三维斑点追踪成像技术对类风湿关节炎患者左室收缩功能的评价
发布时间：2018-01-15 07:18
本文关键词：三维斑点追踪成像技术对类风湿关节炎患者左室收缩功能的评价 出处：《郑州大学》2017年硕士论文 论文类型：学位论文
更多相关文章： 三维斑点追踪成像 类风湿关节炎 左室收缩功能 应变 扭转
【摘要】：背景与目的心血管疾病在类风湿性关节炎(rheumatoid arthritis,RA)患者中发生的风险增高,并且是导致RA患者死亡的主要因素之一。因此,RA患者亚临床心脏受累情况的评估及诊断对于疾病的长期管理有重要作用。三维斑点追踪成像(Three-dimensional speckle tracking imaging,3D-STI)技术实现了对左室心肌应变、旋转及扭转进行无创、可靠的评价。本研究通过应用3D-STI技术分析RA患者左室心肌应变、旋转及扭转参数评价其左室收缩功能,探讨该技术对RA患者左室收缩功能异常的检测价值。方法该研究选取RA患者74例,并根据病程将RA患者分为两组:36例病程5年者为RA1组,38例病程5年者为RA2组。所有受检者分别行经胸常规二维超声心动图获取二维数据。采集左室三维全容积动态图像并运用3D-STI分析软件进行分析,剔除图像质量差及临床资料不合格的病人,获取三维参数:(1)左室心肌16节段纵向峰值应变(PLS)、圆周峰值应变(PCS)、径向峰值应变(PRS)及面积峰值应变(PAS);(2)左室整体纵向峰值应变(GLS)、整体圆周峰值应变(GCS)、整体径向峰值应变(GRS)及整体面积峰值应变(GAS),左室整体旋转角度峰值(LVrot)、整体扭转角度峰值(LVtw)、整体径向位移(Dr)、整体纵向位移(Dl)、整体三维位移(D3d)。并与年龄、性别相匹配的30例健康体检者(对照组)进行上述参数的组间比较。绘制ROC曲线分析3D-STI检测出RA患者左室收缩功能异常的准确性。结果1.随着RA病程的延长,左室心肌各节段收缩功能均可受损,表现为各节段应变减低。与对照组相比较,RA1组及RA2组各节段PLS、PCS、PRS、PAS均减低,但RA1组仅个别节段的PLS(5个节段)、PCS(4个节段)、PRS(1个节段)、PAS(4个节段)差异有统计学意义(P0.05);RA2组绝大多数节段PLS(15个节段)、PCS(14个节段)、PRS(12个节段)、PAS(16个节段)差异有统计学意义(P0.05)。与RA1组相比较,RA2组各节段PLS、PCS、PRS及PAS减低,大部分节段差异有统计学意义(P0.05)。2.RA1组左室GLS、GCS、GRS及GAS低于对照组,但差异无统计学意义(P0.05);RA2组左室GLS、GCS、GRS及GAS较对照组均减低,差异均有统计学意义(P0.05),与RA1组相比,GAS和GLS减低,差异有统计学意义(P0.05)。3.RA1组LVrot、LVtw、Dr、Dl、D3d与对照组相比无明显差异(P0.05);在RA2组中,LVrot、LVtw、Dr、Dl、D3d较对照组明显增高,差异有统计学意义(P0.05);Dr较RA1组增加,差异有统计学意义(P0.05)。LVtw与Dr(r=0.72)、Dl(r=0.63)及D3d(r=0.76)相关性较好。4.3D-STI整体应变参数GLS、GCS、GRS及GAS的ROC曲线下面积分别为0.81、0.67、0.65、0.86,其中GAS对于检测RA患者左室收缩功能异常的效能高于GLS、GCS、GRS。Pearson相关分析表明GLS(r=0.80)、GCS(r=0.68)、GRS(r=-0.66)及GAS(r=0.84)与RA患者的病程有良好的相关性。结论RA患者随着病程的延长,左室心肌收缩功能受损,3D-STI技术通过评估左室心肌应变、旋转及扭转等参数,能早期准确地检测出RA患者左室收缩功能的异常,对评估亚临床心脏受累情况有重要的作用。面积应变作为3D-STI技术的新参数,能更准确地评价左室收缩功能。
[Abstract]:Background and objective cardiovascular disease in rheumatoid arthritis (rheumatoid arthritis, RA) in higher risk patients, and is one of the main causes of death in patients with RA. Therefore, the evaluation and diagnosis of RA patients with subclinical cardiac involvement and plays an important role in long-term tube disease. Imaging three-dimensional speckle tracking (Three-dimensional speckle tracking imaging, 3D-STI) technology to achieve the left ventricular myocardium strain, rotation and torsion of noninvasive, reliable evaluation. This study through the application of 3D-STI technology to analyze myocardial strain in patients with left ventricular RA, rotation and torsion parameters to evaluate the left ventricular systolic function, to explore the value of the detection technology for abnormal left ventricular systolic function in RA patients. Methods 74 RA patients were selected in the study, and according to the course of RA patients were divided into two groups: 36 cases of 5 years duration for the RA1 group, 38 cases of 5 years duration for the RA2 group. All subjects were divided Don't transthoracic two dimensional echocardiography to obtain two-dimensional data acquisition. The left ventricular dynamic three-dimensional full volume image and use 3D-STI software to analyze and eliminate poor image quality and clinical data of patients with unqualified, to obtain the 3D parameters: (1) longitudinal peak left ventricular segmental strain 16 (PLS), circumferentialpeak strain (PCS), peak radial strain (PRS) and peak area strain (PAS); (2) the left ventricular longitudinal peak strain (GLS), the overall peak circumferential strain (GCS), global radial peak strain (GRS) and the whole area of the peak strain (GAS), left ventricular rotation angle peak (LVrot), the overall peak twist (LVtw), radial displacement integral (Dr), the vertical displacement of the overall (Dl), the overall three-dimensional displacement (D3d). And 30 healthy age, gender matched (control group) were compared between the groups. Analysis of the parameters detected by 3D-STI in patients with RA left ventricular ROC curve 鏀剁缉鍔熻兘寮傚父鐨勫噯纭，
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