三维斑点追踪技术评价系统性红斑狼疮患者左心室收缩功能及舒张功能

来源期刊：广州医药 | 58-64 发布时间：2021-11-28 收稿时间：2025/11/13 17:53:35 阅读量：33

作者：: 郭雪婷,

秦文娟,

黄磊,

董珊珊,

王忠,

芦桂林,

关键词：: 超声心动描记术系统性红斑狼疮左心室功能彩色多普勒; Echocardiography Systemic lupus erythematosus Left ventricular function Color Doppler

DOI：: 10.3969/j.issn.1000-8535.2020.02.013

收稿时间：: 2019-11-13
修订日期：
接收日期：
引用总数：: 0

目的运用三维斑点追踪成像(3D-STE)技术,检测系统性红斑狼疮(SLE)患者的左室收缩期峰值应变(S)和应变率(Sr)及舒张指数,探讨其评价 SLE 患者左室整体收缩及舒张功能的临床应用价值。方法选择 30 例 SLE 患者(SLE 组)和 30 例正常人(对照组),分别对其进行二维超声心动图和3D-STI检查,获取心尖四腔、两腔、三腔及心尖长轴二维超声及M型超声切面,测量左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVEDs)、室间隔舒张末期厚度(IVSd)、室间隔收缩末期厚度(IVSs)、左心室后壁舒张末期厚度(LVPWd)、左心室后壁收缩末期厚度(LVPWs)、左心室射血分数(LVEF)、左心室缩短分数(LVFS)、每搏输出量(SV)、左室舒张末期容积(EDV)、收缩末期容积(ESV)、心输出量(CO)、球形指数(SPI)、左室舒张末期质量(LV EDmass)、左室收缩末期质量(LV ESmass)。应用3D-STI行心肌运动分析, 测量左心室整体纵向、圆周、径向及面积收缩期峰值应变(GLS、GCS、GRS、GAS),经胸采集四维全容积图像,应用公式计算各方向相应的舒张期前1/3点时的应变显像舒张指数(SI-DI),公式为(SI-DI=(A-B)/A×100%)。应用统计学分析上述指标在各组间的差异性及其之间的相关性。结果 SLE 组超声心动图的测量数值(LVEF、 LVFS、SV、EDV、CO、LV EDmass、LV ESmass)较对照组降低,差异有统计学意义(P＜0.05),(LVEDd、LVEDs、IVSd、IVSs、LVPWd、LVPWs、ESV、SPI) 与对照组比较, 差异亦均无统计学意义(P＞0.05)。SLE组左心室 GLS、GCS、GRS、GAS均较对照组减低, 差异均有统计学意义(P<0.05)。GAS诊断SLE的敏感度为93.3%,高于GLS(80%)、GCS(66.7%)、GRS(86.7%),GCS诊断SLE的特异度为(93.3%),高于GLS(86.7%)、GAS(86.7%)和GRS(73.3%);应用公式计算得出,SLE组左心室L-SI-DI、C-SI-DI、R-SI-DI 及A-SI-DI均低于正常对照组,差异均有统计学意义(P<0.05);ROC 曲线显示C-SI-DI敏感度(93.3%)及L-SI-DI敏感度(86.7%)高于R-SI-DI(80.0%)、A-SI-DI(80.0%);A-SI-DI特异度(93.3%)及R-SI-DI特异度(93.3%)高于L-SI-DI(73.3%)、C-SI-DI(73.3%)。结论 SLE 患者左室总体收缩及舒张功能减低,4D-STI超声斑点追踪技术可早期检测 SLE 患者左心室收缩及舒张功能的异常。

Objective To detect left ventricular systolic peak strain(S), strain rate(Sr) and diastolic index in patients with systemic lupus erythematosus(SLE) by three-dimensional speckle tracking imaging(3D-STE), and to evaluate the left ventricular total in SLE patients and clinical application value of systolic and diastolic function. Methods Thirty patients with SLE(SLE group) and 30 normal controls(control group) were enrolled. Two-dimensional echocardiography and 4D-STI were performed to obtain sections of apical four-chamber, two-chamber, three-chamber and apical long axis of ultrasound and m-mode ultrasound. To measure left ventricular end-diastolic diameter(LVEDd), left ventricular end-systolic diameter(LVEDs), ventricular septal end-diastolic thickness(IVSd), ventricular septal end-systolic thickness(IVSs), left ventricular posterior wall diastolic end-stage thickness(LVPWd), left ventricular posterior wall end-systolic thickness(LVPWs), left ventricular ejection fraction(LVEF), left ventricular shortening fraction(LVFS), stroke volume(SV), left ventricular end-diastolic volume(EDV), end-systolic volume(ESV), cardiac output(CO), spherical index(SPI), left ventricular end-diastolic mass(LV EDmass), left ventricular end-systolic mass(LV ESmass). 4D-STI myocardial motion analysis, the total longitudinal, circumferential, and radial and area systolic peak strains(GLS, GCS, GRS, GAS) of the left ventricle were measured, and the four-dimensional full-volume images were collected through the thoracic, and the formula was used to calculate the first 1/3 of the diastolic phase in each direction. The formula of strain imaging diastolic index(SI-DI) is(SI-DI=(AB)/A×100%). Statistical analysis was used to analyze the differences between the above indicators and the correlation between the groups. Results The measured values of two-dimensional echocardiography(LVEF, LVFS, SV, EDV, CO, LV EDmass, LV ESmass) in the SLE group were lower than those in the control group, and the difference was statistically significant(P＜0.05). In LVEDd, LVEDs, IVSd, IVSs, LVPWd, LVPWs, SPI, there were no significant differences compared with that of control group(P＞0.05). The left ventricular GLS, GCS, GRS, and GAS in the SLE group were lower than those in the control group. The differences were statistically significant(P<0.05). The sensitivity of GAS in the diagnosis of SLE was 93.3%, higher than GLS(80%), GCS(66.7%), and GRS(86.7%). The specificity of GCS for the diagnosis of SLE was(93.3%), higher than GLS(86.7%), GAS(86.7%) and GRS(73.3%). The left ventricle L-SI-DI, C-SI-DI, in the SLE group was calculated by the formula. R-SI-DI and A-SI-DI were lower than the normal control group, the difference was statistically significant(P<0.05);the ROC curve showed C-SI-DI sensitivity(93.3%) and L-SI-DI sensitivity(86.7%) was higher than R-SI-DI(80.0%), A-SI-DI(80.0%);A-SI-DI specificity(93.3%) and R-SI-DI specificity(93.3%) was higher than L-SI-DI(73.3%) and C-SI-DI(73.3%). Conclusion Total left ventricular systolic and diastolic function in patients with SLE are reduced. 4D-STI ultrasound speckle tracking technique can detect left ventricular systolic and diastolic dysfunction in patients with SLE.

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