实时三平面定量组织速度成像及实时三平面应变率成像技术评价尿毒症患者左室舒张功能及其与PTH的相关性研究
发布时间：2018-07-23 14:01
【摘要】：目的 尿毒症性心肌损害是尿毒症的主要并发症，，其心肌的病理变化是由肥厚到扩张的过程，最终导致心功能不全。实时三平面(RT-3PE, real-time three-plane)定量组织速度成像（QTVI, Quantitative tissue velocity imaging）及RT-3PE应变率成像（SRI, Strain rate imaging）技术是近几年发展起来的新技术，可用于局部心肌运动的定量分析，反映心肌发生病变的程度，早期评估心脏功能。由于尿毒症患者舒张功能减低较收缩功能减低发生早，因此，本研究的主要目的在于：1、采用RT-3PEQTVI和RT-3PE SRI技术测量正常人和尿毒症患者舒张期左室壁运动速度及左室心肌应变率，评价尿毒症患者的左室舒张功能；2、分析左室舒张功能参数与血清甲状旁腺激素（PTH, parathyroid hormone）水平的相关性。从而为临床早期诊断尿毒症心肌病提供有意义的参数指标。 资料与方法 研究对象包括33例正常人（正常组）和30例尿毒症患者（尿毒症组）。收集尿毒症患者近一周的PTH检验结果。仪器选用GE vivid7彩色多普勒超声诊断仪，探头选用M3S及3V探头，安静状态下获取胸骨旁左室长轴标准切面二维灰阶图像及心尖四腔观RT-3PE图像，应用双平面Simpson方法测量左室射血分数（LVEF,left ventricular ejection function），应用脉冲多普勒超声获得二尖瓣口血流频谱，测量舒张早期峰值血流速度（E）及舒张晚期峰值血流速度（A），并计算E/A。脱机分析测量左室各常规参数及左室各节段心肌的舒张早期峰值速度（Ve）、舒张晚期峰值速度（Va）、舒张早期峰值应变率（SRe）、舒张晚期峰值应变率（SRa）。计算Ve/Va、SRe/SRa、左室平均Ve、左室平均SRe。 结果 1.与正常对照组比较：尿毒症组中LAD、LVEDD增大， IVSTD及LVPWTD增厚，血清PTH水平明显升高，心包积液（PE, pericardial effusion）的发生率显著升高，差异具有统计学意义（P＜0.05）；尿毒症组二尖瓣口血流频谱E峰明显降低，A峰升高，E/A比值显著降低，差异具有统计学意义（P＜0.05）。 2.与正常对照组比较：尿毒症组各室壁基底段、中间段Ve明显降低，Va升高，Ve/Va显著降低，差异有统计学意义（P＜0.05）；尿毒症组各室壁基底段、中间段SRe明显降低，SRe/SRa显著降低，差异有统计学意义（P＜0.05）。而SRa测值部分升高、部分降低，差异无统计学意义（P0.05）。 3.与正常对照组比较：尿毒症组左心室壁平均Ve、平均SRe均显著降低，差异有统计学意义（P＜0.05）。尿毒症组左心室壁平均Ve及平均SRe均与PTH呈负相关性。 结论 1. RT-3PE QTVI与RT-3PE SRI技术能够准确评价正常人和尿毒症患者的左室舒张功能，为临床早期诊断、治疗尿毒症心肌病提供了重要依据。 2.正常组左室心肌于舒张期的运动具有一定规律性，即各室壁基底段运动速度均大于中间段。 3.左室舒张功能参数与血PTH水平具有良好的相关性，可作为评估尿毒症患者左室舒张功能的可靠指标。
[Abstract]:Objective Myocardial damage caused by uremia is the main complication of uremia. The pathological changes of myocardium are from hypertrophy to dilatation, leading to cardiac insufficiency. Real-time triplane (RT-3PE) quantitative tissue velocity imaging (QTVI, Quantitative tissue velocity imaging) and RT-3PE strain rate imaging (SRI, Strain rate imaging) are new techniques developed in recent years. They can be used in quantitative analysis of regional myocardial motion and reflect the degree of myocardial lesion. Early assessment of cardiac function. Since the reduction of diastolic function occurred earlier than that of systolic function in uremic patients, the main purpose of this study was to measure the left ventricular wall motion velocity and the left ventricular strain rate in normal subjects and uremic patients during diastolic period by using RT-3PEQTVI and RT-3PE SRI techniques. To evaluate left ventricular diastolic function (LVDF) in patients with uremia and to analyze the correlation between left ventricular diastolic function parameters and serum parathyroid hormone (PTH, parathyroid hormone) level. Therefore, it provides a valuable parameter index for early diagnosis of uremic cardiomyopathy. Materials and methods 33 normal subjects and 30 uremic patients (uremia group) were studied. To collect the PTH test results of uremia patients for nearly a week. GE vivid7 color Doppler ultrasound diagnostic instrument and M3S and 3V probes were used to obtain 2D gray-scale images and four-chamber RT-3PE images of the parasternal left ventricular long axis in quiet state. Left ventricular ejection fraction (LVEF) was measured by biplane Simpson method. Mitral valve flow spectrum was obtained by pulsed Doppler ultrasound. Peak diastolic velocity (E) and late diastolic peak flow velocity (A),) were measured and E / A was calculated. Measurement of early diastolic peak velocities (Ve), late diastolic peak velocities (Va), early peak strain rate (SRe), late diastolic peak strain rate (SRa). VAR SReP SRA, left ventricular mean Veg, left ventricular mean SRea were calculated. Result 1. In uremia group, LVEDD increased, IVSTD and LVPWTD thickened, serum PTH level increased, and the incidence of (PE, pericardial effusion) in pericardial effusion increased significantly (P < 0. 05). In uremia group, the E peak of mitral orifice blood flow spectrum was significantly decreased and the ratio of E / A increased significantly (P < 0. 05), and the ratio of E / A was significantly decreased (P < 0. 05). Compared with the normal control group, the basal segment of the ventricular wall and the middle segment of the uremia group were significantly lower than those of the control group (P < 0. 05), and the SRe of the basal segment and the middle segment of the ventricular wall in the uremic group were significantly lower than those in the control group. The difference was statistically significant (P < 0.05). However, the SRa values increased partly and decreased partly, and the difference was not statistically significant (P0.05). Compared with the control group, the mean Veg and average SRe of left ventricular wall in uremia group were significantly lower than those in normal control group (P < 0. 05). There was a negative correlation between mean ve and SRe of left ventricular wall and PTH in uremia group. Conclusion 1. RT-3PE QTVI and RT-3PE SRI techniques can accurately evaluate left ventricular diastolic function in normal persons and uremic patients, and provide an important basis for early clinical diagnosis and treatment of uremic cardiomyopathy. 2. In normal group, the movement of left ventricular myocardium during diastolic phase is regular, that is, the velocity of basal segment of each ventricular wall is higher than that of middle segment. The parameters of left ventricular diastolic function have good correlation with the level of PTH, which can be used as a reliable index to evaluate left ventricular diastolic function in uremic patients.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.5;R445.1
