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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2016, Vol. 13 ›› Issue (10) : 731 -735. doi: 10.3877/cma.j.jssn.2095-5820.2016.10.004

所属专题： 文献；

心血管超声影像学

斑点追踪技术评价系统性硬化病患者右心室心肌力学功能
熊云涛1, 曹礼庭2,†()   
  1. 1. 610000　成都大学附属医院超声科
    2. 637000　南充，川北医学院附属医院超声诊断科　四川省医学影像学重点实验室
  • 收稿日期:2015-11-24 出版日期:2016-10-01
  • 通信作者: 曹礼庭

Evaluation of right ventricular function in patients with systemic sclerosis by speckle tracking imaging

Yuntao Xiong1, Liting Cao2,†()   

  1. 1. Department of Ultrasonography, the Affiliated Hospital of Chengdu University, Chengdu 610000, China
    2. Medical Imaging Key Laboratory of Sichuan Province, Department of Ultrasonography, the Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
  • Received:2015-11-24 Published:2016-10-01
  • Corresponding author: Liting Cao
  • About author:
    Corresponding author: Cao Liting, Email:
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熊云涛, 曹礼庭. 斑点追踪技术评价系统性硬化病患者右心室心肌力学功能[J]. 中华医学超声杂志（电子版）, 2016, 13(10): 731-735.

Yuntao Xiong, Liting Cao. Evaluation of right ventricular function in patients with systemic sclerosis by speckle tracking imaging[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2016, 13(10): 731-735.

目的

应用二维斑点追踪成像（2D-STI）技术评价系统性硬化病（SSc）患者右心室心肌功能的变化。

方法

选取2012年10月至2014年12月川北医学院附属医院收治的34例SSc患者，其中弥漫皮肤型SSc（dcSSc）18例，局限皮肤型SSc（lcSSc）16例，另选取本院体检中心健康人22名作为健康对照组，行经胸超声心动图检查。应用2D-STI技术测量右心室侧壁整体收缩期纵向峰值应变（GLS）及收缩期、舒张早期、舒张晚期整体纵向峰值应变率（GLSRs、GLSRe、GLSRa），比较SSc组与健康对照组及dcSSc组与lcSSc组各指标的变化情况。分析SSc组GLS与肺动脉收缩压（PASP）及病程的相关性。

结果

（1）SSc组与健康对照组比较，GLS、GLSRs及GLSRe降低[（-20.89±5.98）% vs（-25.41±4.87）%、（-1.44±0.38）/s vs（-1.63±0.21）/s、（1.32±0.40）/s vs（1.62±0.34）/s]，差异有统计学意义（t=-2.963、-2.147、-2.953，P均<0.05），GLSRa比较[（1.51±0.46）/s vs（1.56±0.26）/s]，差异无统计学意义（t=-0.435，P>0.05）；dcSSc组与lcSSc组比较，GLS及GLSRe降低[（-19.10±6.53）% vs（-23.38±5.15）%、（1.16±0.41）/s vs（1.49±0.31）/s]，差异均有统计学意义（t=-2.098、-2.705，P均<0.05]，GLSRs及GLSRa[（-1.33±0.45）/s vs（-1.57±0.25）/s、（1.50±0.54）/s vs（1.52±0.36）/s]，差异无统计学意义（t=-1.833、-0.125，P均>0.05）。（2）SSc组GLS与PASP及病程均呈显著负相关（r=-0.447、-0.500，P均<0.01）。

结论

SSc患者右心室收缩及舒张功能均降低，dcSSc患者较lcSSc患者受损更严重。2D-STI可评价其右心室心肌力学状态改变，其GLS与病程、PASP有一定的相关性。

关键词: 斑点追踪成像，二维, 硬化病，成人, 心功能，右
Objective

To evaluate the right ventricular function by two-dimensional speckle tracking imaging (2D-STI) in patients with systemic sclerosis (SSc).

