应用压力-应变环评价系统性硬化病患者左室心肌做功的定量研究  

Quantitative evaluation of left ventricular myocardial work in patients with systemic scleroderma using pressure-strain loop

作　　者：毛森[1] 蒋雨平 韩友东[1] 刘凯华 殷悦 何旭昱 赵鲁平 Mao Sen;Jiang Yuping;Han Youdong;Liu Kaihua;Yin Yue;He Xuyu;Zhao Luping(Department of Medicine Ultrasound,the Affiliated Hospital of Jining Medical University,Jining 272000,China;Department of Rheumatology and Immunology,the Affiliated Hospital of Jining Medical University,Jining 272000,China;Department of Medical Imaging,the Affiliated Hospital of Jining Medical University,Jining 272000,China)

机构地区：[1]济宁医学院附属医院超声医学科,济宁272000 [2]济宁医学院附属医院风湿免疫科,济宁272000 [3]济宁医学院附属医院医学影像科,济宁272000

出　　处：《中华风湿病学杂志》2025年第2期133-138,I0002,共7页Chinese Journal of Rheumatology

基　　金：济宁市重点研发计划项目(2023YXNS072);济宁市重点研发计划(软科学项目)(2023JNZC082);山东省医药卫生重点学科(济宁医学院附属医院)(鲁卫函[2024]50号)。

摘　　要：目的探讨压力-应变环(PSL)评价左室射血分数正常的系统性硬化病(SSc)患者左室心肌做功的应用价值。方法收集2022年1月至2024年3月期间在济宁医学院附属医院风湿免疫科就诊的30例SSc患者作为观察组,按照年龄±3岁、性别与观察组进行1∶1匹配后,选取同期30名健康志愿者作为对照组。收集临床及超声资料,应用PSL评估并比较2组间左室纵向应变(GLS)、整体做功指数(GWI)、整体有用功(GCW)、整体无用功(GWW)及整体做功效率(GWE)间的差异,将差异有统计学意义的变量经多因素logistic回归分析SSc患者早期左室功能受损的独立预测因素,并构建受试者工作特征(ROC)曲线分析GLS、GWI、GCW、GWW、GWE对SSc患者早期左室功能受损的预测价值。结果与对照组比较,观察组GLS、GWI、GCW、GWE减低(P<0.05),而GWW增大(P<0.05)。多因素logistic回归分析结果显示,GLS[OR(95%CI)=0.51(0.26,1.02),P=0.055]、GWI[OR(95%CI)=1.00(0.99,1.01),P=0.969]、GCW[OR(95%CI)=1.00(0.99,1.02),P=0.771]、GWW[OR(95%CI)=0.90(0.81,1.01),P=0.075]及GWE[OR(95%CI)=0.02(0.00,0.55),P=0.022],其中GWE对预测SSc患者左室心肌做功的显著性最高。ROC曲线表明,与GLS、GWI、GCW、GWW相比,GWE曲线下面积(0.953)最大,GWE≤94%预测SSc患者心肌损害的灵敏度为80.0%,特异度为93.3%。重复性检验结果显示观察者内及观察者间测量的重复性较好。结论压力-应变环为SSc患者早期左室收缩功能受损的定量评估提供了一种新方法,GWE可作为预测系统性硬化病患者早期左室收缩功能受损情况的敏感指标。ObjectiveTo evaluate left ventricular systolic function in patients with systemic scleroderma(SSc)with normal left ventricular ejection fraction using pressure-strain loop(PSL).MethodsTo collect 30 patients with SSc who were treated in the Rheumatology and Immunology Department of Jining Medical University from January 2022 to March 2024 as the observation group,30 healthy volunteers were selected as the control group after 1:1 matching with the observation group according to the age±3 years old and the same gender.Clinical and ultrasound data were collected,PSL was used to evaluate and compare the differences between the two groups in left ventricular longitudinal strain(GLS),global work index(GWI),global useful work(GCW),global useless work(GWW)and global work efficiency(GWE),and the statistically significant variables were analyzed by multivariate logistic regression to analyze the independent predictors of early left ventricular function impairment in patients with SSc,and constructed receiver operating characteristic(ROC)curve to analyze the predictive value of GLS,GWI,GCW,GWW and GWE in early left ventricular function impairment in SSc patients.ResultsCompared with the control group,the observation group GLS,GWI,GCW and GWE decreased(P<0.05),while the GWW increased(P<0.05).Multivariate logistic regression analysis showed that GLS[OR(95%CI)=0.51(0.26,1.02),P=0.055]、GWI[OR(95%CI)=1.00(0.99,1.01),P=0.969]、GCW[OR(95%CI)=1.00(0.99,1.02),P=0.771]、GWW[OR(95%CI)=0.90(0.81,1.01),P=0.075]and GWE[OR(95%CI)=0.02(0.00,0.55),P=0.022],in which GWE had the highest significance in predicting left ventricular myocardial work in SSc patients.ROC curve showed that compared with GLS,GWI,GCW and GWW,the area under GWE curve(0.953)was the largest,and the sensitivity of GWE≤94%to predict myocardial damage in SSc patients was 80.0%,and the specificity was 93.3%.The results of the repeatability test showed that the reproducibility of the intra-observer and inter-observer measurements was good.ConclusionThe PSL provides a ne

关 键 词：超声心动图 硬皮病 系统性 压力-应变环 应变 心肌做功 

分 类 号：R54[医药卫生—心血管疾病]