斑点追踪成像技术评价亚临床甲状腺功能减退症患者心功能

发布时间：2018-03-22 02:36

本文选题：斑点追踪成像技术　切入点：亚临床甲减　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:运用二维斑点追踪成像技术评价亚临床甲减患者的左心室和右心室收缩及舒张功能改变,早期发现其心脏功能的损害。材料及方法:亚临床甲减组(SCH组):选取2016年1月-2016年12月来我院确诊为亚临床甲减患者34例,其中女性23例,男性11例,年龄35-50岁,平均年龄(40.1±1.6)岁。正常对照组:选取性别、年龄相匹配的健康者20例作为对照。其中女性14例,男性6例,年龄35-45岁,平均年龄(39.9±2.8)岁。各组患者于静息状态下行常规超声心动图检查,并分别获取6个标准切面的二维灰阶动态图像(胸骨旁左室二尖瓣短轴切面、胸骨旁左室乳头肌短轴切面、胸骨旁左室心尖短轴切面及心尖四腔切面、心尖三腔切面、心尖两腔切面),帧频大于100帧/秒,每个切面记录3个心动周期以上。测量常规超声心动图相关参数:左室舒张末内径(LVIDd)、左室收缩末内径(LVIDs)、舒张末室间隔厚度(IVSd)、舒张末左室后壁厚度(LVPWd)、右室舒张末内径(RVIDd)、右室收缩末内径(RVIDs)、右室舒张末面积(RVEDA)、右室收缩末面积(RVESA),计算出右室面积变化率(RVFAC),采用Simpson法测量左室射血分数(LVEF)。使用M型超声测量三尖瓣环收缩期位移(TAPSE)。利用qlab9.0软件cmq程序后处理获取的图像,分析测量各组患者的左心室收缩期整体纵向应变(glss)、圆周应变(gcss)、纵向应变率(lrs)、圆周应变率(crs)及右心室整体纵向应变(glss)、纵向应变率(lrs)。选择tmad选项,测量各组患者室间隔-侧壁点连线中点最大位移(tmadmidpt)及室间隔-侧壁点连线中点最大位移占左室长径百分比(tmadmidpt%)。结果:(1)sch组与对照组一般情况比较sch组与对照组相比,年龄、性别、三碘甲状原氨酸(ft3)、甲状腺素(ft4)未见明显差异,无统计学意义(p0.05)。促甲状腺激素(tsh)、心率、血压与对照组相比差异具有统计学意义(p0.05)。(2)sch组与对照组常规超声及tmad情况比较sch组与对照组相比,lvidd、lvids、ivsd、lvpwd、rvidd、rvids、rveda、rvesa、rvfac、lvef、tmad差异均无统计学意义(p0.05)。但是midpt、tmadmidpt%与对照组相比差异具有统计学意义(p0.05)。(3)sch组与对照组左心室心肌应变及应变率比较sch组与对照组比较,左心室的glss、gcss均减低,差异具有统计学意义(p0.05)。各节段收缩期、舒张早期及舒张晚期纵向、圆周峰值应变率(lrse、lrsa、lrss、crse、crsa、crss)与对照组相比减低,差异具有统计学意义(p0.05)。(4)sch组与对照组右心室心肌应变及应变率比较sch组与对照组相比较,右心室的glss及各节段收缩期、舒张早期及舒张晚期峰值应变率(lrse、lrsa、lrss)减低,差异具有统计学意义(P0.05)。结论:1.常规超声心动图检查不能评估早期亚临床甲减患者心脏功能受损情况。2.二维斑点追踪成像技术能够发现早期亚临床甲减患者左心室的收缩及舒张功能受损,为临床及时干预治疗提供可靠依据。3.亚临床甲减患者的右心室收缩及舒张功能受损。
[Abstract]:Objective: to evaluate the changes of left and right ventricular systolic and diastolic function in subclinical hypothyroidism patients with two dimensional speckle tracing imaging. Materials and methods: subclinical hypothyroidism group (SCH group): 34 patients with subclinical hypothyroidism were selected from January 2016 to December 2016, including 23 females, 11 males aged 35-50 years. The average age was 40.1 卤1.6 years. Normal control group: 20 healthy subjects with gender and age matched were selected as control group. 14 female, 6 male, aged 35-45 years, were selected as control group. The mean age was 39.9 卤2.8 years. The patients in each group underwent routine echocardiography in resting state, and obtained 6 standard gray-scale dynamic images of left ventricular mitral valve, parasternal papillary muscle and left ventricular papillary muscle. Left ventricular apical short axis section, apical four-chamber section, apical three-chamber section, apical two-chamber section, frame frequency more than 100 frames per second, parasternal apical short axis section, apical four-chamber section, apical three-chamber section, apical two-chamber section. More than 3 cardiac cycles were recorded on each section. Parameters related to conventional echocardiography were measured: left ventricular end-diastolic diameter (LVIDdN), left ventricular end-systolic diameter (LVIDsN), end-diastolic septal thickness (IVSdN), left ventricular posterior wall thickness (LVPWdN), right ventricular enddiastolic dimension (RV). The right ventricular end-diastolic area (RVEDAA) and the right ventricular end-systolic area (RVESAA) were calculated. The left ventricular ejection fraction (LVEF) was measured by Simpson method. The tricuspid annular systolic displacement was measured by M-mode ultrasound. Qlab9.0 software cmq program post-processing of the image, The whole longitudinal strain