应用超声三维斑点追踪技术评价非ST段抬高型急性冠脉综合征患者心功能变化的研究
发布时间：2019-05-29 03:44
【摘要】：目的:应用超声三维斑点追踪技术(3D-STI)对非ST段抬高型急性冠脉综合征(NSTE-ACS)患者PCI术前与术后及非冠心病患者进行心功能指标比较,并与其冠脉造影结果进行相关性分析。研究该技术在评价PCI术对NSTE-ACS患者心功能变化的临床应用价值。方法:纳入在我院住院行经皮冠脉造影(CAG)检查排除冠心病诊断的患者62例作为对照组,入选同期入院诊断为NSTE-ACS患者137例为观察组,其中急性非ST段抬高型心肌梗死(NSTEMI)患者57例,不稳定性心绞痛(UAP)患者80例。对纳入对象均行常规心脏彩超和3D-STI检查,获取左室整体纵向应变(LVGLS)、圆周应变(LVGCS)、径向应变(LVGRS)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室射血分数(LVEF),同时获取常规超声参数左室收缩末径(LVESD)、左室舒张末内径(LVEDD)、室间隔厚度(IVST)、左室后壁厚度(LVPWT),E/A值。所有患者均行CAG检查,NSTE-ACS患者行经皮冠脉介入(PCI)治疗。搜集所有患者的一般临床资料(主要包括BMI、吸烟史、高血压病史、糖尿病病史、冠心病家族史)及血化验指标N-末端B型脑钠肽(NT-pro BNP)、肌钙蛋白T(c TNT)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、超敏C反应蛋白(hs-CRP)等。对PCI术后患者进行随访3~6个月,观察患者血化验指标及超声指标的变化,记录患者发生的MACE事件。对3D-STI超声心动参数及血清学结果进行分析,对两组间参数比较采用Dunnett-t检验,多组间参数相比利用单因素方差分析法,3D-STI超声心动参数与左室射血分数进行Pearson相关性分析,观察组术前、术后各项指标比较采用配对样本t检验。结果:1.常规超声参数LVESD?LVEDD?IVST?LVPWT在NSTEMI组较UAP组及对照组均明显增大,LVEF明显降低,差异均有统计学意义(P0.05),而在UAP组及对照组之间比较无明显改变。E/A在三组间比较,仅在NSTEMI组较对照组明显减低,差异有统计学意义(P0.05)。3D-STI超声心动检查显示在NSTEMI组患者中LVGLS?LVGCS?LVEF较对照组和UAP组均明显减低,仅LVGRS较对照组明显减低(P0.05),而LVESV较对照组及UAP组均明显增加(P0.05)。在UAP组患者中LVGLS?LVGCS?LVGRS较对照组明显减低(P0.05),而LVEF?LVESV?LVEDV较对照组比较无明显变化(P0.05)。2.LVGLS?LVGCS?LVESV?NT-pro BNP?hs-CRP?c Tn T与LVEF呈负相关,且LVGLS与LVEF相关性较显著,而LVGRS?LVEDV与LVEF未发现有明显相关性(P0.05)。3.LVGLS?LVGCS?LVEF在双支病变和三支病变组中较单支病变组明显减低(P0.05),并且LVGLS?LVEF在三支病变组中较双支病变组也明显减低(P0.05)。LVGRS仅在三支病变组中较单支病变组明显减低(P0.05),在其他组间比较未见明显变化(P0.05)。LVESV在三支病变和双支病变组较单支病变组均明显增大,差异有统计学意义(P0.05)。4.LVGLS?LVGCS?LVGRS?LVEF在UAP组、NSTEMI组中术后均明显增加,而LVESV?LVEDV术后则明显减小(P0.05)。LVGLS?LVGCS?LVEF在单支病变组、双支病变组、三支病变组中术后均明显增加,LVGRS在三支病变组及双支病变组术后明显增加(P0.05)。LVESV?LVEDV在双支病变组及三支病变组术后均明显减小(P0.05),而在单支病变组术后无明显变化(P0.05)。结论:1.3D-STI超声心动技术较常规心脏彩超,能够更客观、有效、全面、定量的反映NSTE-ACS患者左室心功能状况,具有一定的临床应用价值。2.PCI术可以明显改善NSTE-ACS患者心功能状况并改善预后,3D-STI超声技术可以有效的评价PCI疗效。3.3D-STI超声心动参数LVGLS?LVGRS?LVGCS在NSTE-ACS患者中PCI术后均有改善。其中LVGLS较其他参数对评价心功能变化的敏感性更高。4.3D-STI超声技术可以很好的评价冠状动脉缺血程度。
[Abstract]:Objective: To compare the cardiac function of non-ST-segment-elevation acute coronary syndrome (NSTE-ACS) patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) by ultrasonic three-dimensional spot-tracking (3D-STI). To evaluate the clinical value of the technique in evaluating the cardiac function of NSTE-ACS patients. Methods:62 cases of patients with coronary heart disease (CHD) were treated with coronary angiography (CAG) in our hospital, and in the control group,137 patients with NSTE-ACS were enrolled in the same period, and the patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) were enrolled in 57 cases. 80 patients with unstable angina pectoris (UAP). Left ventricular integral longitudinal strain (LVGLS), circumferential strain (LVGCS), radial strain (LVGRS), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), At the same time, the left ventricular systolic end diameter (LVESD), the left ventricular end-diastolic diameter (LVEDD), the ventricular septal thickness (IVST), the left ventricular posterior wall thickness (LVPWT), and the E/ A value were obtained. All patients underwent CAG and NSTE-ACS was treated with percutaneous coronary intervention (PCI). The general clinical data of all patients (including BMI, smoking history, history of hypertension, history of diabetes, family history of coronary heart disease) and blood test index N-terminal B-type brain natriuretic peptide (NT-pro BNP), troponin T (c-TNT), creatine kinase (CK), and creatine kinase isoenzyme (CK-MB) were collected. Hypersensitive C-reactive protein (hs-CRP), etc. The patients with PCI were followed up for 3 to 6 months, and the changes of the blood test