实时三维超声评价骨关节退变患者左心室重构和功能

发布时间：2018-04-22 20:17

本文选题：超声心动描计术 + 心室　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:应用实时三维超声心动图(real-time three-dimensional echocardiography,RT-3DE)评估骨关节退变患者的左心室重构和心脏功能影响,并探讨该超声技术的临床价值,以期指导临床治疗。方法:1.选取来我院就诊骨关节退变患者(研究组)125例,健康志愿者(正常对照组)115例。根据年龄分别分为两个亚组,记录患者身高、体重计算体表面积(Body surface area,BSA)和体重指数(body mass index,BMI)。2.首先采用S5-1探头,获取心室波群M型图像,并测量舒张末期室间隔厚度、左心室后壁厚度及左心室舒张末期内径、左心室容积及收缩功能。根据Devereux校正公式计算左心室质量。3.再于心尖四腔切面,应用simpson“双平面”法,再次测量左心室心内膜容积、左心室舒张末期心外膜容积(LVEDVepi)及收缩功能。计算左心室心肌质量(LVM=1.05×(LVEDVepi-LVEDV))、左心室重构指数(LVRI=LVM/LVEDV)。4.换用X5-1探头,同步连接心电图,选择全容积显像模式,采集连续4个心动周期图像,储存以备脱机分析。软件自动得出左心室容积、收缩功能及左心室质量。RT-3DE全容积采集并进行容积-时间曲线(volume-time curves,VTC)分析,计算左心室最大射血速率(peak ejection rate,PER)、左心室最大充盈速率(peak filling rate,PFR)。比较各参数在各组间及组内的差异及相关性。结果:1.(1)研究组、正常对照组年龄与LVRI相关系数分别是R2=0.711、0.568;(2)研究组、正常对照组体重指数与LVRI相关系数分别是R2=0.787、0.620;(3)病程长短与LVRI相关系数是R2=0.655。(4)研究组、正常对照组年龄与PFR相关系数分别是R2=0.79、0.749;(5)研究组、正常对照组体重指数与PFR相关系数分别是R2=0.844、0.695;(6)病程长短与PFR相关系数是R2=0.661。研究组年龄、BMI与LVRI、PFR相关性较正常对照组更好。病程长短与LVRI、PFR具有良好相关性,随着病程延长,LVRI逐渐增大,PFR逐渐减小。2.研究组LVM、LVRI明显高于同年龄段正常对照组,且差异均有统计学意义(F=14.517、4.318,P0.05)。3.研究组与正常对照组LVEDVI、LVESVI、LVEF、PER差异无统计学意义(F=2.156、2.150、2.070、1.775,P0.05)。4.经相关性分析,RT-3DE与M型超声所测得左心室重构参数的相关系数分别为:0.800(LVEDVI)、0.959(LVMI)及0.934(LVRI);RT-3DE与二维超声所测得左心室重构参数的相关系数分别为:0.837(LVEDVI)、0.970(LVMI)及0.942(LVRI),RT-3DE与二维超声的相关性优于其与M型超声的相关性。5.RT-3DE与M型超声所测得左心室重构参数LVEDVI、LVMI、LVRI差异均有统计学意义(t=15.024、3.126、11.376,P0.05)。RT-3DE与二维超声所测得左心室重构参数LVEDVI、LVMI、LVRI均有统计学差异(t=12.805、3.862、5.861,P0.05)。6.经Bland-Altman一致性检验,RT-3DE和二维超声测量LVRI的一致性较好。结论:1.骨关节退变患者年龄、体重指数、病程长短与左心室重构发生、发展密切相关。2.骨关节退变患者左心室质量和左心室重构指数增加,左心室舒张功能受损严重。3.实时三维超声心动图相对于常规二维超声提供了精确评价左心室形态的条件,评价左心室重构和功能具有更高的准确性和重复性。4.实时三维超声心动图测量的LVRI、LVEF、PER、PFR能综合评价骨关节炎病人左心室重构、收缩功能与舒张功能,积极治疗,提高患者生存率和生存质量。
[Abstract]:Objective: To evaluate the effects of real-time three-dimensional echocardiography (RT-3DE) on left ventricular remodeling and cardiac function in patients with osteoarticular degeneration, and to explore the clinical value of the ultrasound technique in order to guide the clinical treatment. Method: 1. to select 125 cases of patients with osteoarticular degeneration (Study Group) in our hospital. 115 cases of Kang volunteers (normal control group) were divided into two subgroups. The height of the patient was recorded, the body surface area (Body surface area, BSA) and the body mass index (body mass index, BMI).2. first used S5-1 probes to obtain the M image of ventricular wave group, and the thickness of the ventricular septum, the left ventricular posterior wall thickness and the left heart were measured. The internal diameter, left ventricular volume and systolic function at the end of Shi Shuzhang. The left ventricular mass.3. was calculated by the Devereux correction formula and the four cavity of the apical cavity. The left ventricular endocardium volume, the left ventricular epicardial volume (LVEDVepi) and the systolic function were measured again with the Simpson "double plane" method. The left ventricular mass (LVM=1.05 * (L) was calculated (L). VEDVepi-LVEDV), the left ventricular remodeling index (LVRI=LVM/LVEDV).4. was replaced by a X5-1 probe, synchronized electrocardiogram, and full volume imaging mode was selected, 4 consecutive cardiac cycle images were collected and stored for offline analysis. The software automatically acquired left ventricular volume, systolic function and left ventricular mass.RT-3DE full