三维斑点追踪技术评价初发肾病综合征患儿左心室整体应变

发布时间：2018-10-29 11:52

【摘要】：目的:应用三维斑点追踪成像技术(Three-dimensional speckle tracking imaging,3D-STI)探讨初发肾病综合征(Initial onset of nephrotic syndrome,INS)患儿左心室心肌应变的特征,并初步分析在不同24 h尿蛋白总量的患儿中上述指标的变化。方法:收集42例INS患儿(病例组)和30例健康儿童(对照组),对所有受检者进行3D-STI检测,获得三维左心室射血分数(Three-dimensional left ventricular ejection fraction,3D-LVEF)、左心室心肌整体纵向峰值应变(Left ventricular global longitudinal strain,LVGLS)、左心室圆周峰值应变(Left ventricular global circumferential strain,LVGCS)、左心室面积峰值应变(Left ventricular global area strain,LVGAS)、左心室径向峰值应变(Left ventricular global radial strain,LVGRS),采用正态性检验选取合适的统计学方法进行两组间上述参数的比较,并随机抽取病例组中20例INS患儿进行组内及组间的重复性检验,绘制散点图。随后将INS患儿(病例组)按照24 h尿蛋白总量划分为3组,并比较3组内上述参数的差异。结果:1病例组LVEF与对照组比较无明显变化(P0.05)。3D-STI中病例组与对照组相比较,LVGAS与LVGLS明显减低(P均0.01),LVGRS和LVGCS无明显变化。2随机抽取病例组中的20例,经Bland-Altman重复性检验后,得出组间LVGAS、LVGCS、LVGLS、LVGRS的平均差值分别为-0.2、-0.13、0.1及0.2,95%置信区间分别为-2.8%~2.3%、-1.65%~1.29%、-2.1%~2.3%及-3.9%~4.3%;组内LVGAS、LVGCS、LVGLS、LVGRS平均差值分别为0.0、-0.36、-0.4及0.1,95%置信区间分别为-2.9%~2.9%、-2.18%~1.45%、-3.2%~2.4%及-4.4%~4.6%。组内及组间INS病例组应变值有良好的可重复性。3对按照24 h尿蛋白量所划分的3组间的参数进行比较,仅有LVGAS与LVGLS在3组间有明显的统计学差异,并且随着24 h尿蛋白总量的增加,上述应变值减低。结论:INS患儿左心室整体应变存在明显异常变化;3D-STI技术对于评价其应变具有良好的可重复性;随着24 h尿蛋白量的增加,患儿的左心室整体应变可能与疾病严重程度相关。
[Abstract]:Objective: to investigate the characteristics of left ventricular strain in children with primary nephrotic syndrome (Initial onset of nephrotic syndrome,INS) by three-dimensional speckle tracing imaging (Three-dimensional speckle tracking imaging,3D-STI). The changes of the above indexes in children with different 24 h urinary protein contents were analyzed. Methods: 42 children with INS (case group) and 30 healthy children (control group) were examined by 3D-STI, and three dimensional left ventricular ejection fraction (Three-dimensional left ventricular ejection fraction,3D-LVEF) was obtained. Left ventricular global longitudinal peak strain (Left ventricular global longitudinal strain,LVGLS), left ventricular peak strain (Left ventricular global circumferential strain,LVGCS), left ventricular area peak strain (Left ventricular global area strain,LVGAS), left ventricular radial peak strain (Left ventricular global radial strain,) LVGRS), used normal test to select the appropriate statistical method to compare the above parameters between the two groups, and randomly selected 20 cases of INS children to carry out intra-group and inter-group reproducibility test, and draw scatter plot. Then the children with INS were divided into 3 groups according to the total amount of 24 h urine protein, and the differences of the above parameters in the three groups were compared. Results: 1 there was no significant change in LVEF in the case group compared with the control group (P0.05). Compared with the control group, the LVGAS and LVGLS in the 3D-STI group were significantly lower than those in the control group (P0.01), LVGRS and LVGCS, respectively). After Bland-Altman repeatability test, the average difference of LVGAS,LVGCS,LVGLS,LVGRS between groups was -0.2 ~ 0.13% and -2.8% ~ (-2.33) ~ (-1.65)% confidence intervals, respectively. -2.1% and -3.9% respectively; The average difference of LVGAS,LVGCS,LVGLS,LVGRS in the group was 0.0-0.36-0.4 and 0.1U 95% confidence intervals, respectively. The mean confidence intervals of LVGAS,LVGCS,LVGLS,LVGRS were -2.9 and 2.18, respectively. -3.2% and -4.4%. The strain values of INS patients within and between groups had good reproducibility. 3 the parameters of the three groups divided according to 24 h urine protein volume were compared. Only LVGAS and LVGLS had significant statistical differences among the three groups. The above strain value decreased with the increase of 24 h urine protein content. Conclusion: there are obvious abnormal changes in global strain of left ventricle in children with INS, and 3D-STI technique has good reproducibility in evaluating the strain of left ventricle. With the increase of 24 h urinary protein, the global strain of left ventricle may be related to the severity of the disease.
【作者单位】：中国医科大学附属盛京医院超声科;
【基金】：辽宁省科技厅科学技术计划项目(2013225049)
【分类号】：R726.9;R540.45

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