两种Tei指数评价左室舒张功能的一致性分析及其应用

发布时间：2018-05-24 02:24

  本文选题：超声心动描记术 + Tei指数　； 参考：《河北联合大学》2014年硕士论文

【摘要】：目的利用脉冲多普勒和组织多普勒两种方法测定计算左室舒张功能减低患者及正常对照者的心肌运动指数（Tei指数），分析两种Tei指数的一致性，并探讨Tei指数评估左室舒张功能的价值。 方法将140例临床明确诊断的左室舒张功能减低的患者作为病例组，依据超声心动图脉冲多普勒二尖瓣血流频谱E/A比值及组织多普勒二尖瓣环运动速度指标Ea/Aa比值分为中度左室舒张功能减低组（A组）和轻度左室舒张功能减低组（B组）。A组：1E/A2，Ea/Aa 1；B组：E/A 1，，Ea/Aa 1。选取同期进行健康体检，并且年龄、性别与病例组相匹配的80例健康者作为对照组（C组）。所有研究对象经常规超声心动图检查后，利用脉冲多普勒二尖瓣和主动脉瓣的血流频谱测定计算脉冲多普勒Tei指数；组织多普勒成像（TDI）模式下，测量二尖瓣环间隔、侧壁两个位点运动频谱的Ea、Aa速度峰值，计算Ea/Aa比值，以上述两个位点的平均Ea、Aa代替二尖瓣环的整体运动速度指标，同时分别测定计算该二个位点的TDI Tei指数，并计算两个TDI Tei指数的平均值。 结果1中度左室舒张功能减低组（A组）、轻度左室舒张功能减低组（B组）、正常对照组（C组）的脉冲多普勒Tei指数[（0.54±0.06）vs（0.46±0.07）vs（0.36±0.06）]、侧壁TDI Tei指数[（0.54±0.06）vs（0.46±0.07）vs（0.36±0.06）]、间隔TDI Tei指数[（0.56±0.06）vs（0.48±0.07）vs（0.38±0.06）]、平均TDI Tei指数[（0.55±0.06）vs（0.47±0.07）vs（0.37±0.06）]相比较，差异均有统计学意义（P0.01）。2脉冲多普勒Tei指数与LVEF、E峰、Ea/Aa呈负相关（rs=－0.29/－0.23/－0.57，均P0.01），与Aa、E/Ea呈正相关（rs=0.30/0.56，均P0.01）。3两种方法所测Tei指数高度相关；Bland-Altman法显示脉冲Tei指数与TDI Tei指数一致性良好。4Tei指数鉴别左室舒张功能减低的敏感性及特异性均较高。脉冲多普勒Tei指数ROC曲线下面积0.921，以脉冲Tei指数≥0.455作为鉴别左室舒张功能异常的临界点，敏感性为76.7%，特异性为98.7%；侧壁TDI Tei指数ROC曲线下面积0.923，以侧壁TDI Tei指数≥0.443作为鉴别左室舒张功能异常的临界点，敏感性为78.6%，特异性为98.7%。 结论脉冲多普勒Tei指数与组织多普勒Tei指数具有良好的一致性。Tei指数随舒张功能降低程度的加重呈线性增大趋势，与常规超声左心功能参数有一定的相关性，对左室舒张功能异常具有较高的诊断价值。TDI Tei指数精度高，测量简捷，更值得临床推广应用。
[Abstract]:Objective to determine and analyze the consistency of left ventricular diastolic dysfunction in patients with left ventricular diastolic dysfunction and normal controls by using pulsed Doppler and tissue Doppler methods to calculate the myocardial motility index and to analyze the consistency of the two indexes. To explore the value of Tei index in evaluating left ventricular diastolic function. Methods 140 patients with left ventricular diastolic dysfunction were selected as the case group. According to E / A ratio of pulse Doppler mitral flow spectrum and Ea/Aa ratio of tissue Doppler mitral annular movement velocity, we divided them into moderate left ventricular diastolic dysfunction group (group A) and mild left ventricular diastolic dysfunction group (group B). Group A: 1 E / A 2% EA / A 1 B: 1% E / A 1 A / A 1. 80 healthy subjects matched with age and sex were selected as control group. After routine echocardiography, pulse Doppler Tei index was calculated by pulsed Doppler mitral valve and aortic valve flow spectrum, mitral annular septum was measured by tissue Doppler imaging, and mitral annular septum was measured by tissue Doppler imaging. The peak value of EA Aa velocity in the motion spectrum of two sites on the lateral wall was calculated, the Ea/Aa ratio was calculated, the mean EA Aa of the two sites was replaced by the whole velocity index of the mitral annulus, and the TDI Tei exponents of the two sites were measured, respectively. The average values of two TDI Tei exponents were calculated. 缁撴灉1涓�搴﹀乏瀹よ垝寮犲姛鑳藉噺浣庣�

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