volume collection and volume time curve (V). Olume-time curves, VTC) analysis, calculated the maximum ejection rate of the left ventricle (peak ejection rate, PER), the maximum filling rate of the left ventricle (peak filling rate, PFR). Compare the differences and correlation between the various parameters and the groups. Results: 1. (1) study group, normal exposure group age and LVRI correlation coefficient are respectively; (2) research group, positive The correlation coefficient of body mass index and LVRI in the control group was R2=0.787,0.620, respectively. (3) the correlation coefficient between the course length and the LVRI was R2=0.655. (4), the correlation coefficient of age and PFR in the normal control group was R2=0.79,0.749, respectively. (5) the study group, the body mass index and PFR correlation coefficient of the normal control group were R2=0.844,0.695, (6) the duration of the disease was associated with PFR. The coefficient is R2=0.661. study group age, BMI and LVRI, PFR correlation is better than normal control group. The course length and LVRI, PFR have good correlation. As the course lengthened, LVRI gradually increased, PFR gradually reduced.2. study group LVM, LVRI obviously higher than the same age normal control group, and the difference was statistically significant (F=14.517,4.318 There was no statistically significant difference in LVEDVI, LVESVI, LVEF and PER (F=2.156,2.150,2.070,1.775, P0.05).4. by correlation analysis. The correlation coefficients of the left ventricular remodeling parameters measured by RT-3DE and M type ultrasound were 0.800 (LVEDVI), 0.959 (LVMI) and 0.934 (LVRI), respectively. The correlation of the parameters of left ventricular remodeling measured by two-dimensional ultrasound The numbers were as follows: 0.837 (LVEDVI), 0.970 (LVMI) and 0.942 (LVRI). The correlation between RT-3DE and two-dimensional ultrasound was superior to that of the M type ultrasound. The left ventricular remodeling parameters were measured by.5.RT-3DE and M, and the differences in LVMI and LVRI were statistically significant (t= 15.024,3.126,11.376,) and the parameters of left ventricular remodeling measured by two-dimensional ultrasound DVI, LVMI, LVRI were statistically different (t=12.805,3.862,5.861, P0.05).6. was tested by Bland-Altman consistency. The consistency of LVRI measured by RT-3DE and two-dimensional ultrasound was better. Conclusion: 1. the age, body mass index, course length and left ventricular remodeling in patients with osteoarticular degeneration are closely related to the left ventricular mass and left heart of the patients with.2. bone and joint degeneration. The ventricular remodeling index was increased and the left ventricular diastolic function was severely damaged..3. real-time three-dimensional echocardiography provides a precise evaluation of the left ventricular shape relative to conventional two-dimensional ultrasound. The evaluation of left ventricular remodeling and function with higher accuracy and repetitive.4. real-time three-dimensional echocardiography measurement of LVRI, LVEF, PER, and PFR can be used to evaluate the bone in a comprehensive way. Arthritis patients with left ventricular remodeling, systolic function and diastolic function, are actively treated to improve their survival and quality of life.

【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R540.45;R684

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