左心室整体峰值应变与左心室Tei指数评价单纯甲状腺功能亢进患者左心室功能的研究

发布时间：2018-08-12 21:05

【摘要】：目的：探讨单纯甲状腺功能亢进患者左心室整体峰值应变与左心室Tei指数变化特点及其相关性,评价超声四维应变成像技术在单纯甲亢患者左心室功能评估中的应用价值。方法：实验组为经实验室检查，由临床确诊的甲状腺功能亢进患者50例，依据甲状腺功能亢进及甲亢性心脏病诊断标准分为两组：A组，即单纯甲亢组，为病程小于1年、未经治疗的单纯甲状腺功能亢进患者，共35例，男性13例，女性22例，平均年龄29.4±9.5岁；B组，即甲亢性心脏病组，为经确诊的甲亢性心脏病患者，共15例，男性6例，女性9例，平均年龄33.9±4.3岁。对照组为年龄、性别与实验组相匹配的健康志愿者，即C组，共20例，男性10例，女性10例，平均年龄30.1±8.5岁。应用GE Vivid E9彩色超声显像仪，配有M5S及4V探头，频率分别为1.5-4.6MHz、1.5-4.0MHz。所有受检者均采取左侧卧位，同步记录心电图。采集所有受检者的左心室二维图像及实时三维全容积图像，后存盘。二维超声心动图：获取胸骨旁左室长轴切面，测量左室舒张末期内径（LVDD）、左室收缩末期内径（LVSD）、室间隔厚度（IVST）、左室后壁舒张末期厚度（LVPWT）；在心尖四腔观二尖瓣环后间隔侧组织多普勒频谱上进行相关数据测量，并计算出tei指数；获取全容积动态图像，运用四维自动左室心功能分析（4D Auto LVQ）软件，计算出左室舒张末期容积（EDV）、左室收缩末期容积（ESV）、左室射血分数（LVEF）及各项收缩期四维应变参数:左室整体纵向峰值应变（GLS）、左室整体圆周峰值应变（GCS）、左室整体面积峰值应变（GAS）、左室整体径向峰值应变（GRS）、17节段彩色编码的牛眼图显示的各个节段应变参数。结果： 1IVST、LVPWT均值三组间对比，差异无统计学意义（P＞0.05）。A组与C组组间对比， LVDD、LVSD、EDV、ESV、LVEF差异无统计学意义（P＞0.05）。B组与A组及C组进行组间对比，，LVDD、LVSD、EDV、ESV、LVEF差异有统计学意义（P＜0.05），B组LVDD、LVSD、EDV、ESV各测量值均值大于A组及C组均值。B组LVEF均值小于A组及C组; 2A组左心室tei指数大于C组，差异有统计学意义（P＜0.05）。B组tei指数大于A组及C组，差异有统计学意义（P＜0.05）; 3A组GLS、GCS、GAS、GRS绝对值均大于C组，差异均有统计学意义（P＜0.05）。B组GLS、GCS、GAS、GRS绝对值小于A组及C组，差异均有统计学意义（P＜0.05）; 4单纯甲亢患者左心室整体峰值应变与左心室射血分数及左心室tei指数的相关性分析： GLS、GCS、GAS与左室射血分数负相关， GRS与左室射血分数正相关，GLS、GCS、GAS与左心室tei指数负相关，GRS与左室tei指数正相关。结论：单纯甲状腺功能亢进患者左心室结构与正常对照组对比无明显差别。单纯甲亢患者左心室收缩功能增强，左心室整体功能降低。单纯甲亢患者左心室整体峰值应变与左心室射血分数相关性良好，左心室整体峰值应变与左心室tei指数有一定的相关性。四维应变成像技术及左心室Tei指数能够早期、敏感、准确的评价单纯甲亢患者左心室功能的改变。
[Abstract]:Objective: To investigate the relationship between left ventricular global peak strain and left ventricular Tei index in patients with simple hyperthyroidism, and to evaluate the value of ultrasound four-dimensional strain imaging in evaluating left ventricular function in patients with simple hyperthyroidism.
Methods: 50 patients with hyperthyroidism were divided into two groups according to the diagnostic criteria of hyperthyroidism and hyperthyroidism heart disease: group A, simple hyperthyroidism, 35 patients with simple hyperthyroidism whose course of disease was less than one year and untreated, including 13 males and 22 females. Group B, hyperthyroidism heart disease group, was diagnosed as hyperthyroidism heart disease patients, a total of 15 cases, 6 males, 9 females, the average age of 33.9 + 4.3 years. All subjects were in left lateral position and recorded electrocardiogram synchronously. Two-dimensional images of left ventricle and real-time three-dimensional full-volume images of left ventricle were collected. The left ventricular diastole was measured by two-dimensional echocardiography. End-stage internal diameter (LVDD), left ventricular end-systolic diameter (LVSD), interventricular septal thickness (IVST), left ventricular posterior wall end-diastolic thickness (LVPWT); Doppler spectra of posterior septal tissue of apical four-chamber view of the mitral annulus were measured and Tei index was calculated; full-volume dynamic images were obtained, and four-dimensional automatic left ventricular function analysis (4DA) was used. Uto LVQ software was used to calculate left ventricular end-diastolic volume (EDV), left ventricular end-systolic volume (ESV), left ventricular ejection fraction (LVEF) and various four-dimensional systolic strain parameters: global longitudinal peak strain (GLS), global circular peak strain (GCS), global area peak strain (GAS), global radial peak strain (GRS), 17 segments. The strain parameters of each segment displayed in color coded bovine diagram.
Result:
There was no significant difference between group A and group C in LVDD, LVSD, EDV, ESV and LVEF (P > 0.05). There was no significant difference between group B and group A and group C in LVDD, LVSD, EDV, ESV and LVEF (P < 0.05). The mean LVEF of group.B was less than that of group A and group C.
The left ventricular Tei index of group 2A was higher than that of group C (P < 0.05). The Tei index of group B was higher than that of group A and group C (P < 0.05).
The absolute values of GLS, GCS, GAS and GRS in group B were lower than those in group A and group C (P < 0.05).
4 Correlation analysis of left ventricular global peak strain with left ventricular ejection fraction and left ventricular Tei index in patients with simple hyperthyroidism: GLS, GCS, GAS were negatively correlated with left ventricular ejection fraction, GRS was positively correlated with left ventricular ejection fraction, GLS, GCS, GAS was negatively correlated with left ventricular Tei index, and GRS was positively correlated with left ventricular Tei index.
Conclusion:
Left ventricular systolic function was enhanced and left ventricular function was decreased in patients with simple hyperthyroidism. Four-dimensional strain imaging and left ventricular Tei index can be used to evaluate the left ventricular function in patients with simple hyperthyroidism.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R581.1;R540.45

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