速度向量成像技术评价重型地中海贫血患儿左心室收缩功能损害的研究

发布时间：2018-04-16 02:28

本文选题：速度向量成像 + 重型地中海贫血　；参考：《南昌大学》2012年硕士论文

【摘要】：目的：应用速度向量成像（velocity vector imaging,VVI）技术分析正常儿童左心室收缩功能测值特点，评价重型地中海贫血患儿左心室收缩功能的异常改变。方法：对40例正常儿童及80例地中海贫血患儿行常规超声心动图检查。患儿按照血清铁蛋白（serum ferritin, SF）水平分为A、B两组：A组SF＜2500μg/L，40例；B组SF≥2500μg/L，40例。用VVI软件分别测量：1、左室各节段内、外膜心肌纵向收缩期峰值速度（longitudinal velocity，LV）、位移（longitudinaldisplacement，LD）、应变（longitudinal strain，LS）及应变率（longitudinal strainrate，LSR）；2、左室各水平内、外膜心肌径向收缩期峰值速度（radial velocity，RV）、位移（radial displacement，RD）、应变（radial strain，RS）及应变率（radialstrain rate， RSR）；3、左室各水平内、外膜心肌圆周向收缩期峰值应变（circumferential strain，CS）、应变率（circumferential strain rate，CSR）。结果： 1、正常组不同方向VVI测值存在一定规律： ①纵向测值中，左室内、外膜收缩期峰值速度、位移、应变及应变率各参数都以基底段最高，中间段次之，心尖段最低，即基底段＞中间段＞心尖段；其中各节段LV、LD的差异较各节段LS、LSR的差异大。 ②径向测值中，左室内、外膜收缩期峰值速度、位移、应变及应变率各参数都以中间水平最高，基底水平次之、心尖水平最低，即中间水平＞基底水平＞心尖水平；其中各水平RS、RSR的差异较各水平RV、RD的差异大。 ③圆周向测值中，左室内、外膜收缩期峰值应变、应变率各参数都以心尖水平最高，中间水平次之，基底水平最低，即心尖水平＞中间水平＞基底水平；其中内膜各水平CS、CSR的差异较外膜各水平CS、CSR的差异大。 2、正常组三个方向的整体VVI测值中，外膜测值均较内膜低，差异有统计学意义（P＜0.05）。 3、与正常组比较，地中海贫血A组、B组各常规超声心动图参数及左心室心肌重量均无显著性差异（P＞0.05）。 4、与正常组比较，地中海贫血A组、B组的纵向、径向及圆周向VVI测值均出现异常变化：①地中海贫血患儿B组纵向大部分节段和整体VVI参数、圆周向大部分水平和整体VVI参数减低，而径向各水平和整体VVI参数增高，与正常组差异有统计学意义（P＜0.05）；A组部分节段和整体LSR减低，部分水平和整体CS、CSR减低，部分水平和整体RS、RSR增高，与正常组差异有统计学意义（P＜0.05）。 ②地中海贫血患儿B组节段、水平和整体VVI测值与正常组间差异（P＜0.01）较A组节段、水平和整体VVI测值与正常组间差异（P＜0.05）大，A、B两组间部分节段、水平和整体VVI测值差异有统计学意义（P＜0.05）。 ③地中海贫血患儿A组的纵向VVI参数以基底段减低明显，圆周向VVI参数以心尖水平减低明显。 ④地中海贫血患儿B组部分节段、水平和整体LSR和CSR与正常组间差异（P＜0.01）较其余VVI参数与正常组间差异（P＜0.05）大。 ⑤地中海贫血患儿组（主要为B组）心内膜和外膜VVI测值均出现异常变化，其中内膜各节段和整体LSR与正常组间的差异（P＜0.01）较外膜各节段和整体LSR与正常组间的差异（P＜0.05）大。结论： 1、正常儿童左室纵向、径向和圆周向VVI参数在不同节段、不同水平上存在一定规律，，即纵向：基底段＞中间段＞心尖段，径向：中间水平＞基底水平＞心尖水平，圆周向：心尖水平＞中间水平＞基底水平。正常儿童三个方向的整体VVI内膜测值均＞外膜。 2、VVI技术能无创、较准确的评估地中海贫血患儿心脏三个方向（纵向、径向、圆周向）的收缩期运动，并能发现常规超声不能检出的重型地中海贫血患儿心脏收缩期运动异常： ①射血分数正常的地中海贫血患儿左室收缩功能处于亚临床性降低阶段。 ②SF水平较高组的地中海贫血患儿心肌功能受损较严重。 ③地中海贫血患儿心肌运动力量较大的部位收缩功能受损较早。 ④地中海贫血患儿VVI参数中，应变率指标较速度、位移和应变指标更敏感的反映心肌收缩功能的异常改变。 ⑤地中海贫血患儿内膜和外膜心肌均受到损害，其中内膜心肌损害较外膜心肌严重。
[Abstract]:Objective:
The velocity vector imaging (VVI) technique was applied to analyze the characteristics of left ventricular systolic function in normal children, and to evaluate the abnormal changes of left ventricular systolic function in children with severe thalassemia.
Method:
In 40 normal children and 80 cases of thalassemia children underwent routine echocardiography. The patients according to serum ferritin (serum ferritin, SF A) were divided into two groups: A group, B SF < 2500 g/L, 40 cases; group B SF = 2500 g/L, 40 cases were measured by VVI. Software: 1 left ventricular segments in the adventitia, myocardial longitudinal systolic peak velocity (longitudinal, velocity, LV) (longitudinaldisplacement, LD), displacement, strain (longitudinal strain LS) and strain rate (longitudinal strainrate, LSR); 2, the level of left ventricular myocardial membrane, radial peak systolic velocity (radial velocity, RV (radial), displacement, RD displacement strain (radial), strain, RS) and strain rate (radialstrain rate, RSR); 3, the level of left ventricular myocardial membrane, circumferential peak systolic strain (circumferential strain, CS), strain rate (circumferential strain rate, CSR).
Result:
1, there are certain rules in the VVI values of the normal groups in different directions:
(1) in the longitudinal measurement, the parameters of peak systolic velocity, displacement, strain and strain rate in the left ventricle and outer membrane were the highest in the basal segment, the second in the middle segment, and the lowest in the apical segment, that is, the basal segment > the middle segment > the apical segment. The difference of LV and LD in each segment was different from that in each segment LS and LSR.
The radial measurements in the left ventricular peak systolic velocity, membrane displacement, strain and strain rate parameters are in the middle of the highest level, basal level of apical level minimum, intermediate level > > the basal level of apical level; the level of RS, RSR was the level of RV, RD big difference.
