的比值、二尖瓣E峰减速时间、舒张早期二尖瓣环峰值速度均值e'(Mitral e')、Mitral E与Mitral e'的比值比较差异均有统计学意义(均P<0.05)。3组患者3D-GLS、3D-GCS、3D-GRS、3D-GAS比较差异均有统计学意义(均P<0.05)。NPAH组患者3D-GLS、3D-GAS均小于对照组(均P<0.05),MPAH组患者3D-GLS、3D-GCS、3D-GRS、3D-GAS均小于NPAH组和对照组(均P<0.05)。结论3D-STI可定量评价COPD患者左心室功能早期变化,MPAH患者与NPAH患者比较,对左心室功能受到的影响更为明显。Objective To assess the early changes of left ventricular function in patients with chronic obstructive pulmonary diseases(COPD)with three-dimensional speckle tracking imaging(3D-STI).Methods Fifty-two patients with COPD admitted in the First Affiliated Hospital,Zhejiang University School of Medicine from March 2019 to July 2020 were enrolled,including 27 patients with no pulmonary hypertension(NPAH group,PASP<40 mmHg),25 patients with mild pulmonary hypertension(MPAH group,PASP was 40~50 mmHg),30 healthy subjects were also enrolled as control group.The left ventricular diastolic function indexes were measured by conventional echocardiography,the images of three-dimensional full-volume were collected and analyzed by EchoPAC 201 workstation to obtain 3D-STI parameters,including three-dimensional global longitudinal strain(3D-GLS)and three-diemnsional global circumferential strain(3D-GCS),three-diemnsional global radial strain(3D-GRS)and three-diemnsional global area strain(3D-GAS).Results There were significant differences in left ventricle enddiastolic volume,SV,Mitral E/A,mitral valve E-peak deceleration time,mitral annulus average velocity e'-peak(Mitral e'),and Mitral E/e'among the three groups(all P<0.05).There were significant differences in 3D-GLS,3D-GCS,3D-GRS and 3D-GAS among the three groups(all P<0.05).3D-GLS and3D-GAS in the NPAH group were lower than those in the control group(both P<0.05),3D-GLS,3D-GCS,3D-GRS and 3D-GAS in the MPAH group were lower than those in the NPAH group and control group(all P<0.05).Conclusion 3D-STI is an effective assessment method for early changes of left ventricular function in patients with COPD.MPAH patients have more significant impact on left ventricular function than NPAH patients.

关 键 词：三维斑点追踪成像 慢性阻塞性肺疾病 左心室功能 

分 类 号：R563.9[医药卫生—呼吸系统]