二维斑点追踪成像技术评价原发性高血压病人左室收缩功能的价值
发布时间：2018-10-18 07:32
【摘要】：目的原发性高血压主要体现为体循环动脉血压的增高,对心脏的损害主要体现为引起左心室重构、进而导致收缩功能的减低。本文通过应用二维斑点追踪成像技术(STI)获取高血压病人各节段心肌的二维应变值,比较不同构型的心肌在不同方向上的应变和扭转,探讨左心室心肌构型与收缩功能的关系。 方法选取原发性高血压病人132例,除外糖尿病、心率失常等其他疾病的病人。依据Ganau分类法,将其分为4组：正常构型组(NG组38例)、向心性重构组(CR组35例)、向心性肥厚组(CH组31例),离心性肥厚组(EH组28例)。另选年龄、性别与之相匹配的健康志愿者34名作为正常对照组(NC组)。 对入选者行超声心动图检查,获取以下指标：1.左室构型指标：室壁厚度、左室内径：2.左室收缩功能指标,包括：常规指标：左室射血分数(LVEF)、短轴缩短率(FS)；二维应变指标:左室收缩期峰值纵向应变(SL)、周向应变(SC)、径向应变(SR)、旋转角度(Rot),并计算扭转角度(Twist)。 结果1.高血压组(132例)与正常对照组比较：前者的左室壁厚度、重量高于后者,而LVEF均在正常范围内；收缩期应变指标SL显著降低(P0.05),二尖瓣及乳头肌水平的SC、乳头肌水平的SR及左室Twist无明显变化。 2.高血压各构型组与对照组比较：NG组、CR组的SL低于对照组,而二尖瓣水平和乳头肌水平的SC、SR无明显下降；CH组和EH组SL、SC及二尖瓣水平和乳头肌水平的SR与NG组、CR组比较均下降(P0.05)。心尖水平的SR在NG、CR、CH组中呈递增趋势,在EH组中略有降低,但仍比对照组高。Twist在NG组、CR组比对照组略增高,在CH组和EH组中却与对照组相近。 结论二维斑点追踪成像技术能够准确获取高血压病人左心室各方向的运动指标、检测出各构型组室壁运动的细微差异。高血压病人虽能保持左心室的正常泵功能,但心肌的收缩功能已经受到损害,表现为各构型组不同方向的应变值都有不同程度的减低。室壁肥厚之前,主要体现为纵向应变的下降；室壁肥厚以后,左室的纵向应变、周向应变、二尖瓣水平和乳头肌水平的径向应变都有降低。在所有构型组中心尖段的径向应变是呈增高趋势,而左室扭转的波动幅度较低,这可能是左室泵功能保持正常的重要因素。
[Abstract]:Objective essential hypertension mainly reflects the increase of arterial blood pressure of systemic circulation, and the damage to the heart mainly results in left ventricular remodeling, which leads to the decrease of systolic function. Two-dimensional speckle tracing imaging (STI) was used to obtain the two-dimensional strain values of each segment of myocardium in hypertensive patients. The strain and torsion of myocardium with different configurations in different directions were compared, and the relationship between left ventricular myocardial configuration and systolic function was discussed. Methods 132 patients with essential hypertension, including diabetes, arrhythmia and other diseases were selected. According to Ganau classification, it was divided into 4 groups: normal configuration group (NG group, 38 cases), concentric remodeling group (CR group, 35 cases), concentric hypertrophy group (CH group, 31 cases) and centrifugal hypertrophy group (EH group, 28 cases). Another 34 healthy volunteers of age and gender were selected as normal control group (NC group). The following indexes were obtained by echocardiography: 1. Left ventricular wall thickness, left ventricular diameter: 2. Left ventricular systolic function index, including: conventional index: left ventricular ejection fraction (LVEF), short axis shortening rate (FS); two-dimensional strain index: left ventricular systolic peak longitudinal strain (SL), radial strain (SC), radial strain (SR), rotation angle (Rot), and calculate torsion angle (Twist). Result 1. The left ventricular wall thickness and weight of the hypertension group (132 cases) were higher than that of the control group, while LVEF was within the normal range. The systolic strain index (SL) was significantly decreased (P0.05), but there was no significant change in SR and left ventricular Twist in SC, of mitral valve and papillary muscle. 2. Compared with the control group, the SL of NG group, CR group was lower than that of control group, but SC,SR of mitral valve level and papillary muscle level had no significant decrease, SR and NG group of CH group and EH group and SR group and NG group of mitral valve level and papillary muscle level in CH group and EH group were lower than those in CR group (P0.05). The apical level of SR increased in NG,CR,CH group, decreased slightly in EH group, but still higher than that in control group. Twist in NG group, CR group was slightly higher than control group, but similar in CH group and EH group. Conclusion Two-dimensional speckle tracing imaging can accurately obtain the left ventricular motion indexes in all directions of hypertensive patients, and detect the subtle differences of ventricular wall motion in each configuration group. Although hypertensive patients can maintain the normal pump function of the left ventricle, the contractile function of the myocardium has been damaged, which shows that the strain values in different directions of each configuration group are decreased to varying degrees. The longitudinal strain, the circumferential strain, the radial strain of the mitral valve and the papillary muscle were all decreased after the hypertrophy of the ventricular wall before the hypertrophy of the ventricular wall, and the longitudinal strain, the circumferential strain, the radial strain of the mitral valve and the papillary muscle were all decreased after the hypertrophy of the ventricular wall. The radial strain of the central apical segment of all the configurations showed an increasing trend, while the fluctuation of left ventricular torsion was relatively low, which may be an important factor in maintaining the normal left ventricular pump function.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R544.11;R445.1
