二维斑点追踪技术评价代谢综合征患者左心房重构及功能变化  

Evaluation of the Left Atrial Remodeling and Function Variation in Patients with Metabolic Syndrome by Two-Dimensional Speckle Tracking Imaging

作　　者：徐艳萍[1] 王雪艳 李奔[3] 贾梅[1] 纳丽莎[1] 贾武梅[4] 杨锐英[5] 

机构地区：[1]宁夏医科大学总医院心脏中心功能检查部,银川750004 [2]宁夏固原市原州区人民医院,固原756000 [3]宁夏医科大学总医院心脑血管病医院心内科,银川750002 [4]银川市第一人民医院,银川750001 [5]宁夏医科大学总医院心脏中心内科干部病房,银川750004

出　　处：《宁夏医科大学学报》2016年第11期-,共6页Journal of Ningxia Medical University

摘　　要：目的探讨二维斑点追踪技术(2D-STI)定量评价代谢综合征(MS)患者左心房(LA)重构及功能改变的临床价值。方法选择明确诊断的MS患者、MS并高血压患者(HMS)、健康对照组各30例,常规超声测量LA前后径(LAAPD)、LA上下径(LAUDD)、LA左右径(LALRD)、室间隔厚度(IVST),左室后壁厚度(LVPWT),左室舒张末期内径(LVDd)、左室收缩末期内径(LVDs)、左室射血分数(LVEF)、二尖瓣口舒张早期最大血流速度(E)、舒张晚期最大血流速度(A)、E峰减速时间(Dct)、计算E/A,二尖瓣前叶瓣环舒张早期峰值速度(e),计算E/e;测量LA最大容积(LAVmax)、LA最小容积(LAVmin)、LA收缩前容积(LAVpre)。2D-STI测量LA6个壁3个节段共18段的纵向应变峰值(LS)、应变达峰时间(TLS),计算LA整体纵向峰值应变(PALS)和LA整体纵向应变达峰时间(TPLS),对上述测量结果进行统计学分析。结果与对照组比较,MS组、HMS组LAAPD、LAUDD、LALRD、IVSd、LVPWd增大(P<0.01),LVDd、LVDs、LVEF差异无统计学意义(P>0.05);与MS组比较,HMS组LAAPD、IVSd、LVPWd增大(P<0.01);与对照组比较,MS组e减低(P<0.01)、A增加(P<0.05),HMS组A、E/e增加,E/A、e、Dct减低(P<0.01或<0.05);与对照组比较,MS组及HMS组LAVmax、LAVmin、LAVpre、LAV、LAVI增大,PALS减低(P<0.01),PALS在HMS组与MS组间差异无统计学意义(P>0.05);三组间的TPLS差异无统计学意义(P>0.05);PALS与LAVmax、LAVmin、LAVpre、LAV、LAVI均呈负相关(P<0.05)。结论 MS患者LA增大,左室舒张功能减低,LA储存器功能减低,2D-STI可用于评价MS患者LA重构及功能的改变。Objective To explore the clinical value of two-dimensional speckle tracking imaging(2D-STI)in quantitatively assessing the left atrial remodeling and function variation in patients with Metabolic Syndrome.Methods 30 cases with MS(the MS group),30 cases with hypertension and MS(the HMS group)and 30 healthy subjects(the control group) were enrolled. LA antero-posterior diameter(LAAPD),LA up-down diameter(LAUDD),LA left-right diameter(LALRD),interventricular septum thickness(IVST),left ventricular posterior wall thickness(LVPWT),Left ventricular end diastolic diameter(LVEDd),left ventricular end systolic diameter(LVESd)were measured and left ventricular ejection fraction(LVEF)were calculated in the three groups. Early diastolic mitral flow(E)and Late diastolic mitral flow(A)and E/Aratio,E-wave deceleration time(Dct)were determined and E/a,E/e were calculated. left atrial maximum volume(LAVmax),left atrial minimum volume(LAVmin)left atrial pre-systolic volume(LAVpre). 18 segmentals longitudinal peak strain(LS)and time to longitudinal peak strain(TLS)of left atrial were performed using 2D-STI,and global left atrial longitudinal peak strain(PALS),global time to left atrial longitudinal peak strain(TPLS)were averaged over 18 segmens.Results Compared with the control group,LAAPD,LAUDD,LALRD,IVSd,LVPWd increased significantly(P<0.01)in the MS and HMS group while LVDd,LVDs,LVEF showed significantly different(P>0.05)among groups. Compared with the MS group,LAAPD,IVST,LVPWT increased significantly(P<0.01) in the HMS group. Compared with the control group,e reduced(P<0.01)and A increased significantly(P<0.05)in the MS Group While A,E/e increased and E/A,e,Dct reduced(P<0.01 or <0.05)in the HMS group and LAVmax,LAVmin,LAVpre,LAV and LAVI increased in the MS Group and HMS group(P<0.01),PALS reduced(P<0.01). The PALS with LAVmax,LAVmin,LAVpre,LAV,LAVI all showed negative correlation(P<0.05). Conclusion 2D-STI can be used to evaluate LA remodeling and LA function in the MS patients.

关 键 词：左心房 代谢综合征 高血压 二维斑点追踪成像 重构 纵向应变 

分 类 号：R445.1[医药卫生—影像医学与核医学]