不同构型原发性高血压患者左心室心肌收缩功能研究

发布时间：2018-03-14 09:40

本文选题：高血压　切入点：心室构型　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:利用斑点追踪成像技术评价不同左心室构型原发性高血压患者左心室心肌纵向、径向及圆周运动改变,并探讨其临床意义。方法:按照2005年中国高血压防治指南修订委员会制定的高血压诊断及分级标准,选取在2015年11月至2016年3月期间在我院就诊的原发性高血压患者150例。根据左心室质量指数和相对室壁厚度,将其分为3组:左心室构型正常组55例,左心室向心性肥厚组53例,左心室离心性肥厚组42例。选取年龄、性别、体重相匹配的50例健康志愿者作为对照组。采用Philips IE elite彩色多普勒超声诊断仪,QLAB 9.0工作站中的CMQ插件脱机分析。对上述病例组和对照组进行超声心动图检查,常规测量心脏舒张末期左心室内径、舒张末期室间隔心肌厚度、左心室后壁心肌厚度,应用双平面Simpsons法测量左室射血分数。在心尖四腔心切面、心尖二腔心切面、左心室长轴切面及胸骨旁左心室短轴切面采集二维灰介动态图像。利用斑点追踪成像技术在心尖四腔心切面、心尖二腔心切面测量左心室纵向应变、应变率;在胸骨旁左心室短轴切面测量左心室圆周、径向应变、应变率。并对上述结果进行统计学分析。结果:3个高血压组与正常对照组比较,高血压组左心室心肌纵向应变及应变率较正常对照均减低,差异有统计学意义(P0.05),离心性肥厚组纵向心肌应变减低更为明显,且低于向心性肥厚组、左心室构型正常组(P0.05);向心性肥厚组和左室构型正常组减低程度基本一致,但均低于正常对照组;离心性肥厚组、向心性肥厚组心肌径向应变、应变率较左室构型正常组和正常对照组均减低,差异有统计学意义(P0.05),离心性肥厚组心肌径向运动应变、应变率较向心性肥厚组减低(P0.05);离心性肥厚组圆周运动应变、应变率较向心性肥厚组组、左室构型正常组及正常对照组圆周运动均减低,差异有统计学意义(P0.05),向心性肥厚组、左室构型正常组及正常对照组圆周运动应变、应变率比较,差异无显著性意义(P0.05)。离心性肥厚组左心室纵向、径向及圆周峰值应变、应变率与向心性肥厚组、左心室构型正常组及健康对照组比较均减低(P0.05);向心性肥厚组左心室纵向、径向应变、应变率与左心室构型正常组及正常对照组比较均减低(P0.05);左心室构型正常组纵向峰值应变、应变率与健康对照组比较减低(P0.05)。结论:高血压早期左心室纵向应变首先减低,径向和圆周方向应变维持正常,以代偿减低的纵向心肌收缩力,左心室纵向应变是反映左心室收缩功能早期改变的敏感指标。高血压进展期左心室重构,左心室纵向应变、径向应变依次减低,左心室圆周应变维持正常。左心室重构发展到离心性肥厚,圆周应变最后减低,是高血压患者维持正常左心室收缩功能的关键指标。
[Abstract]:Objective: to evaluate the changes of longitudinal, radial and circular motion of left ventricular myocardium in patients with essential hypertension with different left ventricular configurations by speckle tracking imaging. Methods: according to the criteria of hypertension diagnosis and classification established by the revised Committee of Chinese Hypertension Prevention and treatment in 2005, From November 2015 to March 2016, 150 patients with essential hypertension were selected and divided into three groups according to the left ventricular mass index (LVMI) and the relative wall thickness. 53 cases of left ventricular concentric hypertrophy group and 42 cases of left ventricular eccentric hypertrophy group. 50 healthy volunteers matched with body weight were used as control group. The off-line analysis of CMQ plug-in in Philips IE elite color Doppler ultrasound diagnostic instrument and QLAB9.0 workstation was used. Echocardiography was performed on the above mentioned cases and the control group. The left ventricular ejection fraction (LVEF), left ventricular septal thickness, left ventricular posterior wall thickness and left ventricular ejection fraction (LVEF) were measured by biplane Simpsons method. Two dimensional gray media dynamic images were collected on the long axis section of the left ventricle and the short axis section of the left ventricle adjacent to the sternum. The longitudinal strain and strain rate of the left ventricle were measured on the apical four chamber section and the apical two chamber section by using the speckle tracing imaging technique. The left ventricular circumference, radial strain and strain rate were measured on the short axis of the left ventricle adjacent to the sternum. The longitudinal strain and strain rate of left ventricular myocardium in hypertension group were significantly lower than those in normal control group (P 0.05). The longitudinal myocardial strain in centrifugal hypertrophy group was significantly lower than that in concentric hypertrophy group. The degree of decrease in the concentric hypertrophy group and the left ventricular normal group was basically the same, but lower than that in the normal control group, while in the centrifugal hypertrophy group, the radial strain of the myocardium in the concentric hypertrophy group was lower than that in the eccentric hypertrophy group. The strain rate was lower than that in the normal group and the control group, the difference was statistically significant (P 0.05). The radial motion strain and strain rate of the eccentric hypertrophy group were lower than that of the concentric hypertrophy group (P 0.05), and the peripheral motion strain of the centrifugal hypertrophy group was lower than that of the concentric hypertrophy group. The strain rate was lower than that in the concentric hypertrophy group, the normal left ventricular configuration group and the normal control group, and the difference was statistically significant (P 0.05). The circular motion strain and strain rate of the concentric hypertrophy group, the normal left ventricular configuration group and the normal control group were compared. There was no significant difference between the two groups (P 0.05). The longitudinal, radial and circumferential peak strain, strain rate and strain rate in centrifugal hypertrophy group were significantly lower than those in concentric hypertrophy group, normal left ventricular configuration group and healthy control group (P 0.05), and in concentric hypertrophy group (P 0.05), the left ventricular longitudinal value in concentric hypertrophy group was significantly lower than that in concentric hypertrophy group (P < 0.05). The radial strain and strain rate were lower than those of the normal group and the control group, and the longitudinal peak strain of the normal left ventricular configuration group was significantly lower than that of the normal group. Conclusion: in the early stage of hypertension, the longitudinal strain of left ventricle first decreased, and the radial and circumferential strain remained normal to compensate for the decreased longitudinal myocardial contractility. Left ventricular longitudinal strain is a sensitive index to reflect the early changes of left ventricular systolic function. The left ventricular circumference strain is normal, the left ventricular remodeling develops to eccentric hypertrophy, and the circumferential strain finally decreases, which is the key index to maintain the normal left ventricular systolic function in patients with hypertension.
【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】：R544.11;R445.1

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