Methods

A total of 34 patients with SSc were enrolled in the Affiliated Hospital of North Sichuan Medical College from October 2012 to December 2014, including 18 patients with diffuse cutaneous SSc (dcSSc) and 16 with limited cutaneous SSc (lcSSc). For comparison, 22 matched healthy control subjects were also included in the study. All subjects underwent transthoracic echocardiography. Right ventricular free wall global longitudinal peak systolic strain (GLS) and systolic, early and late diastolic strain rate (GLSRs, GLSRe, GLSRa) were measured by 2D-STI respectively. Each parameter was compared between groups. The correlations of GLS with pulmonary arterial systolic pressure (PASP) and disease duration in patients with SSc were analyzed.

Results

(1) Compared with controls, GLS, GLSRs and GLSRe in patients with SSc decreased significantly [(-20.89±5.98)% vs (-25.41±4.87)%, (-1.44±0.38)/s vs (-1.63±0.21)/s, (1.32±0.40)/s vs (1.62±0.34)/s, t=-2.963, -2.147, -2.953, all P<0.05)]. Patients with dcSSc showed worse values in GLS and GLSRe [(-19.10±6.53)% vs (-23.38±5.15)%, (1.16±0.41)/s vs (1.49±0.31)/s, t=-2.098, -2.705, all P<0.05)], as compared with lcSSc [(-1.33±0.45)/s vs (-1.57±0.25)/s, (1.50±0.54)/s vs (1.52±0.36)/s, t=-1.833, -0.125, all P>0.05)]. (2) GLS was inversely correlated with PASP as well as disease duration (r=-0.447, -0.500, all P<0.01).

Conclusions

Right ventricular systolic and diastolic functions have damaged in patients with SSc. Patients with dcSSc show worse functions as compared to patients with lcSSc. 2D-STI analysis can be used to assess the right ventricular function accurately. GLS is moderately correlated with PASP and disease duration.

Key words: Speckle tracking imaging, two-dimensional, Scleredema adultorum, Entricular function, right
图2 SSc患者右心室侧壁应变率曲线
表1 SSc组与健康对照组一般资料及常规超声参数比较
组别 例数 男/女 年龄（岁） BMI（kg/m2） 心率（次/min） RAESD（mm） RVEDD（mm） RVOT（mm）
SSc组 34 5/29 51.7±10.0 21.0±1.2 73.6±12.3 33.8±7.2 32.5±7.4 26.7±3.1
健康对照组 22 3/19 50.9±10.4 21.5±1.2 70.6±9.1 32.3±3.5 31.1±3.1 26.3±2.3
t值/χ2值 ? 0.000a 0.287 -1.552 0.992 0.935 0.820 0.533
P值 ? >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
组别 例数 MPA（mm） PASP（mmHg） RV-tei RV-FAC（%） Em（cm/s） Am（cm/s） E/Em
SSc组 34 22.6±3.4 32.6±23.7 0.49±0.20 43.7±7.6 11.6±3.1 17.1±4.4 5.9±1.9
健康对照组 22 20.6±1.5 19.0±4.9 0.37±0.15 47.8±5.6 13.6±2.9 16.8±4.3 4.5±0.8
t值 ? 2.691 2.668 2.352 -2.164 -2.397 0.312 3.221
P值 ? <0.01 <0.05 <0.05 <0.05 <0.05 >0.05 <0.01
表2 SSc组与健康对照组及SSc两亚组间右心室侧壁整体纵向应变参数比较（±s）
组别 例数 GLS（%） GLSRs（s-1） GLSRe（s-1） GLSRa（s-1）
SSc组 34 -20.89±5.98 -1.44±0.38 1.32±0.40 1.51±0.46
健康对照组 22 -25.41±4.87 -1.63±0.21 1.62±0.34 1.56±0.26
t值 ? -2.963 -2.147 -2.953 -0.435
P值 ? <0.01 <0.05 <0.01 >0.05
组别 例数 GLS（%） GLSRs（s-1） GLSRs（s-1） GLSRa（s-1）
dcSSc组 18 -19.10±6.53 -1.33±0.45 1.16±0.41 1.50±0.54
lcSSc组 16 -23.38±5.15 -1.57±0.25 1.49±0.31 1.52±0.36
t值 ? -2.098 -1.833 -2.705 -0.125
P值 ? <0.05 >0.05 <0.05 >0.05
图4 系统性硬化病患者右心室侧壁整体收缩期纵向峰值应变与肺动脉收缩压相关散点图
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