超声心动图在鉴别诊断心肌淀粉样变性两种主要分型中的意义  

Significance of echocardiography in distinguishing between two main subtypes of myocardial amyloidosis

作　　者：樊翀 裴磊磊 杨春[1] 张涛[1] 朱雯瑾[1] 王顺[1] FAN Chong;PEI Leilei;YANG Chun;ZHANG Tao;ZHU Wenjin;WANG Shun(Department of Cardiovascular Medicine,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061;School of Public Health,Xi’an Jiaotong University Health Science Center,Xi’an 710061,China)

机构地区：[1]西安交通大学第一附属医院心血管内科,陕西西安710061 [2]西安交通大学医学部公共卫生学院,陕西西安710061

出　　处：《西安交通大学学报（医学版）》2024年第5期789-793,共5页Journal of Xi’an Jiaotong University（Medical Sciences）

摘　　要：目的研究超声心动图在鉴别诊断心肌淀粉样变性(cardiac amyloidosis,CA)两种主要分型——转甲状腺素蛋白型(ATTR)和免疫球蛋白轻链型(AL)中的价值。方法回顾性分析2021年11月至2024年1月西安交通大学第一附属医院确诊的50例CA患者超声心动图参数,其中ATTR型6例,AL型44例,用t检验和χ2检验筛选出可能鉴别两种分型的参数,用受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)分析这些参数对两种分型的鉴别诊断能力。结果ATTR组和AL组患者的一般情况、整体平均纵向应变值(global longitudinal strain,GLS)、心尖段平均应变与基底段平均应变的比值、射血分数与GLS比值(EFSR)、左室心肌最厚处厚度、左室壁相对厚度、房室瓣是否增厚、双房是否增大差异均无统计学意义(P>0.05)。ATTR组房间隔厚度大于AL组(P<0.05),ATTR组E/e’(频谱多普勒舒张早期峰值流速/组织多普勒频舒张早期峰值流速)比值大于AL组(P<0.05)。ROC曲线分析显示,房间隔厚度、E/e’鉴别两种分型的曲线下面积分别为0.891(95%CI:0.792~0.991),0.826(95%CI:0.698~0.955),两者联合诊断的灵敏度100.00%,特异度95.24%。结论超声心动图参数E/e’比值、房间隔厚度可能对鉴别诊断CA患者两种主要分型具有一定的临床意义。Objective To explore the application value of echocardiography in the differential diagnosis of transthyretin cardiac amyloidosis(ATTR-CA)and immunoglobulin light chain cardiac amyloidosis(AL-CA).Methods We conducted a retrospective analysis of echocardiographic parameters of 50 confirmed CA patients diagnosed between November 2021 and January 2024 at The First Affiliated Hospital of Xi’an Jiaotong University,including 6 cases of ATTR and 44 cases of AL.Parameters that could potentially distinguish between the two subtypes were selected using t-tests andχ2 tests,and the diagnostic capabilities of these parameters for the two subtypes were analyzed using receiver operating characteristic(ROC)curves.Results There were no statistically significant differences in general characteristics,global longitudinal strain(GLS),ratio of apical to basal strain,ejection fraction to GLS ratio(EFSR),maximum thickness of left ventricular myocardium,relative thickness of left ventricular wall,presence of thickened atrioventricular valves,or presence of enlarged atria between ATTR and AL groups(P>0.05).The interventricular septal thickness was greater than in ATTR group than in AL group(P<0.05),and the E/e’ratio(ratio of spectral Doppler early diastolic peak velocity to tissue Doppler early diastolic peak velocity)was greater in ATTR group than in AL group(P<0.05).ROC curve analysis showed that the areas under the curve for distinguishing between the two subtypes based on interventricular septal thickness and E/e’ratio were 0.891(95%CI:0.792-0.991)and 0.826(95%CI:0.698-0.955),respectively,with a sensitivity of 100.00%and specificity of 95.24%for combined diagnosis.Conclusion Echocardiographic parameters,including E/e’ratio and interventricular septal thickness,may have clinical significance in distinguishing between the two main subtypes of CA in patients.

关 键 词：心肌淀粉样变性(CA) 转甲状腺素蛋白 免疫球蛋白轻链 斑点追踪成像 

分 类 号：R445.1[医药卫生—影像医学与核医学]