基于时空概念评价慢性肾脏病患者心内外膜旋转及扭转的研究

发布时间：2018-05-01 15:21

本文选题：斑点追踪 + 慢性肾脏病　；参考：《浙江中医药大学》2014年硕士论文

【摘要】：目的通过二维斑点追踪技术(STI)探讨慢性肾脏病(CKD)患者心内外膜在不同时相的旋转与扭转运动。从时间、空间两个方面对不同分期的CKD患者心功能进行评价,了解其最初发生改变的部位及时相。方法根据慢性肾脏病临床实践指南(K/DOQI)中的肾功能分期标准,将1-3期CKD患者设为CKD1组,4-5期CKD患者设为CKD2组,每组各25例,正常对照组25例。先行常规超声心动图检查,获取常规测值左室射血分数(LVEF).心率(HR)、左房前后径(LA)、左室舒张末期内径(LVIDd).等容舒张时间(IVRT).二尖瓣口前向血流E峰、A峰速度,二尖瓣环的组织运动e峰、a峰、Sm速度等。运用STI技术测量一个心动周期内心底及心尖水平的心内外膜旋转的方向与角度,并计算出心内外膜整体扭转角度,利用公式解旋率=(AVC点旋转角度-MVO点旋转角度)/AVC点旋转角度*100%IVRT算出解旋率。将3组研究对象的常规超声测值以及运用STI技术测量3组研究对象在不同时相的心内外膜旋转角度、扭转角度、解旋率进行比较。应用相关性分析探讨左室心内外膜的旋转及扭转角度与LVEF的关系,左室心内外膜的解旋率与E/A比值、IVRT的关系。结果超声常规测值：CKD1、2组的IVRT延长,LA增大,A峰速度增快,E/A值减小,e峰速度减慢,a峰速度增快,e/a值减小,E/e值增大,差异有统计学意义。除此之外,CKD2组的LVIDd增大,LVEF减低,E峰速度减慢,Sm减低。STI测值：①等容收缩期：3组研究对象的基底段与心尖段心内外膜的旋转角度均无明显改变。②射血期：CKD1、2组心内膜的旋转角度在基底段与心尖段均减小；CKD2组心外膜的旋转角度在基底段与心尖段减小,CKD1组无改变。CKD1组与CKD2组间心尖段心外膜的旋转角度差异有统计学意义(P0.05)。③等容舒张期末：CKD1、2组心内膜的解旋率在基底段与心尖段均减小；CKD1、2组心外膜的解旋率在基底段同样减小。④左室心内外膜扭转角度及解旋率的比较：CKD1、2组的心内膜扭转角度均减小；CKD2组的心外膜扭转角度也减小；CKD1、2组心内膜的解旋率同样减小,而心外膜的解旋率,三组间均无统计学差异。相关性分析：左室内膜与外膜的扭转角度与LVEF均呈正相关(依次：r=0.645,r=0.395,P0.001),且内膜大于外膜；基底段的心内外膜旋转角度与LVEF呈负相关,而心尖段心内膜旋转角度与LVEF呈中度正相关；左室心内膜解旋率与E/A比值呈正相关,而左室心内膜与心外膜的解旋率均与IVRT呈负相关。结论STI技术在LVEF下降之前较早发现CKD患者左室旋转及扭转运动异常,并且可以评价CKD患者心功能最初改变的具体时相(射血期与等容舒张期末)以及具体方位(由心内膜向心外膜改变)。
[Abstract]:Objective to investigate the rotational and torsional motion of the cardiac internal and external membrane in patients with chronic kidney disease (CKD) at different phases by using two dimensional speckle tracing technique (STI). The heart function of CKD patients with different stages was evaluated in terms of time and space. Methods according to the standard of renal function staging in the clinical practice guide of chronic kidney disease (KR / DOQI), the patients with stage 1-3 CKD were divided into CKD1 group, stage 4-5 CKD group and CKD2 group with 25 cases in each group and 25 cases in normal control group. Routine echocardiography was performed to obtain the values of left ventricular ejection fraction (LVEF). HRV, left atrial anterior and posterior diameter, left ventricular end diastolic diameter and LVIDdV. The isovolumic relaxation time was equal to that of IVRTT. The velocity of E peak A and S m velocity of mitral annulus were observed. The STI technique was used to measure the direction and angle of the rotation of the epicardial membrane at the heart bottom and apical level in a cardiac cycle, and to calculate the angle of the whole torsion of the epicardial membrane. The rotation angle of AVC point and the rotation angle of AVC point and the rotation angle of AVC point are calculated by the formula unspin rate and the rotation angle of AVC point and the rotation angle of AVC point and 100IVRT. The conventional ultrasonic measurements of the three groups of subjects and the STI technique were used to measure the rotation angle, torsion angle and unspin rate of the inner and outer heart membrane of the three groups of subjects at different time phases. The correlation analysis was used to study the relationship between the rotation and torsion angle of the left ventricular endocardial membrane and LVEF, and the relationship between the left ventricular endocardial membrane unrotation rate and the E / A ratio. Results the IVRT prolongation LA increased and the E / A value decreased in the normal ultrasound group. The peak velocity increased and the E / a value decreased. The difference was statistically significant. In addition, in CKD2 group, there was no significant change in the rotation angle of the basal segment and the apical part of the epicardial membrane between the basal segment and the apical segment of the subjects in the study group: 1 / 1 isovolumic systolic phase. 2. 2. At ejection stage, the rotation angle of the epicardial membrane was not significantly changed in the two groups. Membrane rotation angle decreased in basal segment and apical segment; epicardial rotation angle in CKD2 group decreased in basal segment and apical segment. There was significant difference in epicardial rotation angle between CKD1 group and CKD2 group. Comparison of endocardial unwinding rate in basal and apical segments of the left ventricular endocardial torsion angle and resolution rate in the basal segment and the basal segment of the CKD _ 1 / 2 group A comparison of endocardial torsion rate in the left ventricular endocardial torsion angle and resolution rate in the left ventricular endocardial membrane of the two groups at the end of diastolic period: both in basal segment and at the apical segment of the heart; comparison of the endocardial torsion angle and resolution rate in the basal segment In CKD2 group, the angle of epicardial torsion was also decreased, and the endocardial unwinding rate was also decreased in CKD1 + 2 group. However, there was no statistical difference between the three groups in epicardial spin rate. Correlation analysis showed that the torsion angle between left ventricular intima and adventitia was positively correlated with LVEF (1: r = 0. 645A 0.395U P 0.001, and the endomembrane rotation angle of basal segment was negatively correlated with LVEF, while that of apical segment was positively correlated with LVEF), and that between endocardial rotation angle of basal segment was negatively correlated with LVEF, and that between endocardial rotation angle of apical segment and LVEF was moderately positive. There was a positive correlation between endocardial spin rate and E / A ratio, but a negative correlation between endocardial and epicardial spin rate and IVRT. Conclusion the abnormal left ventricular rotation and torsion in patients with CKD were detected by STI technique before the decrease of LVEF. It can also be used to evaluate the specific phase (ejection phase and isovolumic diastolic end) and the specific orientation (from endocardial to epicardial changes) of cardiac function in patients with CKD.
【学位授予单位】：浙江中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692;R445.1

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