index and the ultrasonic index of the patients were observed, and the MACE events occurred in the patients were recorded. The 3-D-STI echocardiographic parameters and the serological results were analyzed. Dunnett-t test was used to compare the parameters between the two groups. The correlation between the three-group parameters and the left ventricular ejection fraction was analyzed by using one-factor analysis of variance method, 3D-STI echocardiography and left ventricular ejection fraction. The post-operative indexes were compared with the paired t-test. Results:1. The LVESD? LVEDD? IVST? LVPWT in the NSTEMI group was significantly higher in the NSTEMI group than in the UAP group and the control group (P0.05), and there was no significant change between the UAP group and the control group. The results showed that the LVGLS-LVGCS-LVEF in the patients with NSTEMI was significantly lower in the NSTEMI group than in the control group (P0.05). Compared with the control group and UAP group, the LVESV was significantly increased (P0.05). LVGLS-LVGCS-LVGRS in the patients with UAP group was significantly lower than that in the control group (P0.05). LVEF-LVESV? LVESV? NT-pro BNP? hs-CRP? c Tn T was negatively correlated with LVEF, and the correlation between LVGLS and LVEF was significant. The LVGRS-LVEDV had no significant correlation with LVEF (P0.05). There was no significant change between the other groups (P0.05). The LVESV was significantly increased in the three-vessel and double-branch lesion groups, and the difference was significant (P0.05). The results showed that LVGRS increased significantly after operation (P <0.05). LVESV? LVEDV decreased significantly after operation (P0.05). Conclusion: 1.3 D-STI echocardiography is a more objective, effective, comprehensive and quantitative analysis of left ventricular function in patients with NSTE-ACS. The 3D-STI ultrasound technique can be used to evaluate the curative effect of the PCI. The LVGLS-LVGRS-LVGCS of the 3D-STI echocardiography is improved after PCI in the patients with NSTE-ACS. The sensitivity of LVGLS to the change of heart function was higher than that of other parameters.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4
本文编号：2487614
[Abstract]:Objective: To compare the cardiac function of non-ST-segment-elevation acute coronary syndrome (NSTE-ACS) patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) by ultrasonic three-dimensional spot-tracking (3D-STI). To evaluate the clinical value of the technique in evaluating the cardiac function of NSTE-ACS patients. Methods:62 cases of patients with coronary heart disease (CHD) were treated with coronary angiography (CAG) in our hospital, and in the control group,137 patients with NSTE-ACS were enrolled in the same period, and the patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) were enrolled in 57 cases. 80 patients with unstable angina pectoris (UAP). Left ventricular integral longitudinal strain (LVGLS), circumferential strain (LVGCS), radial strain (LVGRS), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), At the same time, the left ventricular systolic end diameter (LVESD), the left ventricular end-diastolic diameter (LVEDD), the ventricular septal thickness (IVST), the left ventricular posterior wall thickness (LVPWT), and the E/ A value were obtained. All patients underwent CAG and NSTE-ACS was treated with percutaneous coronary intervention (PCI). The general clinical data of all patients (including BMI, smoking history, history of hypertension, history of diabetes, family history of coronary heart disease) and blood