实时三平面定量组织速度成像及应变率成像技术评价干燥综合征患者左室舒张功能

发布时间：2018-06-12 19:25

本文选题：干燥综合征 + 三平面定量组织速度成像　；参考：《昆明医科大学》2015年硕士论文

【摘要】：目的：采用实时三平面(real-time three-plane, RT-3PE)定量组织速度成像(Quantitative tissue velocity imaging, QTVI)及应变率成像(Strain rate imaging, SRI)技术,测量正常人和干燥综合征患者舒张期左室壁运动速度及左室心肌应变、应变率,评价不同类型的干燥综合征患者的左室舒张功能,探讨该技术对干燥综合征患者心脏功能变化的初步诊断价值。对象：选择2014年6月至2015年2月于昆明医科大学第一附属医院风湿免疫科住院患者。根据2002年美国-欧洲干燥综合征分类标准共识确诊为干燥综合征的患者27例。再按是否合并类风湿性关节炎,分为原发性干燥综合征患者(原发组)及继发性干燥综合征组(继发组)两个亚组,原发组15例,继发组12例,健康对照组30例。排除标准：1)各种先天性心脏病、肥厚型心肌病、严重的瓣膜病、冠状动脉粥样硬化性心脏病、原发性高血压病等其它心脏病变；2)代谢性疾病：糖尿病、血脂代谢异常者；3)三平面图像质量差,无法获取资料信息者。方法：选用美国GE E9彩色多普勒超声诊断仪,M5S探头,安静状态下获取二维灰阶图像,测量左室各常规参数,M-型超声测量左室射血分数(LVEF, left ventricular ejection fraction),应用脉冲多普勒超声获得二尖瓣口血流频谱,测量舒张早期峰值血流速度(Ep)及舒张晚期峰值血流速度(Ap),并计算Ep/Ap。运用4V探头,获取心尖四腔观RT-3PE图像,采用RT-3PEQTVI和RT-3PE SRI技术获取并储存图像,脱机分析左室12节段心肌的舒张早期峰值速度(Ve),舒张晚期峰值速度(Va),舒张早期峰值应变率(SRe),舒张晚期峰值应变率(SRa),计算左室平均Ve, Va, Ve/Va,左室SRe/SRa,利用SPSS17.0统计软件对不同分组的干燥综合征患者所对应室壁的各舒张期峰值、应变峰值进行比较分析。结果：1.与正常组比较,干燥综合征患者心脏结构、左室收缩功能指标差异无统计学意义(P0.05)。2.本研究应用脉冲多普勒超声获得二尖瓣口血流频谱,计算Ep/Ap,正常对照组和干燥综合征组比较差异均无统计学意义。3.运用RT-3PEQTVI技术：3.1与正常组对比：原发组后间隔基底段Ve减小,差异有统计学意义外,其余11个节段的Ve,12个节段的Ve/Va, mVe, mVe/mVa无明显降低,Va, mVa无明显升高,差异无统计学意义。继发组12个节段Ve, Ve/Va, mVe, mVe/mVa降低,Va, mVa升高,差异有统计学意义。3.2与原发组比较：继发组12个节段Ve, Ve/Va, mVe, mVe/mVa降低；Va,mVa升高,差异有统计学意义。4.运用RT-3PE SRI技术：4.1与正常组对比：原发组12个节段SRe和SRa, SRe/SRa无明显变化,差异无统计学意义。继发组12个节段SRa差异无统计学意义,SRe, SRe/SRa降低,差异有统计学意义。4.2与原发组对比：继发组12个节段除SRa无明显变化,差异无统计学意义外,SRe, SRe/SRa有明显变化,差异有统计学意义。结论：1.干燥综合征患者左室舒张功能的改变早于收缩功能异常和左室形态改变。2.本次研究应用脉冲多普勒超声获得二尖瓣口血流频谱,计算Ep/Ap,该指标评价左室舒张功能不敏感。3. RT-3PE QTVI与RT-3PE SRI技术评价干燥综合征患者的左室舒张功能早于并优于单纯的Ep/Ap峰方法。4. RT-3PE SRI技术中SRe, SRe/SRa均可作为左室舒张功能受损评价指标。RT-3PE QTVI技术中Ve, Va, Ve/Va, mVe, mVa, mVe/mVa均可作为左室舒张功能受损评价指标。5. RT-3PE QTVI技术与RT-3PE SRI技术对干燥综合征患者的左室舒张功能评价相关指标对比,RT-3PE QTVI指标Ve较为敏感,RT-3PE QTVI优于RT-3PE SRI技术。
[Abstract]:Objective: to measure the velocity of left ventricular wall movement and left ventricular myocardial strain and strain rate in normal and Sjogren syndrome patients by using real-time three plane (real-time three-plane, RT-3PE) quantitative tissue velocity imaging (Quantitative tissue velocity imaging, QTVI) and strain rate imaging (Strain rate imaging, SRI). The left ventricular diastolic function of the patients with Sjogren syndrome and the preliminary diagnostic value of this technique on cardiac function changes in patients with Sjogren syndrome. Object: from June 2014 to February 2015 at the First Affiliated Hospital of Kunming Medical University, patients in the Department of Rheumatology, according to the consensus of the United States European Sjogren syndrome classification standard in 2002. 27 patients with Sjogren syndrome were divided into two subgroups, primary Sjogren syndrome (primary group) and secondary Sjogren syndrome group (secondary group), 15 cases in primary group, 12 in secondary group, 30 in healthy control group, and 30 in healthy control group. 