本文编号：2139638
[Abstract]:Objective Myocardial damage caused by uremia is the main complication of uremia. The pathological changes of myocardium are from hypertrophy to dilatation, leading to cardiac insufficiency. Real-time triplane (RT-3PE) quantitative tissue velocity imaging (QTVI, Quantitative tissue velocity imaging) and RT-3PE strain rate imaging (SRI, Strain rate imaging) are new techniques developed in recent years. They can be used in quantitative analysis of regional myocardial motion and reflect the degree of myocardial lesion. Early assessment of cardiac function. Since the reduction of diastolic function occurred earlier than that of systolic function in uremic patients, the main purpose of this study was to measure the left ventricular wall motion velocity and the left ventricular strain rate in normal subjects and uremic patients during diastolic period by using RT-3PEQTVI and RT-3PE SRI techniques. To evaluate left ventricular diastolic function (LVDF) in patients with uremia and to analyze the correlation between left ventricular diastolic function parameters and serum parathyroid hormone (PTH, parathyroid hormone) level. Therefore, it provides a valuable parameter index for early diagnosis of uremic cardiomyopathy. Materials and methods 33 normal subjects and 30 uremic patients (uremia group) were studied. To collect the PTH test results of uremia patients for nearly a week. GE vivid7 color Doppler ultrasound diagnostic instrument and M3S and 3V probes were used to obtain 2D gray-scale images and four-chamber RT-3PE images of the parasternal left ventricular long axis in quiet state. Left ventricular ejection fraction (LVEF) was measured by biplane Simpson method. Mitral valve flow spectrum was obtained by pulsed Doppler ultrasound. Peak diastolic velocity (E) and late diastolic peak flow velocity (A),) were measured and E / A was calculated. Measurement of early diastolic peak velocities (Ve), late diastolic peak velocities (Va), early peak strain rate (SRe), late diastolic peak strain rate (SRa). VAR SReP SRA, left ventricular mean Veg, left ventricular mean SRea were calculated. Result 1. In uremia group, LVEDD increased, IVSTD and LVPWTD thickened, serum PTH level increased, and the incidence of (PE, pericardial effusion) in pericardial effusion increased significantly (P < 0. 05). In uremia group, the E peak of mitral orifice blood flow spectrum was significantly decreased and the ratio of E / A increased significantly (P < 0. 05), and the ratio of E / A was significantly decreased (P < 0. 05). Compared with the normal control group, the basal segment of the ventricular wall and the middle segment of the uremia group were significantly lower than those of the control group (P < 0. 05), and the SRe of the basal segment and the middle segment of the ventricular wall in the uremic group were significantly lower than those in the control group. The difference was statistically significant (P < 0.05). However, the SRa values increased partly and decreased partly, and the difference was not statistically significant (P0.05). Compared with the control group, the mean Veg and average SRe of left ventricular wall in uremia group were significantly lower than those in normal control group (P < 0. 05). There was a negative correlation between mean ve and SRe of left ventricular wall and PTH in uremia group. Conclusion 1. RT-3PE QTVI and RT-3PE SRI techniques can accurately evaluate left ventricular diastolic function in normal persons and uremic patients, and provide an important basis for early clinical diagnosis and treatment of uremic cardiomyopathy. 2. In normal group, the movement of left ventricular myocardium during diastolic phase is regular, that is, the velocity of basal segment of each ventricular wall is higher than that of middle segment. The parameters of left ventricular diastolic function have good correlation with the level of PTH, which can be used as a reliable index to evaluate left ventricular diastolic function in uremic patients.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.5;R445.1
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