二维斑点追踪技术评价类风湿性关节炎患者心室收缩功能

摘要

Objective To evaluate the left ventricular and right ventricular systolic function by two‐dimensional speckle tracking echocardiography ( 2D‐STE) in patients with rheumatoid arthritis ( RA ) . Methods Fifty five patients with RA and 50 healthy subjects were received echocardiography . 2D‐STE were applied for all the subjects to obtain left ventricular global longitudinal strain ( LVGLS) and right ventricular global longitudinal strain ( RVGLS) .Tricuspid annular plane systolic excursion ( TAPSE) and the change ratio of right ventricular area ( RVACR) were measured by echocardiography . The anti‐cyclic citrullinated peptide antibodies ( anti‐CCP‐II) ,rheumatoid factor ( RF) ,C‐reactive protein ( CRP) and erythrocyte sedimentation rate ( ESR) were detected in both group . The LVGLS and RVGLS in RA group were used to conduce correlation analysis with the level of anti‐CCP‐II ,RF ,CRP , ESR and the duration of disease . Results There was a significant decrease in RVGLS and LVGLS in RA group compared with control group( P <0 .05) . However there was no statistical differenc in TAPSE and RVACR between RA and control group( P > 0 .05) . The anti‐CCP‐II ,RF ,CRP and ESR in RA group increased significantly compared with control group ( P < 0 .001 ) . The result of correlation analysis showed there was no correlation between RVGLS ,LVGLS and anti‐CCP‐II ,RF ,CRP ,ESR in RA group . However ,RVGLS and LVGLS were negatively correlated with the duration of disease . Conclusions LVGLS and RVGLS in RA patients were lower than those in healthy people ,strain decreases with the extension of disease duration ,2D‐STE may be an efficacious assessment to assess left ventricular and right ventricular systolic function in patients w ith RA .%目的：应用超声二维斑点追踪显像（two‐dimensional speckle tracking echocardiography ，2D‐STE）技术评价类风湿性关节炎（rheumatoid arthritis ，RA）患者心室收缩功能。方法55例RA患者（RA组）和50例健康者（对照组）行超声心动图检查，应用2D‐S T E获取左室整体纵向应变（lef t ventricular global longitudinal strain ，LVGLS）及右室整体纵向应变（right ventricular global longitudinal strain ，RVGLS），超声测量三尖瓣环位移（tricuspid annular plane systolic excursion ， TAPSE）及右室面积变化率（change ratio of right ventricular area ， RVACR）。检测两组患者抗环瓜氨酸肽（anti‐cyclic citrullinated peptide antibodies ，抗‐CCP‐II）抗体、类风湿因子（rheumatoid factor ， RF）、C反应蛋白（C‐reactive protein ，CRP）水平及红细胞沉降率（erythrocyte sedimentation rate ， ESR）。将RA患者的LVGLS和RVGLS分别与抗‐CCP‐II抗体、 RF、CRP、 ESR 及病程进行相关性分析。结果 RA 组LVGLS和RVGLS均较对照组减低，差异有统计学意义（ P ＜0.05）。TAPSE与RVACR在两组间比较差异均无统计学意义（ P ＞0.05）。RA患者血清中抗‐CCP‐II抗体、RF、CRP水平及ESR均较对照组升高，差异有统计学意义（ P ＜0.001）。相关性分析结果表明， RA患者的LVGLS和RVGLS与抗‐CCP‐II抗体、RF、CRP水平及ESR均无明显相关性，而与病程长短呈负相关。结论 RA患者左心室和右心室整体纵向应变值较健康人低，应变值随病程延长而减小，2D‐S T E技术可以用于评估RA患者左室及右室收缩功能。