二维斑点追踪超声心动图技术对法布雷病患者右心室功能及应变特征的评估  

Value of Two-dimensional Speckle Tracking Imaging on Assessment of Right Ventricular Function in Patients With Fabry Disease

作　　者：王涵 刘琳[1,2] 赵亚雯 张巍[3] 李阳[4] 杨颖[1,2] 马为[1,2] WANG Han;LIU Lin;ZHAO Yawen;ZHANG Wei;LI Yang;YANG Ying;MA Wei(Department of Cardiology,Peking University First Hospital,Beijing 100034,China;Echocardiography Core Lab,Institute of Cardiovascular Disease,Peking University First Hospital,Beijing 100034,China;Department of Neurology,Peking University First Hospital,Beijing 100034,China;Department of Nephrology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院心内科,北京100034 [2]北京大学第一医院,心血管疾病研究所,超声心动图中心实验室,北京100034 [3]北京大学第一医院神经内科,北京100034 [4]北京大学第一医院肾内科,北京100034

出　　处：《中国循环杂志》2024年第10期997-1002,共6页Chinese Circulation Journal

基　　金：国家重点研发计划(2021YFC2501106);中央高水平医院临床科研业务费(2023SF06)~~。

摘　　要：目的:利用二维斑点追踪超声心动图技术评估法布雷病患者的右心室功能及应变特征。方法:回顾性收集2014年8月至2023年6月在北京大学第一医院经病理或基因检查证实的法布雷病患者57例(法布雷病组)和性别、年龄(±2岁)相匹配的健康对照者57例(正常对照组),比较两组临床基线资料、常规超声心动图参数及二维斑点追踪超声心动图技术测量的右心室应变参数。另将法布雷病组根据左心室质量指数(LVMI)大小分为左心室肥厚(LVH)亚组(n=22,男性LVMI≥115 g/m^(2),女性LVMI≥95 g/m^(2))和无LVH亚组(n=35,男性LVMI<115 g/m^(2),女性LVMI<95 g/m^(2)),比较两亚组的右心室应变特征,并分析右心室应变特征与LVH的关系。结果:(1)与正常对照组比,法布雷病组心率慢、B型利钠肽水平高、估算肾小球滤过率低,左心室后壁厚度(LVPWd)、室间隔厚度(IVSd)、右心室游离壁厚度(RVWT)增加,LVMI升高(P均<0.05)。(2)与无LVH亚组比,LVH亚组年龄大、收缩压高、估算肾小球滤过率低、B型利钠肽水平高,LVMI升高,RVWT增加(P均<0.05)。(3)与正常对照组比,法布雷病组的左心室整体长轴应变(LVGLS)、右心室整体长轴应变(RVGLS)、右心室游离壁应变(RVFWS)及右心室游离壁基底段应变(bal-RVFWS)、中间段应变(mid-RVFWS)和心尖部应变(api-RVFWS)均下降(P均<0.05)。右心室应变差值(ΔRV)在法布雷病组和正常对照组间的差异无统计学意义(P>0.05)。(4)与无LVH亚组比,LVH亚组的LVGLS、RVGLS均降低,ΔRV升高(P均<0.05),RVFWS、bal-RVFWS、mid-RVFWS和api-RVFWS在两亚组间的差异均无统计学意义(P均>0.05)。结论:法布雷病患者的右心室整体和节段应变均已受到损害,其中伴LVH的患者RVGLS减低而RVFWS相对保留。Objectives:To explore the clinical value of two-dimensional speckle tracking echocardiography(STE)on evaluating right ventricular function in patients with Fabry disease(FD).Methods:From August 2014 to June 2023,57 patients with FD and 57 age-(±2 year)and sex-matched healthy controls were included in this study.Clinical characteristics,echocardiographic parameters and right ventricular strain parameters were compared between the two groups.According to the left ventricular mass index(LVMI),FD patients were further divided into the left ventricular hypertrophy(LVH)group(n=22,men:LVMI≥115 g/m^(2),women:LVMI≥95 g/m^(2))and the non-LVH(n=35,men:LVMI<115 g/m^(2),women:LVMI<95 g/m^(2))group,the association between right ventricular strain and LVH in FD patients was analyzed.Results:(1)The brain natriuretic peptide(BNP)level was higher,heart rate and estimate glomerular filtration rate(eGFR)were lower in the FD group than in healthy control group(all P<0.05).Interventricular septum(IVS)and left ventricular posterior wall(LVPW)thickness as well as left ventricular mass index(LVMI)and right ventricular free wall(RVFW)thickness were significantly higher in FD group than in healthy control group(all P<0.05).(2)Subgroup analysis showed that the age,systolic blood pressure,BNP,LVMI and RVFW thickness were significantly higher,while eGFR was lower in the LVH group than in the non-LVH group(all P<0.05).(3)The left ventricular global longitudinal strain(LVGLS),right ventricular global longitudinal strain(RVGLS),right ventricular free wall strain(RVFWS),RVFWS at basal,middle and apical segment were lower in FD patients than in healthy controls(all P<0.05).There was no significant difference in right ventricular strain difference value(ΔRV)between the FD group and controls(P>0.05).(4)In the LVH group,LVGLS and RVGLS were significantly declined andΔRV increased(all P<0.05),while RVFWS and all three segments preserved compared with the non-LVH group(all P>0.05).Conclusions:Myocardial strain analysis is valuable on the assessm

关 键 词：法布雷病 超声心动图 斑点追踪技术 心肌应变 右心室功能 

分 类 号：R54[医药卫生—心血管疾病]