不同心功能状态下特发性肺动脉高压患者心室同步性的超声研究

摘要

目的：初步分析不同心功能状态下特发性肺动脉高压（IPAH）患者的心室间同步性变化特点。　　方法：2010-10至2014-12期间我院住院的IPAH患者40例为IPAH组，并同期选择相匹配的23例健康受试者为正常对照组。采用超声组织多普勒技术比较两组心室的舒张期和收缩期达峰时间（Te和Ts），左右心室、室间隔之间的达峰时间差，心室间的舒张和收缩期达峰时间差（Te-Ts）。　　结果：IPAH组不同心功能级别患者的右心室收缩期和舒张期达峰时间均长于左心室和室间隔处（P<0.05）。与正常对照组相比，IPAH组的心功能减低，左心室与室间隔的收缩期和舒张期达峰时间与对照组比较差异有统计学意义（P<0.05），其收缩期达峰时间有延长趋势；但舒张期达峰时间逐渐缩短，对于右心室舒张期达峰时间延长后又相对缩短。IPAH组患者世界卫生组织（WHO）心功能Ⅳ级患者左心室收缩期达峰时间长于Ⅱ，Ⅲ级，Ⅳ级患者左右心室和室间隔舒张达峰时间短于Ⅱ，Ⅲ级患者，差异有统计学意义（P<0.05）。IPAH组患者的右心室-室间隔间和右心室-左心室间舒张期达峰差值与正常对照组比较差异均有统计学意义（P<0.05）；左心室-室间隔间舒张期达峰差值IPAH组Ⅳ级与正常对照组比较差异有统计学意义（P<0.05），其中IPAHⅣ级与正常对照组差异最大。IPAH组不同心功能分级患者与正常对照组相比，左心室和室间隔处的Te-Ts逐渐缩短，并且Ⅱ级＞Ⅲ级＞Ⅳ级，差异有统计学意义。　　结论：不同心功能的IPAH患者心室间的收缩和舒张均可能产生不同步，随着心功能的减低，心室间Te-Ts可能表现为特异性的缩短。% Objective:To preliminarily study the characteristics of ventricular synchronicity in patients of idiopathic pulmonary arterial hypertension (IPAH) with different heart function. Methods:Our research included in 2 groups:IPAH group, n=40 patients intermittently collected in our hospital from 2010-10 to 2014-12 and Control group, n=23 normal subjects from the same period of time. Tissue Doppler echocardiography was conducted to compare interventricular systolic and diastolic time to peak (Ts and Te), their differences (Te-Ts) and (Te-Ts) of left ventricle (LV), right ventricle (RV), interventricular septum (IVS) between 2 groups. Results:Ts and Te of RV were longer than Ts and Te of LV and IVS in both groups, P<0.05. Compared with Control group, by heart function reducing, IPAH group showed different Ts and Te of LV and IVS, P<0.05 and Ts was gradually prolonged, Te was gradually shorter;while Te of RV became longer firs tand then became shorter thereafter. In IPAH group, the patients with heart function grade IV had the longer Ts of LV and IVS than those with heart functionII, III;the patients with heart function IV had the shorter Te of LV, RV and IVS than those with heart function II, III, all P<0.05. In IPAH group with different heart function, Te between RV-IVS and RV-LV were different from Control group, all P<0.05;Te between LV-IVS in heart function IV patients had the largest difference from Control group, P<0.05. Compared with Control group, IPAH group had gradually decreased Te-Ts of LV and IVS by heart function reducing asgrade II>III>IV, all differences had statistic meaning. Conclusion:IPAH patients with different right heart function may have interventricular systolic and diastolic de-synchronicity;by reduced heart function, interventricular Te-Ts could be specifically shortened.