类风湿关节炎左心室收缩功能的超声压力-应变环评价  

Evaluation of left ventricular systolic function by echocardiographic pressure-strain loops in patients with rheumatoid arthritis

作　　者：任梅 尹立雪[2] 朱静[2] 胡家锐 何金梅 雷菊 REN Mei;YIN Li-xue;ZHU Jing;HU Jia-rui;HE Jin-mei;LEI Ju(North Sichuan Medical College,Nanchong Sichuan 637000,China;Sichuan Provincial People's Hospital,University of Electronic Science and Technology of China,Chengdu 610072,China;Zunyi Medical University,Zunyi Guizhou 563003,China)

机构地区：[1]川北医学院,四川南充637000 [2]四川省医学科学院·四川省人民医院,四川成都610072 [3]遵义医科大学,贵州遵义563003

出　　处：《中国临床医学影像杂志》2022年第10期704-709,共6页Journal of China Clinic Medical Imaging

基　　金：国家自然科学基金(81671852);中央高校基本科研业务费专项资金(ZYGX2020ZB038)。

摘　　要：目的:应用超声压力-应变环(Pressure-strain loops,PSL)技术可视化评价类风湿关节炎(Rheumatoid arthritis,RA)患者左心室心肌做功参数变化,探讨应用心肌做功参数评估RA患者潜在亚临床左心室心肌功能损伤的临床价值。方法:选取2021年5月—2022年2月于四川省人民医院就诊的RA患者78例,根据疾病病程分为短病程组(病程≤5年)和长病程组(病程>5年),每组39例,选取33例健康体检者为对照组。各组均应用超声心动图获取常规左心室结构和功能参数,应用斑点追踪技术获得整体纵向应变(Global longitudinal strain,GLS)及峰值应变离散度(Peak strain dispersion,PSD),应用PSL技术获得心肌做功参数:整体做功指数(Global work index,GWI)、整体有用功(Global constructive work,GCW)、整体无用功(Global waste work,GWW)及整体做功效率(Global work efficiency,GWE)。比较三组间不同参数的差异以及心肌做功参数与常规左心室功能参数和病程的相关性。结果:(1)常规超声心动图参数:与对照组相比,长病程组舒张末期左心室后壁厚度、舒张末期室间隔厚度增厚(P<0.05),短病程组和长病程组Tei指数均增大(P<0.05)。(2)应变参数和心肌做功参数:与对照组相比,短病程组和长病程组GLS、GWI、GCW均减低(P<0.05),长病程组PSD增加(P<0.05),GWW、GWE差异无统计学意义(P>0.05)。与短病程组相比,长病程组GWI降低(P<0.05),余应变参数和心肌做功参数差异均无统计学意义(P>0.05)。(3)相关性分析:GWI、GCW、GWE与GLS呈负相关(r=-0.407,-0.385,-0.451;P<0.001),GWW与GLS呈正相关(r=0.383,P<0.001),GCW、GWE与Tei指数呈负相关(r=-0.190,-0.911;P<0.05),GWW与左心室射血分数呈负相关(r=-0.250,P=0.008),GWE与左心室射血分数呈正相关(r=0.273,P<0.01),GWI、GCW与病程呈负相关(r=-0.274,-0.242;P<0.05)。结论:不同病程RA患者均出现心肌做功明显减低,应用PSL可有效检出RA患者早期左心室心肌功能受损改变,为临床系�Objective:To quantitatively evaluate the changes of left ventricular myocardial work parameters by echocardiographic pressure-strain loops(PSL)in patients with rheumatoid arthritis(RA),to explore the potential clinical value of myocardial work parameters in assessing subclinical left ventricular myocardial dysfunction in patients with RA.Methods:A total of78 patients with RA who were enrolled in Sichuan Provincial People’s Hospital from May 2021 to February 2022 were selected.The patients were divided into short course group(course of RA disease≤5 years)and long course group(course of RA disease>5 years)according to the course of RA disease,with 39 cases in each group,and 33 healthy subjects were selected as the control group.The left ventricular geometric and functional parameters were acquired by conventional echocardiography,and the global longitudinal strain(GLS)and peak strain dispersion(PSD)were obtained by speckle tracking imaging(STI),and the myocardial work parameters were acquired by PSL:global work index(GWI),global constructive work(GCW),global waste work(GWW),global work efficiency(GWE).The differences of related parameters among groups were compared,and the correlation between myocardial work parameters and conventional functional parameters and the course of RA disease were analyzed.Results:Conventional echocardiographic parameters:compared with the control group,the end-diastolic left ventricular posterior wall thickness(LVPWd)and end-diastolic interventricular septal thickness(IVSd)increased in the long course group(all P<0.05),and the Tei index increased in both short course group and long course group(P<0.05).Strain parameters and myocardial work parameters:compared with the control group,the GWI,GCW,GLS in the short course group and the long course group were significantly lower(all P<0.05),and PSD increased in the long course group(P<0.05),but there were no significant differences in GWW and GWE(all P>0.05).Compared with the short course group,GWI decreased in the long course group(P<0.05

关 键 词：关节炎 类风湿 心室功能 左 超声心动描记术 

分 类 号：R593.22[医药卫生—内科学] R540.45[医药卫生—临床医学]