二维斑点追踪技术评估类风湿关节炎相关肺间质性疾病继发肺动脉高压患者右心功能的应用价值  

Application Value of Two-Dimensional Speckle Tracking Echocardiography in Evaluating Right Ventricle Func⁃tion in Patients with Pulmonary Arterial Hypertension Secondary to Rheumatoid Arthritis-Associated Interstitial Lung Disease

作　　者：李甜甜 景红霞 郑光美 肖彬 李威 胡培 LI Tian-tian;JING Hong-xia;ZHENG Guang-mei;XIAO Bin;LI Wei;HU Pei(Ultrasound Ima-ging Center,Renmin Hospital,Hubei University of Medicine,Shiyan,Hubei 442000,China)

机构地区：[1]湖北医药学院附属人民医院超声影像中心,湖北十堰442000

出　　处：《湖北医药学院学报》2024年第4期376-379,共4页Journal of Hubei University of Medicine

基　　金：湖北省十堰市科技局引导性科研项目(22Y72)。

摘　　要：目的:探讨二维斑点超声技术在类风湿关节炎相关性间质性肺疾病(rheumatoid arthritis-associated in⁃terstitial lung disease,RA-ILD)继发肺动脉高压患者右心损害评估中的应用价值。方法:选取2022年1月至2023年6月就诊于我院RA-ILD患者56例,按照肺动脉收缩压(PASP)分为轻度组17例、中度组14例、重度组10例,将肺动脉压正常的15例RA-ILD患者作为对照组,测量右心相关超声心动图指标,包括:三尖瓣环收缩期位移(TAPSE)、三尖瓣环收缩期峰值速度(Sm)、右心室面积变化分数(RVFAC)、右心室心肌做功指数(RMPI)、右心室游离壁长轴应变(RVLSFw)。分析上述指标在各组间的差异。结果:与对照组比较,轻度组TAPSE、Sm、RVFAC、RMPI各参数差异无统计学意义(均P>0.05),轻度组RVLSFw较对照组减低,差异有统计学意义(P<0.05)。轻、中、重度组RMPI逐渐增加,TAPSE、Sm、RVFAC、RVLSFw依次减低,组间差异有统计学意义(均P<0.05)。Pearson相关性分析显示:RVLSFw与RMPI呈正相关,与TAPSE、RVFAC、Sm呈负相关。ROC曲线显示RVLSFw评估右心功能不同指标下降的诊断价值均较高。结论:应用二维斑点追踪技术能更早发现RA-ILD继发肺动脉高压患者右心室收缩功能的变化,有助于临床对该类患者病情进展及预后的评估。Objective To explore the applicability of two-dimensional speckle-tracking echocardiography(2D-STE)in as⁃sessing right ventricle function in patients with pulmonary arterial hypertension(PAH)secondary to rheumatoid arthritis-as⁃sociated interstitial lung disease(RA-ILD).A total of 56 RA-ILD patients treated in the People's Hospital,Hubei Universi⁃ty of Medicine from January 2022 to June 2023 were divided into groups based on their pulmonary artery systolic pressure(PASP):mild(17 cases),moderate(14 cases),and severe(10 cases).A control group comprised 15 RA-ILD patients with normal pulmonary artery pressure.Right ventricle echocardiographic parameteres,including tricuspid annular plane sys⁃tolic excursion(TAPSE),tricuspid annular peak systolic velocity(Sm),right ventricular fractional area change(RVFAC),right ventricular myocardial performance index(RMPI),and right ventricular free wall longitudinal strain(RVLSFw)were measured.Differences in these indices among the groups were analyzed.Results Compared with the conditions in the control group,no significant differences were observed in TAPSE,Sm,RVFAC,and RMPI in the mild group(all P>0.05),while RVLSFw showed a reduction(P<0.05).A gradual increase in RMPI and a decrease in TAPSE,Sm,RVFAC,and RVLSFw were noted from mild to severe groups,with significant intergroup differences(all P<0.05).Pearson correlation analysis revealed a positive correlation between RVLSFw and RMPI and a negative correlation with TAPSE,RVFAC,and Sm.ROC curve demonstrated that RVLSFw possesses high diagnostic efficacy in evaluating declining markers of right ventri⁃cle function.Conclusion 2D-STE facilitates the early detection of changes in the systolic function of the right ventricle in PAH patients due to RA-ILD,supporting its significant role in the clinical assessment and prognosis of affected patients.

关 键 词：二维斑点追踪技术 类风湿性关节炎 间质性肺疾病 肺动脉高压 心室功能 右 

分 类 号：R593.22[医药卫生—内科学] R544.1[医药卫生—临床医学] R540.45