大动脉炎患者左室心肌应力改变的初步临床研究  

Changes in left ventricular myocardial strain in patients with Takayasu arteritis:a preliminary clinical study

作　　者：任艺 王莹[2] 刘明熙[3] 刘敏[4] 蒋涛[3] 郭晓娟[3] 杨媛华[5] 龚娟妮[5] REN Yi;WANG Ying;LIU Mingxi;LIU Min;JIANG Tao;GUO Xiaojuan;YANG Yuanhua;GONG Juanni(Capital Medical University,Beijing 100069,China;Department of Pathology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,012m;Department of Radiology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China;Department of Radiology,China-Japart Friendship Hospital,Beijing 100029,China;Department of Pulmonary and Critical Care Medicine,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学,北京100069 [2]首都医科大学附属北京朝阳医院病理科,北京100020 [3]首都医科大学附属北京朝阳医院放射科,北京100020 [4]中日友好医院放射科,北京100029 [5]首都医科大学附属北京朝阳医院呼吸与危重症科,北京100020

出　　处：《实用放射学杂志》2021年第8期1275-1280,共6页Journal of Practical Radiology

基　　金：北京自然科学基金项目(7182149);国家自然科学基金面上项目(81871328)。

摘　　要：目的探讨大动脉炎(TA)患者左室心肌应力改变的特征及其临床影响因素。方法前瞻性纳入经临床确诊的TA患者25例,正常对照组17例,所有研究对象均行心脏磁共振(CMR)检查,TA组同时采集相关临床指标。应用特征追踪技术计算左室全心和节段性峰值应力(PS)及应变率(PSR)。结果TA组较对照组左室基底段和中间段的周向PS,中间段舒张期周向、径向、纵向PSR,基底段舒张期径向PSR均显著降低(P<0.05)。分层分析表明射血分数(EF)>50%的TA组左室第4节段纵向PS、第1节段各方向PS以及第4、6节段舒张期径向PSR比对照组减低(P<0.05);心肌延迟强化(LGE)组较无LGE组基底段周向PS减低有统计学意义;全心纵向应力(GLS)与血沉呈中等负相关性(r=-0.50,P<0.05)。结论TA患者左心功能障碍主要表现为基底段及中间段周向应力减低;对于EF>50%的患者存在基底段PS及PSR减低,且与心肌纤维化有关。血沉升高会影响GLS。本研究为深入探讨TA患者心肌受损机制提供了思路。Objective To explore the characteristics of left ventricular myocardial strain changes in patients with Takayasu arteritis(TA)and its clinical influencing factors.Methods 25 patients diagnosed with TA clinically and 17 normal controls who underwent cardiac magnetic resonance(CMR)examination were prospectively enrolled.Clinical indicators of patients with TA were collected.Global,segmental peak strain(PS)and peak strain rate(PSR)of left ventricular were analyzed by feature tracking technology.Results Circumferential PS of basal and middle segments and diastolic radialfcircumferential,longitudinal PSR of middle segment,diastolic radial PSR of basal segment were significantly lower in the TA group compared to control group(P<0.05).Stratified analysis revealed that longitudinal PS of segment 4,PS of segment 1 in all directions and diastolic radial PSR of segments 4,6 in patients with TA with ejection fraction(EF),50%were statistically impaired compared with controls(P<0.05).Moreover,circumferential PS of basal segment in myocardial late gadolinium enhancement(LGE)group was significantly lower than that in non-LGE group.Global longitudinal strain(GLS)had a moderate negative correlation with erythrocyte sedimentation rate(r=-0.50,P<0.05).Conclusion The left ventricular dysfunction in TA patients is mainly manifested as decreased circumferential strain in the basal and middle segments.For patients with EF,50%»there are PS and PSR impairments in the basal segment,which are related to myocardial fibrosis.The increase of erythrocyte sedimentation rate may affect GLS.This study may provide insight into the mechanisms underlying myocardial damage in TA patients.

关 键 词：心脏磁共振 大动脉炎 左室 

分 类 号：R445.2[医药卫生—影像医学与核医学] R543.5[医药卫生—诊断学]