超声二维应变成像评价早期酒精性心肌病患者左心室心肌周向收缩功能

摘要

目的 应用超声二维应变成像(2DSI)评价早期酒精性心肌病(ACM)患者左心室心肌周向收缩功能的价值.方法 选取男性饮酒者86例[A组:31例,每日饮啤酒2～3瓶(1100～1650ml)或白酒≥90 g(相当于纯乙醇75ml),每周3～5日,时间5～8年;B组:34例,饮酒量同A组,每周3～5日,时间9～20年;C组:21例,每日饮啤酒≥4瓶(2200 ml)或白酒≥150 g(相当于纯乙醇125 ml),每周6～7日,时间10年以上,符合ACM诊断标准].另选正常志愿者40名(D组)纳入研究.对4组进行常规超声和2DSI检查,并测定左心室舒张末期内径(LYD<,d>)、收缩末期内径(LVD<,s>)、舒张末期室间隔厚度(IVST<,d>)、舒张末期左心室后壁厚度(PWT<,d>)、左心室射血分数(LVEF)和E/A比值.结果 A组与D组间各常规超声参数差异无统计学意义(P>0.05);B组舒张功能参数E/A与D组及A组比较差异有统计学意义(P<0.01),余各常规超声参数差异均无统计学意义(P>0.05),C组各常规超声参数与D组、A组和B组间差异有统计学意义(P<0.01).左心室短轴心肌二维周向收缩期峰值应变各组间比较:A组与D组间差异无统计学意义(P>0.05);B组与D、A组比较,C组与D、A、B组比较,所有节段心肌收缩期峰值应变明显减低(P<0.05).结论 2DSI技术能有效评估酒精性心肌病左心室心肌周向收缩功能的改变,准确评价早期酒精性心肌病患者左心室心肌周向收缩功能.%Objective To observe the left ventricular circumferential systolic function of patients with early alcoholic cardiomyopathy (ACM) with two-dimensional strain imaging (2DSI). Methods Eighty-six male drinkers were divided into 3 groups: Group A (n=31) consumed 390 ≥90g ethanol or 2 to 3 bottles (1100-1650 ml) beer daily for 5 to 8 years, 3 to 5 days per week; group B (n=34) consumed ≥90 g ethanol or 2 to 3 bottles (1100--1650 mi) beer daily for 9 to 20 years,3 to 5 days per week; group C (n=21) consumed 3150≥150 g ethanol or ≥4 bottles (2200 ml) beer daily for more than 10 years, 6 to 7 days per week, consistent with diagnostic criteria of alcoholic cardiomyopathy (ACM). Forty healthy volunteers were enrolled to group D. The parameters of conventional echocardiography and 2DSI were obtained, including left ventricular end diastolic diameter (LVDd), left ventricular end systolic diameter (LVDs), interventricular septum thickness at end-diastole (IVSTd), posterior wall thickness at end-diastole (PWTd), left ventricular ejection fraction (LVEF) and E/A. Results ①The conventional echocardiographic parameters were not statistically different between group A and D (P　＞0. 05). Compared with those of group A and D, no statistical different was found in group B except E/A (P＜0. 01).There were significantly differences of conventional echocardiographic parameters in group C compared to group A, B and D　(P＜0. 05). ②Circumferential two-dimensional peak systolic strain of left ventricular short-axis in group A and D were not　significantly different (P＞0.05). Peak systolic strains in all sections of group B were lower than those in group A and D,and in group C were lower than in group D, A and B (P＜0. 05). Conclusion 2DSI can effectively assess the changes of　left ventricular circumferential systolic function of alcohol-induced myocardial damage, accurately evaluate the impact of alcohol-induced early myocardial damage to left ventricular circumferential systolic function.