test index N-terminal B-type brain natriuretic peptide (NT-pro BNP), troponin T (c-TNT), creatine kinase (CK), and creatine kinase isoenzyme (CK-MB) were collected. Hypersensitive C-reactive protein (hs-CRP), etc. The patients with PCI were followed up for 3 to 6 months, and the changes of the blood test index and the ultrasonic index of the patients were observed, and the MACE events occurred in the patients were recorded. The 3-D-STI echocardiographic parameters and the serological results were analyzed. Dunnett-t test was used to compare the parameters between the two groups. The correlation between the three-group parameters and the left ventricular ejection fraction was analyzed by using one-factor analysis of variance method, 3D-STI echocardiography and left ventricular ejection fraction. The post-operative indexes were compared with the paired t-test. Results:1. The LVESD? LVEDD? IVST? LVPWT in the NSTEMI group was significantly higher in the NSTEMI group than in the UAP group and the control group (P0.05), and there was no significant change between the UAP group and the control group. The results showed that the LVGLS-LVGCS-LVEF in the patients with NSTEMI was significantly lower in the NSTEMI group than in the control group (P0.05). Compared with the control group and UAP group, the LVESV was significantly increased (P0.05). LVGLS-LVGCS-LVGRS in the patients with UAP group was significantly lower than that in the control group (P0.05). LVEF-LVESV? LVESV? NT-pro BNP? hs-CRP? c Tn T was negatively correlated with LVEF, and the correlation between LVGLS and LVEF was significant. The LVGRS-LVEDV had no significant correlation with LVEF (P0.05). There was no significant change between the other groups (P0.05). The LVESV was significantly increased in the three-vessel and double-branch lesion groups, and the difference was significant (P0.05). The results showed that LVGRS increased significantly after operation (P <0.05). LVESV? LVEDV decreased significantly after operation (P0.05). Conclusion: 1.3 D-STI echocardiography is a more objective, effective, comprehensive and quantitative analysis of left ventricular function in patients with NSTE-ACS. The 3D-STI ultrasound technique can be used to evaluate the curative effect of the PCI. The LVGLS-LVGRS-LVGCS of the 3D-STI echocardiography is improved after PCI in the patients with NSTE-ACS. The sensitivity of LVGLS to the change of heart function was higher than that of other parameters.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4
【参考文献】
相关期刊论文 前10条
1 王子宽;杨竞肖;白宝宝;金葵花;郭晓兰;;急性心肌梗死患者血清hs-CRP及CK-MB水平与患者Gensini评分相关性研究[J];陕西医学杂志;2017年01期
2 陈丽;王效增;李毅;王贺阳;荆全民;王耿;徐凯;韩雅玲;;冠脉病变支数对冠脉介入治疗术后1年主要心脑血管事件影响[J];临床军医杂志;2016年11期
3 方达伟;;冠心病患者PCI手术前后左心室运动功能分析[J];中外医疗;2016年28期
4 李韶南;刘震;黄慧芳;陈平安;雷晓明;;老年急性冠脉综合征患者胰岛素抵抗与冠状动脉钙化积分及预后的关系[J];中华老年多器官疾病杂志;2016年08期
5 王利芳;杨晋;;急性左心衰竭为主要表现的急性心肌梗死的临床研究[J];中国实用医刊;2016年15期
6 张庆华;李燕萍;;三维斑点追踪技术用于急性冠状动脉综合征PCI术后的评价[J];国际医学放射学杂志;2016年04期
7 王小亭;赵华;刘大为;张宏民;隆云;柴文昭;张青;;重症急性左心收缩功能不全患者心脏超声评价及其与预后关系的研究[J];中华内科杂志;2016年06期
8 朱威;徐琳;邱健;马骏;郭琰;招慧;雷洪强;蔡泽坤;;基于血压变异性的评分系统与高血压患者靶器官损害的相关性[J];南方医科大学学报;2016年04期
9 侯琳琳;王邦宁;高潮;陈振飞;冯俊;;急性心肌梗死患者血浆NT-proBNP水平与心肌坏死程度及近期预后的关系[J];浙江医学;2016年07期
10 李丹;张敏郁;高宇;王建华;汪洪斌;王秀玲;;三维斑点追踪成像技术评价冠状动脉不同程度狭窄心肌应变[J];中华医学超声杂志(电子版);2016年03期
相关硕士学位论文 前5条
1 李林;超声三维斑点追踪技术对冠心病患者PCI前后左室壁运动的评价与分析[D];蚌埠医学院;2014年
2 邓玉姣;超声新技术评价急性心肌梗死和左心室心尖球形综合征患者左心室容积及心肌功能[D];大连医科大学;2014年
3 曾乐凤;应用实时三维斑点追踪技术评价肥厚型心肌病左室整体和局部的收缩功能[D];浙江大学;2014年
4 王丽萍;斑点追踪成像技术及实时三维超声心动图评价冠心病患者PCI或CABG术前后左室心功能变化[D];第三军医大学;2012年
5 郭珊;实时三维超声心动图定量评估心肌梗死后左室整体及局部心肌重量和功能的临床研究[D];福建医科大学;2007年
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