二维斑点追踪技术评估窒息新生儿左室纵向收缩功能及其与心肌损伤的相关性  

Evaluation of the correlation between longitudinal systolic function of the left ventricle and myocardial damage in asphyxia neonates by two-dimensional speckle tracking imaging

作　　者：陈成彩 陆亿[2] 姚小敏 李丽珍[1] CHEN Chengcai;LU Yi;YAO Xiaomin;LI Lizhen(Department of Ultrasound Medicine,Affiliated Hospital of Youjiang Medical University for Nationalities,Guangxi 533000,China)

机构地区：[1]右江民族医学院附属医院超声医学科,广西壮族自治区百色市533000 [2]右江民族医学院附属医院重症医学科,广西壮族自治区百色市533000 [3]右江民族医学院附属医院新生儿科,广西壮族自治区百色市533000

出　　处：《临床超声医学杂志》2022年第5期353-357,共5页Journal of Clinical Ultrasound in Medicine

基　　金：2020年度广西高校中青年教师科研基础能力提升项目(2020KY13012);2018年百色市科学研究与技术开发计划项目(百科20184711)。

摘　　要：目的应用二维斑点追踪(2D-STI)技术评估窒息新生儿左室纵向收缩功能,探讨其与心肌损伤的相关性。方法选取我院经临床确诊合并心肌损伤的足月窒息新生儿61例,根据Apgar评分分为轻度窒息组31例(Apgar评分4~7分)和重度窒息组30例(Apgar评分0~3分);另选同期出生的正常足月新生儿30例作为对照组。应用常规超声心动图获取各组左室舒张末期内径(LVDId)、左室短轴缩短率(LVFS)、左室射血分数(LVEF);2D-STI获取左室基底段、中间段、心尖段共17个节段峰值应变(LPSS)及左室三腔心整体纵向应变(GLS-LAX)、四腔心整体纵向应变(GLS-A4C)、两腔心整体纵向应变(GLS-A2C)、左室整体平均纵向应变(GLS-AVG);比较各组上述各参数差异;分析GLS-AVG与血清肌酸激酶同工酶(CK-MB)、肌钙蛋白(cTnT)的相关性。结果各组LVDId、LVFS、LVEF比较差异均无统计学意义。各组左室基底段、中间段、心尖段有14个节段LPSS比较差异均有统计学意义(均P<0.05);重度窒息组左室基底段、中间段各节段LPSS均不同程度降低;轻度窒息组左室基底段仅前间壁、下间壁、下壁LPSS降低,中间段仅前壁、下间壁、前侧壁LPSS降低,与对照组比较差异均有统计学意义(均P<0.05);重度窒息组和轻度窒息组左室心尖段仅下壁、侧壁LPSS降低,与对照组比较差异均有统计学意义(均P<0.05)。各组GLS-LAX、GLS-A4C、GLS-A2C、GLS-AVG比较差异均有统计学意义(均P<0.05);重度窒息组和轻度窒息组GLS-LAX、GLS-A4C、GLS-A2C、GLS-AVG均低于对照组,重度窒息组GLS-LAX、GLS-A4C、GLS-A2C、GLS-AVG均低于轻度窒息组,差异均有统计学意义(均P<0.05)。GLS-AVG与CK-MB、cTnT均呈负相关(r=-0.515、-0.912,均P=0.000)。结论2D-STI可早期定量评估窒息新生儿左室纵向收缩功能,且其与心肌损伤指标CK-MB、cTnT相关。ObjectiveTo evaluate the longitudinal systolic function of left ventricle in neonates with asphyxia by twodimensional speckle tracking(2D-STI),and to investigate the correlation between left ventricular longitudinal systolic function and myocardial damage.MethodsSixty-one asphyxia neonates with myocardial damage were divided into mild asphyxia group(31 cases,Apgar score 4~7)and severe asphyxia group(30 cases,Apgar score 0~3)according to Apgar score,and 30 normal neonates were selected as control group.The left ventricular diastolic diameter(LVDId),left ventricular short axis shortening(LVFS)and left ventricular ejection fraction(LVEF)were measured by conventional echocardiography.The peak strain(LPSS)of 17 segments at base segment,middle segment and apex segment of left ventricle,the global longitudinal strain of left ventricle at three-chamber view(GLS-LAX),the global longitudinal strain at four chamber view(GLS-A4C),global longitudinal strain at two-chamber view(GLS-A2C)and global mean longitudinal strain of left ventricle(GLS-AVG)were obtained by 2D-STI.The differences of the above parameters in all groups were compared.The correlation between GLS-AVG and serum creatine kinase isoenzyme(CK-MB),troponin(cTnT)were analyzed.ResultsThere were no significant difference of LVDId,LVFS and LVEF among all groups.LPSS of 14 segments at basal segment,middle segment and apex segment of left ventricle were significantly different among all groups(all P<0.05).LPSS of basal and middle segments of left ventricle decreased to different degrees in severe asphyxia group,LPSS of basal segment of left ventricle decreased only in anterior septum,lower septum and lower wall in mild asphyxia group,LPSS of middle segment of left ventricle decreased only in anterior septum,lower septum and anterior wall in mild asphyxia group,and the differences were statistically significant compared with those in control group(all P<0.05).LPSS of inferior wall and lateral wall at apical segment decreased in severe asphyxia group and mild asphyxia gro

关 键 词：超声心动描记术 斑点追踪 二维 新生儿窒息 心功能 左 心肌损伤 相关性 

分 类 号：R540.45[医药卫生—心血管疾病] R722.12[医药卫生—内科学]