The circumference measurements in the left ventricle, epicardial systolic peak strain and strain rate parameters in apical level is the highest, the middle level of the basal level of the lowest, namely, intermediate level, apical basal level; the level of CS CSR in the endometrium, the difference is the level of membrane CS, CSR difference.
2, in the total VVI measurements of the three directions of the normal group, the outer membrane values were lower than that of the endometrium, and the difference was statistically significant (P < 0.05).
3, compared with the normal group, there was no significant difference between the conventional echocardiographic parameters and the left ventricular myocardial weight in group A of thalassemia and group B (P > 0.05).
4, compared with the normal group, Mediterranean anemia group A, B group of radial and longitudinal, circumferential VVI values appeared abnormal changes of patients with thalassemia group B longitudinal most of the segments and the overall VVI parameters, circumferential most level and the overall parameters of VVI decreased, while the radial and the overall level of VVI parameters increased. There was statistical significance compared with the normal control group (P < 0.05); group A segment and the overall LSR decreased, and the overall level of part CS, part of the reduced CSR and the overall level of RS, RSR increased, with significant differences between the normal group (P < 0.05).
(2) there was a significant difference between the B level of the thalassemia group and the normal group (P < 0.01) compared with the normal group (A < 0.05). There was a significant difference between the A group and the normal group (P < 0.05). There was a statistically significant difference between the two segments of A and B between the two groups (P < 0.05).
(3) the longitudinal VVI parameters of group A in children with thalassemia were decreased obviously in the basal segment, and the circumference to the VVI parameters decreased significantly with the apical level.
(4) partial segment of B group in children with thalassemia, the difference between the level and the overall LSR and the overall CSR and the normal group (P < 0.01) was larger than the other VVI parameters and the normal group (P < 0.05).
(5) the VVI values of the endocardium and the outer membrane of the thalassemia children group (mainly B group) all showed abnormal changes. The difference between the intimal segments and the whole LSR and the normal group (P < 0.01) was larger than that of the outer membrane segments and the whole LSR group (P < 0.05).
1 normal children, left ventricular longitudinal, radial and circumferential VVI parameters in different segments, there are certain rules, different levels of vertical basal segment middle segment > >: apical, middle level radial: basal level > > apex level circumference: apical level > > middle level of basal level of three normal children. The direction of the overall VVI values were greater than intima adventitia.
2, VVI technology can evaluate the systolic motion of three directions (longitudinal, radial and circumferential) of the heart of thalassemia in a noninvasive and accurate way. It can also find abnormal systolic dyskinesia in children with severe thalassemia which can not be detected by conventional ultrasound.
(1) left ventricular systolic function in children with normal ejection fraction in thalassemia is in a subclinical stage.
The myocardial dysfunction in children with thalassemia in the higher SF level group was more severe.
In children with thalassemia, the systolic function of the parts of the myocardium with greater movement strength is impaired earlier.
(4) in the VVI parameters of thalassemia, the index of strain rate is more sensitive than the speed, displacement and strain index, which reflects the abnormal changes of myocardial contractile function.
The intimal and epicardial myocardium of children with thalassemia were damaged, and the damage of intima myocardium was more serious than that of the outer membrane.

【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R445.1;R725.5

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