超声二维应变成像评价心肌酒精性损害后左室的旋转和扭转运动

摘要

目的：应用超声二维应变成像（2DSI）评价酒精性心肌病（ACM）对左室旋转及扭转运动的影响。方法选取40例体检健康且不饮酒男性为对照组，102例男性饮酒者据饮酒程度分为3组：A组35例，每日饮酒量>75 ml （无水乙醇），每周3～5 d，饮酒5～8年；B组39例，饮酒9～20年，其余同A组；C组28例，每日饮酒量>125 ml（无水乙醇），每周6～7 d，饮酒10年以上，饮酒量符合酒精性心肌病诊断标准。常规超声测量其左室舒张末期内径（LVDd）、左室收缩末期内径（LVDs）、舒张末期室间隔厚度（IVSTd）、舒张末期左室后壁厚度（PWTd）、左室射血分数（LVEF），脉冲多普勒测量并计算血流频谱二尖瓣口舒张早期与晚期血流速度峰值比值（E/A）；2DSI测量左室短轴二尖瓣水平、心尖水平心肌二维收缩期旋转角度及左室收缩期扭转角度峰值应变。结果 B组E/A较对照组和A组减小（P﹤0．01）。与对照组、A组及B组比较， C组LVDd、LVDs、IVSTd、PWTd、均增大，LVEF及E/A减小（均P﹤0．01）。C组左室短轴二尖瓣水平、心尖水平心肌二维收缩期旋转角度及左室收缩期峰值扭转角度较对照组、A组及B组均减低（均P﹤0．01）。结论2DSI能够对酒精性损害后左室心肌的旋转角度及左室扭转的变化进行有效评价。%Objective To evaluate alcoholic cardiomyopathy(ACM)on the left ventricular rotation and twist by two-dimensional strain imaging(2DSI). Methods Forty healthy male adults without drinking history were used as the control group, 102 male chronic alcohol abusers were divided into three groups,including group A(more than 90 g ethanol or 2 to 3 bottles (1100~1650 ml)of beer daily for 5~8 years ,3~5 days per week(n=35),group B(more than 90 g ethanol or 2 to 3 bottles (1100~1650 ml)of beer daily for 9~20 years,3~5 days per week(n=39)and group C(more than 150 g ethanol or more than 4 bottles(≥2200 ml)of beer daily or 150 g ethanol(pure alcohol)for 10 years or more,6~7 days per week(n=28),which were consistent with diagnostic criteria of alcoholic cardiomyopathy. The parameters of the conventional echocardiography and 2DSI were obtained respectively. The left ventricular end diastolic diameter(LVDd),left ventricular end systolic diameter(LVDs), interventricular septum thickness diastolic(IVSTd),left ventricular posterior wall thickness diastolic(PWTd),left ventricular ejection fraction(LVEF)and E/A were respectively measured by conventional echocardiography. The peak systolic rotation of two-dimensional strain at the levels of mitral annulus and apex of left ventricular short-axis and the peaksystolic torsion of left ventricular were measured. Results The E/A value in group B was decreased compared with control group and group A (P<0.01). The LVDd,LVDs,IVSTd,PWTd in group C were larger than those in control group and group A and B(P﹤0.01),but the LVEF and E/A value were smaller. The peak systolic rotation of two-dimensional strain at the levels of mitral annulus and apex of left ventricular short-axis and the peak systolic torsion of left ventricular were decreased compared with group A,B and control group(P<0.01). Conclusion 2DSI can effectively assess the change of left ventricular peak systolic rotation and torsion in patients with alcoholic cardiomyopathy.