發(fā)布時間：2018-01-15 07:18

  本文關(guān)鍵詞：三維斑點追蹤成像技術(shù)對類風(fēng)濕關(guān)節(jié)炎患者左室收縮功能的評價　出處：《鄭州大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 三維斑點追蹤成像 類風(fēng)濕關(guān)節(jié)炎 左室收縮功能 應(yīng)變 扭轉(zhuǎn)

【摘要】：背景與目的心血管疾病在類風(fēng)濕性關(guān)節(jié)炎(rheumatoid arthritis,RA)患者中發(fā)生的風(fēng)險增高,并且是導(dǎo)致RA患者死亡的主要因素之一。因此,RA患者亞臨床心臟受累情況的評估及診斷對于疾病的長期管理有重要作用。三維斑點追蹤成像(Three-dimensional speckle tracking imaging,3D-STI)技術(shù)實現(xiàn)了對左室心肌應(yīng)變、旋轉(zhuǎn)及扭轉(zhuǎn)進(jìn)行無創(chuàng)、可靠的評價。本研究通過應(yīng)用3D-STI技術(shù)分析RA患者左室心肌應(yīng)變、旋轉(zhuǎn)及扭轉(zhuǎn)參數(shù)評價其左室收縮功能,探討該技術(shù)對RA患者左室收縮功能異常的檢測價值。方法該研究選取RA患者74例,并根據(jù)病程將RA患者分為兩組:36例病程5年者為RA1組,38例病程5年者為RA2組。所有受檢者分別行經(jīng)胸常規(guī)二維超聲心動圖獲取二維數(shù)據(jù)。采集左室三維全容積動態(tài)圖像并運用3D-STI分析軟件進(jìn)行分析,剔除圖像質(zhì)量差及臨床資料不合格的病人,獲取三維參數(shù):(1)左室心肌16節(jié)段縱向峰值應(yīng)變(PLS)、圓周峰值應(yīng)變(PCS)、徑向峰值應(yīng)變(PRS)及面積峰值應(yīng)變(PAS);(2)左室整體縱向峰值應(yīng)變(GLS)、整體圓周峰值應(yīng)變(GCS)、整體徑向峰值應(yīng)變(GRS)及整體面積峰值應(yīng)變(GAS),左室整體旋轉(zhuǎn)角度峰值(LVrot)、整體扭轉(zhuǎn)角度峰值(LVtw)、整體徑向位移(Dr)、整體縱向位移(Dl)、整體三維位移(D3d)。并與年齡、性別相匹配的30例健康體檢者(對照組)進(jìn)行上述參數(shù)的組間比較。繪制ROC曲線分析3D-STI檢測出RA患者左室收縮功能異常的準(zhǔn)確性。結(jié)果1.隨著RA病程的延長,左室心肌各節(jié)段收縮功能均可受損,表現(xiàn)為各節(jié)段應(yīng)變減低。與對照組相比較,RA1組及RA2組各節(jié)段PLS、PCS、PRS、PAS均減低,但RA1組僅個別節(jié)段的PLS(5個節(jié)段)、PCS(4個節(jié)段)、PRS(1個節(jié)段)、PAS(4個節(jié)段)差異有統(tǒng)計學(xué)意義(P0.05);RA2組絕大多數(shù)節(jié)段PLS(15個節(jié)段)、PCS(14個節(jié)段)、PRS(12個節(jié)段)、PAS(16個節(jié)段)差異有統(tǒng)計學(xué)意義(P0.05)。與RA1組相比較,RA2組各節(jié)段PLS、PCS、PRS及PAS減低,大部分節(jié)段差異有統(tǒng)計學(xué)意義(P0.05)。2.RA1組左室GLS、GCS、GRS及GAS低于對照組,但差異無統(tǒng)計學(xué)意義(P0.05);RA2組左室GLS、GCS、GRS及GAS較對照組均減低,差異均有統(tǒng)計學(xué)意義(P0.05),與RA1組相比,GAS和GLS減低,差異有統(tǒng)計學(xué)意義(P0.05)。3.RA1組LVrot、LVtw、Dr、Dl、D3d與對照組相比無明顯差異(P0.05);在RA2組中,LVrot、LVtw、Dr、Dl、D3d較對照組明顯增高,差異有統(tǒng)計學(xué)意義(P0.05);Dr較RA1組增加,差異有統(tǒng)計學(xué)意義(P0.05)。LVtw與Dr(r=0.72)、Dl(r=0.63)及D3d(r=0.76)相關(guān)性較好。4.3D-STI整體應(yīng)變參數(shù)GLS、GCS、GRS及GAS的ROC曲線下面積分別為0.81、0.67、0.65、0.86,其中GAS對于檢測RA患者左室收縮功能異常的效能高于GLS、GCS、GRS。Pearson相關(guān)分析表明GLS(r=0.80)、GCS(r=0.68)、GRS(r=-0.66)及GAS(r=0.84)與RA患者的病程有良好的相關(guān)性。結(jié)論RA患者隨著病程的延長,左室心肌收縮功能受損,3D-STI技術(shù)通過評估左室心肌應(yīng)變、旋轉(zhuǎn)及扭轉(zhuǎn)等參數(shù),能早期準(zhǔn)確地檢測出RA患者左室收縮功能的異常,對評估亞臨床心臟受累情況有重要的作用。面積應(yīng)變作為3D-STI技術(shù)的新參數(shù),能更準(zhǔn)確地評價左室收縮功能。
[Abstract]:Background and objective cardiovascular disease in rheumatoid arthritis (rheumatoid arthritis, RA) in higher risk patients, and is one of the main causes of death in patients with RA. Therefore, the evaluation and diagnosis of RA patients with subclinical cardiac involvement and plays an important role in long-term tube disease. Imaging three-dimensional speckle tracking (Three-dimensional speckle tracking imaging, 3D-STI) technology to achieve the left ventricular myocardium strain, rotation and torsion of noninvasive, reliable evaluation. This study through the application of 3D-STI technology to analyze myocardial strain in patients with left ventricular RA, rotation and torsion parameters to evaluate the left ventricular systolic function, to explore the value of the detection technology for abnormal left ventricular systolic function in RA patients. Methods 74 RA patients were selected in the study, and according to the course of RA patients were divided into two groups: 36 cases of 5 years duration for the RA1 group, 38 cases of 5 years duration for the RA2 group. All subjects were divided Don't transthoracic two dimensional echocardiography to obtain two-dimensional data acquisition. The left ventricular dynamic three-dimensional full volume image and use 3D-STI software to analyze and eliminate poor image quality and clinical data of patients with unqualified, to obtain the 3D parameters: (1) longitudinal peak left ventricular segmental strain 16 (PLS), circumferentialpeak strain (PCS), peak radial strain (PRS) and peak area strain (PAS); (2) the left ventricular longitudinal peak strain (GLS), the overall peak circumferential strain (GCS), global radial peak strain (GRS) and the whole area of the peak strain (GAS), left ventricular rotation angle peak (LVrot), the overall peak twist (LVtw), radial displacement integral (Dr), the vertical displacement of the overall (Dl), the overall three-dimensional displacement (D3d). And 30 healthy age, gender matched (control group) were compared between the groups. Analysis of the parameters detected by 3D-STI in patients with RA left ventricular ROC curve 鏀剁緝鍔熻兘寮傚父鐨勫噯紜，

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