二维超声斑点追踪成像在原发性高血压患者左室心肌应变及心功能评价中的应用价值

摘要

目的：探讨二维超声斑点追踪成像（2D－STI）在原发性高血压患者左室心肌应变及心功能评价中的临床应用价值。方法选择原发性高血压患者60例，根据左室心肌质量指数（LVMI）进行亚层分组，即无左室心肌肥厚患者33例（NLVH组）和左室心肌肥厚27例（LVH组）。选取同期健康体检结果正常者40例。均行常规超声及2D －STI 检查，记录左房前后径（LAD）、左室舒末内径（LVDd）、左室缩末内径（LVDs）、室间隔舒末厚度（IVSTd）、左室后壁舒末厚度（LVPWTd）、短轴缩短率（FS），计算左室心肌质量指数（LVMI）；测量二尖瓣口舒张早期血流速度（E）、二尖瓣口舒张晚期血流速度（A）和E／A值，以及二尖瓣环舒张早期运动速度（Ea）、心房收缩期峰值速度（Aa）和Ea／Aa值；分析左心室室壁收缩期纵向应变（LS）及径向应变（RS），左心室收缩期峰值应变率（SRs）、舒张早期峰值应变率（SRe）、舒张晚期峰值应变率（SRa）。结果（1）NLVH组患者LAD、IVSTd、LVPWTd、LVMI及LVM较正常对照组均显著升高（P＜0．05）；LVH组患者LAD、LVDd、LVDs、IVSTd、LVPWTd、LVMI及LVM较正常对照组、NLVH组均显著升高（P＜0．05）。（2）正常对照组、NLVH组及LVH组LVEF、FS呈递减趋势，但差异无统计学意义（P＞0．05）；A呈递增趋势，E及E／A呈递减趋势（P＜0．05）。（3）正常对照组、NLVH组及LVH组在同一水平左心室室壁收缩期LS值呈递减趋势。（4）NLVH组在同一水平左心室室壁短轴收缩期RS值均高于正常对照组及LVH组（P＜0．05），而LVH组收缩期RS值明显低于正常对照组及NLVH组（P＜0．05）。（5）与正常对照组比较，NLVH组和LVH组SRs、SRe降低，SRa升高（P＜0．05）；与NLVH组比较，LVH组SRs、SRe降低，SRa升高（P＜0．05）。结论2D－STI可早期、准确地评价原发性高血压患者左心室心肌整体及局部功能，为临床的诊治提供重要依据。%Objective To analyze the longitudinal and radial strain features of the left ventricle in patients with primary hypertension shown by two-dimensional speckle tracking imaging (2D -STI),and to evaluate the function of the left ventricle of the patients. Methods A total of 60 patients with primary hypertension were selected,and divided into non-left ventricular hypertrophy group (NLVH group,33 patients)and left ventricular hypertrophy group (LVH group,27 patients)according to the left ventricular mass in-dexes (LVMI).And 40 subjects with normal results when health examination in the same period were selected.All the subjects under-went routine ultrasonography and 2D-STI,LAD,LVDd,LVDs,IVSTd,LVPWTd,and FS were recorded,and left ventricular mass inde-xes (LVMI)was calculated;E,A,and E/A value were measured;Ea,Aa,and Ea/Aa value were measured;and LS,RS,SRs,SReand SRawere analyzed.Results (1 )The patients of the NLVH group had higher LAD,IVSTd,LVPWTd,LVMI,and LVM than the normal control group (all P<0.05);the patients of the LVH group had higher LAD,LVDd,LVDs,IVSTd,LVPWTd,LVMI,and LVMthan the other groups (all P<0.05).(2)The normal control group,NLVH group,and LVH group had decreasing LVEF and FS,but the differ-ences were statistically insignificant (P>0.05);the three groups had increasing A and decreasing E and E/A (P<0.05).(3)The normal control group,NLVH group,and LVH group had decreasing LS values of the left ventricular wall in systole period at the same levels.(4)The NLVH group had higher RS values of the minor axis of the left ventricular wall in systole period at the same levels than the other groups(both P>0.05);while the LVH group had significantly lower RS value in systole period than the other groups (P<0. 05 ).(5 )When compared with the normal control group,the NLVH group and LVH group had significantly decreased SRs and SRe and significantly increased SRa (P<0.05);and when compared with the NLVH group,the LVH group had significantly decreased SRs and SRe and significantly increased SRa (P<0.05).Conclusion 2D-STI can accurately evaluate the whole and local functions of the myocardium of left ventricle in patients with primary hypertension in early stage,and provide important foundations for clinical diagnosis and treatment.