1) all kinds of congenital heart disease, hypertrophic cardiomyopathy, severe valve Membrane disease, coronary atherosclerotic heart disease, primary hypertension and other heart diseases; 2) metabolic diseases: diabetes, abnormal blood lipid metabolism; 3) the poor quality of the three plane images. Methods: the American GE E9 color Doppler hyperacoustic diagnostic apparatus, the M5S probe, and the two dimensional gray scale under quiet state The left ventricular parameters were measured in the image. The left ventricular ejection fraction (LVEF, left ventricular ejection fraction) was measured by M- ultrasound. The mitral valve flow spectrum was obtained by pulsed Doppler ultrasound. The early diastolic peak blood flow velocity (Ep) and the late diastolic peak blood flow velocity (Ap) were measured, and 4V probes were used to obtain the four cavities of the apex. RT-3PE images, RT-3PEQTVI and RT-3PE SRI techniques were used to obtain and store images. The early diastolic peak velocity (Ve), late diastolic peak velocity (Va), early diastolic peak strain rate (SRe) and late diastolic peak strain rate (SRa) were analyzed. The left ventricular mean Ve, Va, Ve/Va, left ventricular SRe/SRa were calculated. Compared with the normal group, 1. compared with the normal group, there was no significant difference in cardiac structure and left ventricular systolic function index in patients with Sjogren syndrome (P0.05).2. in this study, pulse Doppler ultrasound was used to obtain mitral valve flow frequency The difference between the normal control group and the Sjogren syndrome group was no significant difference between the normal control group and the Sjogren syndrome group.3. using RT-3PEQTVI technique: 3.1 compared with the normal group, the Ve decreased in the basal segment of the primary group, and the difference was statistically significant. The Ve of the other 11 segments, the Ve/Va of the 12 segments, mVe, mVe/mVa did not decrease obviously, and the Va, mVa did not rise obviously, and the difference was poor. There was no statistical significance. 12 segments of secondary group Ve, Ve/Va, mVe, mVe/mVa, Va, mVa increased, and the difference was statistically significant between.3.2 and the original group: secondary group 12 segments Ve, Ve/Va, mVe, mVe/mVa decrease; Va, the difference was statistically significant: 4.1 of the normal group: 12 segments of the primary group There was no significant difference between SRa and SRe/SRa. There was no statistical difference between the 12 segments of secondary group, SRe, SRe/SRa decreased, and the difference was statistically significant between.4.2 and the original group: there was no significant difference between the secondary group and the secondary group except SRa, there was no significant difference between SRe and SRe/SRa, the difference was statistically significant. The difference was statistically significant. 1. the changes of left ventricular diastolic function in patients with Sjogren syndrome were earlier than systolic dysfunction and left ventricular shape change.2.. This study used pulsed Doppler ultrasound to obtain mitral valve flow spectrum and calculated Ep/Ap. This index was used to evaluate left ventricular diastolic dysfunction.3. RT-3PE QTVI and RT-3PE SRI to evaluate the left ventricle of patients with Sjogren syndrome. The diastolic function is earlier than that of the simple Ep/Ap peak method.4. RT-3PE SRI technique, SRe, SRe/SRa can be used as a marker of left ventricular diastolic function damage evaluation.RT-3PE QTVI technology, Ve, Va, Ve/Va, mVe, etc. The relative indexes of left ventricular diastolic function were compared, RT-3PE QTVI index Ve was more sensitive, and RT-3PE QTVI was superior to RT-3PE SRI technology.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R593.2

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