实时三维超声心动图、二维斑点追踪技术联合血浆游离细胞DNA水平评估心肌梗死患者右房容积及心肌受损的价值  

Value of real-time three-dimensional echocardiography,two-dimensional speckle tracking imaging combined with plasma free cell DNA in evaluating right atrial volume and myocardial damage in patients with myocardial infarction

作　　者：王佳玲 张瑜[1] 王春燕 WANG Jialing;ZHANG Yu;WANG Chunyan(Echocardiography Room,Nantong First People’s Hospital,Jiangsu 226001,China)

机构地区：[1]江苏省南通市第一人民医院心超室,226001 [2]上海市公共卫生临床中心心内科

出　　处：《临床超声医学杂志》2021年第12期895-900,共6页Journal of Clinical Ultrasound in Medicine

基　　金：江苏省自然科学基金青年科技人才专项资金项目(BK20162363)。

摘　　要：目的探讨实时三维超声心动图(RT-3DE)、二维斑点追踪(2D-STI)技术联合血浆游离细胞DNA(cf DNA)水平评估急性下壁心肌梗死(AIMI)伴右室心肌梗死(RVMI)患者右房容积及心肌受损情况的临床价值。方法 98例AIMI患者根据是否合并RVMI分为AIMI组50例和AIMI伴RVMI组48例,另选38例体检健康者为对照组,比较二维超声心动图、RT-3DE、2D-STI及血浆cf DNA检测结果。绘制受试者工作特征(ROC)曲线评估RT-3DE、2D-STI、血浆cf DNA水平单独及联合诊断AIMI伴RVMI的价值。结果 AIMI组二维超声心动图、RT-3DE及2D-STI检测指标与对照组比较差异均无统计学意义。AIMI伴RVMI组三尖瓣口舒张早期前向血流速度峰值(E)与三尖瓣环舒张早期运动速度峰值(e’)的比值、右房最大容积指数(RAVmaxI)、右房最小容积指数(RAVminI)、右房收缩前容积指数(RAVpreI)、右房总排空容积指数(TSVI)、右房被动排空容积指数(PSVI)及右房主动排空容积指数(ASVI)均高于对照组和AIMI组,e’、三尖瓣环收缩期位移(TAPSE)、右房被动排空分数(PEF)、心肌的正向应变(LSpos)及正、负向应变绝对值之和(LStot)均低于对照组和AIMI组,差异均有统计学意义(均P<0.05)。AIMI伴RVMI组血浆cf DNA水平高于对照组和AIMI组,AIMI组血浆cf DNA水平亦高于对照组,差异均有统计学意义(均P<0.05)。ROC曲线分析显示,RT-3DE、2D-STI联合血浆cf DNA水平诊断AIMI伴RVMI的ROC曲线下面积、敏感性、特异性分别为0.908、90.0%,91.7%,均高于各方法单独及两两联合应用(均P<0.05)。结论 RT-3DE、2D-STI联合血浆cf DNA水平能准确评估AIMI伴RVMI患者右房各时相容积改变及心肌受损情况,为临床治疗方案的选择提供依据。Objective To explore the value of real-time three-dimensional echocardiography(RT-3 DE),twodimensional speckle tracking imaging(2 D-STI)combined with plasma free cell DNA(cf DNA)in evaluating rihgt atrial volume and myocardial damage in patients with acute inferior myocardial infarction(AIMI)with right ventricular myocardial infarction(RVMI).Methods Totally 98 AIMI patients were divided into AIMI group(50 patients)and AIMI+RVMI group(48 patients)according to whether combined with RVMI.Another 38 healthy patients were selected as the control group.All patients underwent two-dimensional echocardiography,RT-3 DE,and 2 D-STI,plasma cf DNA was tested and the results were compared and analyzed.Receiver operating characteristic(ROC)curve was drawn to evaluate the value of RT-3 DE,2 D-STI,plasma cf DNA alone and in combination in diagnosing AIMI with RVMI.Results The two-dimensional echocardiography,RT-3 DE and 2 DSTI detection indexes of the AIMI group were not statistically different from those of the control group.The ratio(E/e’)of the peak diastolic anterior blood flow velocity(E)of the tricuspid valve orifice and the peak velocity of the tricuspid annulus early diastole(e’),the maximum and minimum volume index of the right atrium(RAVmaxI,RAVminI),right atrium pre-systolic volume index(RAVpreI),right atrium total emptying volume index(TSVI),right atrium passive emptying volume index(PSVI),and right atrium active emptying volume index(ASVI)in the AIMI+RVMI group were higher than those of the control group and AIMI group(all P<0.05),e’,tricuspid annulus systolic displacement(TAPSE),right atrial passive emptying fraction(PEF),and myocardial positive strain(LSpos)and the sum of absolute value of positive and negative strain(LStot)were lower than those of the control group and AIMI group(all P<0.05).The plasma cf DNA level of AIMI+RVMI group was higher than that of the control group and AIMI group(both P<0.05),and the plasma cf DNA level of AIMI group was also higher than that of the control group(P<0.05).ROC curve

关 键 词：超声心动描记术 实时 三维 斑点追踪 二维 血浆游离细胞DNA 心肌梗死 急性 心室 右 心肌损伤 

分 类 号：R540.45[医药卫生—心血管疾病]