本文编号：2278427
[Abstract]:Objective essential hypertension mainly reflects the increase of arterial blood pressure of systemic circulation, and the damage to the heart mainly results in left ventricular remodeling, which leads to the decrease of systolic function. Two-dimensional speckle tracing imaging (STI) was used to obtain the two-dimensional strain values of each segment of myocardium in hypertensive patients. The strain and torsion of myocardium with different configurations in different directions were compared, and the relationship between left ventricular myocardial configuration and systolic function was discussed. Methods 132 patients with essential hypertension, including diabetes, arrhythmia and other diseases were selected. According to Ganau classification, it was divided into 4 groups: normal configuration group (NG group, 38 cases), concentric remodeling group (CR group, 35 cases), concentric hypertrophy group (CH group, 31 cases) and centrifugal hypertrophy group (EH group, 28 cases). Another 34 healthy volunteers of age and gender were selected as normal control group (NC group). The following indexes were obtained by echocardiography: 1. Left ventricular wall thickness, left ventricular diameter: 2. Left ventricular systolic function index, including: conventional index: left ventricular ejection fraction (LVEF), short axis shortening rate (FS); two-dimensional strain index: left ventricular systolic peak longitudinal strain (SL), radial strain (SC), radial strain (SR), rotation angle (Rot), and calculate torsion angle (Twist). Result 1. The left ventricular wall thickness and weight of the hypertension group (132 cases) were higher than that of the control group, while LVEF was within the normal range. The systolic strain index (SL) was significantly decreased (P0.05), but there was no significant change in SR and left ventricular Twist in SC, of mitral valve and papillary muscle. 2. Compared with the control group, the SL of NG group, CR group was lower than that of control group, but SC,SR of mitral valve level and papillary muscle level had no significant decrease, SR and NG group of CH group and EH group and SR group and NG group of mitral valve level and papillary muscle level in CH group and EH group were lower than those in CR group (P0.05). The apical level of SR increased in NG,CR,CH group, decreased slightly in EH group, but still higher than that in control group. Twist in NG group, CR group was slightly higher than control group, but similar in CH group and EH group. Conclusion Two-dimensional speckle tracing imaging can accurately obtain the left ventricular motion indexes in all directions of hypertensive patients, and detect the subtle differences of ventricular wall motion in each configuration group. Although hypertensive patients can maintain the normal pump function of the left ventricle, the contractile function of the myocardium has been damaged, which shows that the strain values in different directions of each configuration group are decreased to varying degrees. The longitudinal strain, the circumferential strain, the radial strain of the mitral valve and the papillary muscle were all decreased after the hypertrophy of the ventricular wall before the hypertrophy of the ventricular wall, and the longitudinal strain, the circumferential strain, the radial strain of the mitral valve and the papillary muscle were all decreased after the hypertrophy of the ventricular wall. The radial strain of the central apical segment of all the configurations showed an increasing trend, while the fluctuation of left ventricular torsion was relatively low, which may be an important factor in maintaining the normal left ventricular pump function.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R544.11;R445.1
【参考文献】
相关期刊论文 前8条
1 文利;郑嘉荣;高云华;谭开彬;钱频;;超声斑点跟踪成像对扩张型心肌病患者左室短轴二维应变的定量研究[J];临床超声医学杂志;2008年02期
2 白江涛;孙建辉;;应变和应变率显像评价高血压左室心功能的临床研究[J];临床内科杂志;2006年01期
3 姜楞;;心脏再同步化治疗及超声心动图的应用[J];现代实用医学;2006年01期
4 张丽;谢明星;付曼丽;王新房;吕清;韩伟;张静;刘莹莹;王静;项飞翔;;Assessment of Age-related Changes in Left Ventricular Twist by Two-dimensional Ultrasound Speckle Tracking Imaging[J];Journal of Huazhong University of Science and Technology(Medical Sciences);2007年06期
5 王金锐,那日苏,秦林金,刘志耀,刘国辉,王淑敏,杨敬英;室壁应力与应变的关系评价高血压病左室收缩功能[J];中国医学影像技术;2003年12期
6 马红;谢明星;胡莉君;王静;王新房;吕清;卢晓芳;杨亚利;;超声斑点追踪成像技术评价2型糖尿病患者左心室收缩功能[J];中国医学影像技术;2008年07期
7 林英;郝力丹;郭瑞强;陈金玲;周青;;实时三维超声心动图和超声斑点追踪技术评价扩张型心肌病左心室收缩同步性[J];中国医学影像技术;2009年05期
8 李卫芹;谢明星;王新房;吕清;卢晓芳;张丽;王淑珍;;斑点追踪显像技术评价正常婴幼儿、儿童及青少年收缩期左心室各节段室壁旋转运动[J];中国医学影像技术;2009年07期
，本文编号：2278427
本文链接：https://www.wllwen.com/yixuelunwen/fangshe/2278427.html
