双多普勒同步取样技术测量Tei指数联合脑钠肽r评价急性冠状动脉综合征左心功能的研究

摘要

目的 分析组织多普勒法(TDI)同步取样技术测量心肌做功指数(Tei,即TDI-Tei指数)联合N-末端脑钠肽前体(NT-proBNP)对急性冠状动脉综合征(ACS)患者左心功能测定的临床应用价值.方法 选取广西右江民族医学院附属医院于2013年8月~2016年6月期间收治的84例ACS患者作为观察组研究对象,同期选取本院40例健康受试者作为对照组,两组均采用常规经胸超声心动图和组织双多普勒同步取样技术测定其Tei指数,对比分析两组TDI-Tei指数和相关收缩指数[等容收缩时间(ICT)/射血时间(ET)],舒张指数[等容舒张时间(IRT)/ET].观察组患者入院后立即检测NT-proBNP含量,分析其TDI-Tei指数与二尖瓣口血流的A峰/二尖瓣口血流的E峰(E/A)、左室射血分数(LVEF)及NT-proBNP的相关性.结果 与对照组相比,观察组患者的TDI-Tei指数明显延长,而其相关收缩指数和舒张指数也明显增加,差异有统计学意义(P均<0.05);观察组患者的TDI-Tei指数与其NT-proBNP的对数值则呈正相关的关系(r=0.654,P<0.001),而TDI-Tei指数与其LVEF呈负相关的关系(r=-0.569,P<0.001),其LVEF与NT-proBNP的对数值呈负相关的关系(r=-0.468,P=0.001).结论 TDI-Tei可准确评价急诊ACS患者的左室整体功能,将其与NT-proBNP及LVEF具有很好的相关性,可间接反映左室功能.%Objective To analyze the clinical application value of myocardial performance index (Tei index) detected by synchronous sampling technique of tissue Doppler imaging (TDI-Tei) combining N-terminal pro-brain natriuretic peptide (NT-proBNP) for reviewing left ventricular function in patients with acute coronary syndrome (ACS).Methods ACS patients (n=84, observation group) and health controls (n=40, control group) were chosen from the Affiliated Hospital of Youjiang Medical University for Nationalities from Aug. 2013 to Jun. 2016. Tei index was detected by using transthoracic echocardiography (TTE) and synchronous sampling technique of TDI in 2 groups. TDI-Tei and relevant systolic indexes [ratio of isovolumic contraction time to ejection time (ICT/ET)] and relevant diastolic index [isometric relaxation time (IRT)/ET] were compared and analyzed in 2 groups. The content of NT-proBNP was detected immediately after admission, and correlation between TDI-Tei and ratio of peak A of mitral flow velocity (A) to peak E of mitral flow velocity (E, E/A), and between left ventricular ejection fraction (LVEF) and NT-proBNP were analyzed in observation group.Results TDI-Tei was significantly prolonged, and relevant systolic indexes and relevant diastolic index increased significantly in observation group compared with control group (allP<0.05). TDI-Tei was positively correlated to NT-proBNP (r=0.654,P<0.001), TDI-Tei was negatively correlated to LVEF (r=-0.569,P<0.001), and LVEF was negatively correlated to NT-proBNP (r= -0.468,P=0.001) in observation group. Conclusion TDI-Tei can used for reviewing the whole left ventricular function, and correlation among TDI-Tei, NT-proBNP and LVEF can indirectly reflect left ventricular function in ACS patients.