二维斑点追踪分层应变技术评价高胆红素血症新生儿早期左心室收缩功能改变的临床价值  

Evaluation of early left ventricular myocardial systolic function in neonates with hyperbilirubinemia by two-dimensional speckle tracking stratified strain technique

作　　者：陈自勉[1] 刘磊[2] 邵军[1] 沈红[1] 孙步高 方爱娟 CHEN Zimian;LIU Lei;SHAO Jun;SHEN Hong;SUN Bugao;FANG Aijuan(Department of Ultrasound Diagnostics,Affiliated Kunshan Hospital of Jiangsu University,Suzhou 215300,China;Department of Ultrasound Medicine,Affiliated Drum Tower Hospital of Nanjing University,Nanjing 210000,China)

机构地区：[1]江苏大学附属昆山医院超声诊断科,江苏苏州215300 [2]南京大学附属鼓楼医院超声医学科,江苏南京210000

出　　处：《医学影像学杂志》2023年第6期961-965,共5页Journal of Medical Imaging

基　　金：南京市医学科技发展项目(编号:YKK18086)。

摘　　要：目的探讨通过二维斑点追踪显像(2D-STI)技术评价高胆红素血症新生儿(hyperbilirubinemia of newborn,HBN)左心室心肌收缩功能的变化。方法选取134例达到高胆红素血症诊断水平的患儿作为HBN组,56例健康新生儿作为对照组。对不同室壁和节段的内膜下、中层和外膜下心肌进行斑点追踪分析,计算不同部位的心肌整体纵向应变。结果两组新生儿组内比较左心室整体分层纵向应变(LS)存在相同的梯度特征:内膜下至外膜下呈递减趋势,这一梯度特征同样存在于各节段心肌分层LS(P<0.001);基底段至心尖段心肌呈递增趋势(P<0.001)。与对照组比较,HBN组室壁分层应变参数:室间隔三层心肌均减低(P=0.019,0.019,0.023);前壁三层心肌LS均减低,其中内膜下及外膜下心肌LS差异有统计学意义(P<0.05)。节段分层应变参数:心尖段三层心肌均减低,其中仅心尖段外膜下心肌LS差异有统计学意义(P=0.043);整体应变参数:三层心肌整体应变均减低,但差异无统计学意义(P>0.05)。结论2D-STI分层应变技术能够量化评价左心室不同室壁、不同节段和不同层次心肌的纵向应变受损情况,早期发现HBN心肌收缩功能的亚临床改变。Objective The study aimed to evaluate the changes in left ventricular contractility in newborns with hyperbilirubinemia by 2D speckle tracking imaging.Methods 134 neonates who reached the diagnostic level of HBN as the HBN group was selected,and the control group included 56 healthy newborns.In each ventricular wall and segment,speckle tracking analysis was performed in the subintimal,middle,and subadventitial myocardium.The overall longitudinal strain of the myocardium in different ventricular walls and segments and global longitudinal strain(GLS)were computed.Results The gradient of the left ventricular GLS had the same characteristics in both groups of newborns.There was a decreasing trend of longitudinal strain(LS)from the intima to the adventitia(i.e.,GLSendo>GLSmid>GLSepi).This gradient was also present in stratified LS in each myocardial segment(P<0.001).The LS showed an increasing trend from the basal to the apical segment(P<0.001).Stratified strain parameters of the ventricular wall(i.e.,the 3-layer myocardium:LSendo-SEPT,LSmid-SEPT,and LSepi-SEPT)were all significantly lower in the HBN group than in the control group(P=0.019,P=0.019,and P=0.023,respectively).LSendo-ANT,LSmid-ANT,and LSepi-ANT were also reduced,and the difference between LSendo-ANT and LSepiANT was statistically significant.The segmental stratified strain parameters(i.e.,the apical 3-layer myocardium:LSepia,LSmid-a,and LSepi-a)decreased,and the difference in LSepi-a was statistically significant(P=0.043).Overall strain parameters(i.e.,the 3-layer myocardial overall strain:GLSendo,GLSmid,and GLSepi)were reduced,but the difference was not statistically significant.Conclusions 2DSTI stratified strain technology can quantitively evaluate changes in the LS of the left ventricle in different ventricular walls,wall segments,and layers of the myocardium.

关 键 词：斑点追踪 分层应变 新生儿高胆红素血症 超声心动图 左心室收缩功能 

分 类 号：R722.18[医药卫生—儿科] R445.1[医药卫生—临床医学]