左心室压力-应变环对阻塞型睡眠呼吸暂停综合征患者心肌功能的评价  

Assessment of myocardial function in patients with obstructive sleeping apnea syndrome by left ventricular pressure-strain loop

作　　者：金姗 丁雪晏 蔡绮哲[1] 李一丹[1] 赵智玲[2] 郭兮恒[2] 吕秀章[1] Jin Shan;Ding Xueyan;Cai Qizhe;Li Yidan;Zhao Zhiling;Guo Xiheng;Lyu Xiuzhang(Department of Echocardiography,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China;Department of respiratory and critical care medicine,Beijing institure of respiratory medicine,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院心脏超声科,100020 [2]首都医科大学附属北京朝阳医院呼吸与危重症医学科(北京市呼吸疾病研究所),100020

出　　处：《中华医学超声杂志（电子版）》2023年第6期575-580,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的应用左心室压力-应变环(PSL)评价阻塞型睡眠呼吸暂停综合征(OSAS)患者心肌功能,探讨OSAS患者早期心功能改变及其与疾病严重程度的关系。方法纳入2021年2月至2021年7月于首都医科大学附属北京朝阳医院确诊的OSAS患者107例,根据睡眠呼吸暂停低通气指数(AHI)将其分为轻度组(5≤AHI<15)32例、中度组(15≤AHI<30)34例及重度组(AHI≥30)41例。另选取24例健康受试者作为对照组。通过二维斑点追踪超声心动图(STE)分析比较各组受试者左心室整体纵向应变(GLS)。应用左心室PSL评价心肌整体做功指数(GWI)、整体有效做功(GCW)、整体无效做功(GWW)及整体做功效率(GWE),并进行组间比较。此外,对心肌做功参数与AHI的相关性及AHI的独立相关因素进行分析。结果OSAS患者中,中度组GLS、GWI较对照组减低(P<0.05);重度组GLS、GWI及GCW较对照组、轻度及中度组减低(P<0.01),GWE较对照组及轻度组减低(P<0.05);OSAS患者GLS与AHI呈负相关(r=-0.458,P<0.001),GWI、GCW、GWE与AHI均呈负相关(r=-0.482、-0.374、-0.272,P均<0.01);多因素回归分析显示,AHI与GWI(β=-0.206,P<0.05)、体质量指数(β=0.185,P<0.05)及最低血氧饱和度(β=-0.473,P<0.001)独立相关。结论中重度OSAS患者心肌功能减低,GLS与GWI均为评价其心肌功能变化的敏感参数,心肌功能与疾病严重程度呈负相关,GWI与AHI独立相关。Objective To evaluate global myocardial function in patients with obstructive sleeping apnea syndrome(OSAS)by left ventricular pressure-strain loop(PSL)noninvasively and investigate the correlation between myocardial function and the severity of the disease.Methods One hundred and seven patients with OSAS at Beijing Chao-Yang Hospital from February 2021 to July 2021 were included.According to apnea-hypopnea index(AHI),the patients were divided into mild group(5≤AHI<15,n=32),moderate group(15≤AHI<30,n=34),and severe group(AHI≥30,n=41).Twenty-four healthy subjects were selected as a control group.The global longitudinal strain(GLS)of the left ventricle was measured by two-dimensional speckle tracking echocardiography(STE)and was compared among the groups.Left ventricular PSL was used to assess global work index(GWI),global constructive work(GCW),global waste work(GWW),and global work efficiency(GWE),and comparisons were made among groups.In addition,correlation between myocardial work parameters and AHI was analyzed and independent predictors of AHI were identified.Results Compared with the control group,GLS and GWI were decreased in the moderate group(P<0.05).GLS,GWI,and GCW were decreased in the severe group compared with those in the control group,mild group,and moderate group(P<0.01).GWE was reduced in the severe group compared with that in the control group and mild group(P<0.05).GLS was negatively correlated with AHI(r=-0.458,P<0.001),and GWI,GCW,and GWE were negatively correlated with AHI in OSAS patients(r=-0.482,-0.374,and-0.272,respectively;P<0.01).Multivariate linear regression analysis demonstrated that AHI was independently associated with GWI(β=-0.206,P<0.05),body mass index(BMI)(β=0.185,P<0.05),and lowest arterial oxygen saturation(LSaO2)(β=-0.473,P<0.001).Conclusions Myocardial function is impaired in patients with moderate and severe OSAS.Myocardial function can be sensitively evaluated by GWI and GLS and is negatively correlated with the severity of OSAS.GWI is independently associated wi

关 键 词：超声心动描记术 压力-应变环 左心室 心肌功能 阻塞型睡眠呼吸暂停综合征 

分 类 号：R54[医药卫生—心血管疾病]