of left ventricle was measured in each group. The whole longitudinal strain of left ventricle was measured, and the tmad option was chosen to select the tmad option, and the whole longitudinal strain of the right ventricle was measured by using the tmad option, and the whole longitudinal strain of the right ventricle was measured by using the method of measuring the whole longitudinal strain of the left ventricle, the circumferential strain, the circumferential strain rate, the circular strain rate and the right ventricular global longitudinal strain. The maximal displacement of midpoint on the line between ventricular septal and lateral wall points and the percentage of midpoint displacement of ventricular septal to lateral wall point in left ventricular length were measured in each group. Results compared with the control group, the age and sex of the sch group were higher than that of the control group. There was no significant difference in triiodothyronine ft3, thyroxine tsh4, and there was no significant difference between them (P 0.05). TSH, heart rate, TSH, TSH, TSH, TSH, TSH, TSH, TSH, TSH, TSH, TSH, The difference of blood pressure between the control group and the control group was significant (p 0.05). There was no significant difference between the sch group and the control group in conventional ultrasound and tmad. There was no significant difference between the sch group and the control group in the lvpwdsivsdl / lvpwddftmad. However, there was no significant difference between the sch group and the control group in the rate of midmidpt% and in the control group (P 0.05), but there was no significant difference between the sch group and the control group in the blood pressure (P < 0.05), but there was no significant difference between the sch group and the control group (P > 0.05) in the comparison between the sch group and the control group. Comparison of strain and strain rate of left Ventricular Myocardium in the sch group and the control group, the comparison between the sch group and the control group was made. The GCSs of the left ventricle were significantly lower than those of the control group (P < 0.05). The peak strain rate of the left ventricle in the systolic, early diastolic and late diastolic stages was significantly lower than that in the control group, and the peak strain rate of the left ventricle was significantly lower than that in the control group. The difference was statistically significant in the right ventricular myocardial strain and strain rate in the sch group and the control group. Compared with the control group, the glss of the right ventricle and the peak strain rate of the early diastolic and late diastolic segments in the sch group were lower than those in the control group, and that in the sch group was lower than that in the control group. Conclusion: 1. Conventional echocardiography can not evaluate cardiac dysfunction in patients with early subclinical hypothyroidism .2.Two-dimensional speckle tracing imaging can find left ventricle in patients with early subclinical hypothyroidism. Impaired systolic and diastolic function, To provide a reliable basis for clinical intervention in patients with subclinical hypothyroidism of the right ventricular systolic and diastolic function damage.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R581.2;R540.45

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