發(fā)布時(shí)間：2018-03-23 06:10

  本文選題：二維斑點(diǎn)追蹤技術(shù)　切入點(diǎn)：先天性甲狀腺功能低下　出處：《吉林大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：先天性甲狀腺功能低下(congenital hypothyroidism，CH，簡稱甲低)是目前一種兒科常見的內(nèi)分泌疾病，臨床表現(xiàn)為永久性或暫時(shí)性的甲狀腺激素水平降低及出生后促甲狀腺激素(TSH)水平升高。心臟是甲狀腺激素作用的一個(gè)重要靶器官，甲狀腺激素對維持心臟功能具有重要的意義。甲狀腺激素可調(diào)節(jié)心肌細(xì)胞多種基因的轉(zhuǎn)錄，甲狀腺激素T3與核受體結(jié)合促進(jìn)蛋白質(zhì)的合成，，從而影響氨基酸和糖類等在細(xì)胞膜上的運(yùn)輸，同時(shí)甲狀腺激素也影響肌漿網(wǎng)對鈣離子的吸收和膜鈣ATP酶活性。此外，甲狀腺激素還有核外作用，如短期內(nèi)T3變化可以改變心臟鈉、鈣離子通道特性，改變細(xì)胞內(nèi)鈉、鈣離子水平，從而影響心臟收縮及節(jié)律變化。甲狀腺激素可以增加心肌細(xì)胞腎上腺素能受體的基因表達(dá)，增強(qiáng)交感-腎上腺素系統(tǒng)的敏感性；還可以降低外周血管阻力、提高心排血量。Heron MI等實(shí)驗(yàn)室研究表明，甲狀腺激素對冠狀動脈微小動脈生長有一定的影響，甲狀腺功能減低時(shí)可抑制微小動脈生長，甲亢時(shí)，則相反。國內(nèi)動物實(shí)驗(yàn)提示甲狀腺激素減少可使新生大鼠心肌鈣轉(zhuǎn)運(yùn)蛋白表達(dá)異常，直接抑制相關(guān)酶的活性，導(dǎo)致心肌細(xì)胞內(nèi)Ca2+超載，從而引起心臟收縮和舒張功能下降。 目的：探討甲低患兒左室整體及局部收縮功能的改變，本研究應(yīng)用二維斑點(diǎn)追蹤技術(shù)對甲低患兒左室縱向收縮功能進(jìn)行檢測，并探討其臨床應(yīng)用價(jià)值。 方法：二維斑點(diǎn)追蹤成像技術(shù)（two dimension speckle-trackingimaging,2D-STI）是在二維的基礎(chǔ)上，在心臟室壁中選定一定范圍的感興趣區(qū)。隨著心動周期，分析軟件根據(jù)組織灰階自動逐幀追蹤上述感興趣區(qū)內(nèi)心肌組織像素的位置和運(yùn)動，并與第一幀圖像中的位置相比較，計(jì)算整個(gè)感興趣區(qū)內(nèi)各節(jié)段心肌的變形。2D-STI技術(shù)與傳統(tǒng)超聲技術(shù)相比,不受聲束方向與室壁運(yùn)動方向間夾角的影響，無角度依賴性，能更準(zhǔn)確地反映心肌的局部收縮和舒張功能。研究中應(yīng)用的自動功能成像(automated function imaging，AFI)是斑點(diǎn)追蹤成像技術(shù)中的實(shí)用性分析軟件，能迅速分析獲取室壁運(yùn)動異常的數(shù)據(jù)和牛眼圖。 本研究選取我院診斷為甲低的患兒35例及與患兒年齡相匹配的正常兒童30例。兩組研究對象均排除其他疾病。應(yīng)用AFI分析軟件測量左室壁各節(jié)段收縮縱向峰值應(yīng)變(longitudinal peak systolic strain,LPSS)、及該切面收縮期總應(yīng)變（GLS）、平均總應(yīng)變(GLS-Avg)、18節(jié)段的應(yīng)變曲線及牛眼圖。 結(jié)果：（1）左室收縮功能常規(guī)參數(shù)比較:甲低組左室射血分?jǐn)?shù)（LVEF）和左室短軸縮短率(LVFS%)與正常對照組比較，差異無統(tǒng)計(jì)學(xué)意義（P0.05）。(2)左室壁收縮期縱向峰值應(yīng)變（LPSS）比較:與正常對照組相比甲低患兒左室前壁基底段，側(cè)壁心尖段、室間隔基底段、中間段，后壁收縮期縱向峰值應(yīng)變明顯減低（P0.05）。(3)左室各切面收縮期總應(yīng)變及平均總應(yīng)變的比較:左室整體收縮期應(yīng)變（GLS）明顯低于正常組（P0.05）。 結(jié)論：本研究中使用AFI技術(shù)能夠準(zhǔn)確、快速地檢測心肌整體及局部收縮功能的改變，具有良好的可行性和準(zhǔn)確性，是臨床上評估左心室功能的有效手段。研究結(jié)果表明，甲低患兒存在左心室整體和局部的收縮功能改變，AFI技術(shù)可早期發(fā)現(xiàn)甲低患兒心臟功能的細(xì)微變化，及時(shí)反饋給臨床，對指導(dǎo)臨床用藥具有重要意義。
[Abstract]:Congenital hypothyroidism (congenital, hypothyroidism, CH, referred to as CH) is currently a common pediatric endocrine disease, the clinical manifestations of thyroid hormone level in permanent or temporary decrease and postnatal thyroid stimulating hormone (TSH) levels. The heart is an important target organ of thyroid hormones, thyroid hormone an important role in maintaining cardiac function. Thyroid hormone can regulate transcription of many genes in myocardial cells, thyroid hormone nuclear receptor T3 and promote protein synthesis, thus affecting the amino acids and sugars on the cell membrane transport, and thyroid hormones also affect the absorption and membrane of sarcoplasmic reticulum calcium ATP enzyme activity. In addition, thyroid hormone has extranuclear effects, such as short term changes of T3 can change the cardiac sodium, calcium channel characteristics, the change of intracellular sodium, calcium levels, from The effect of cardiac systolic and rhythm. The expression of thyroid hormone can increase myocardial adrenergic receptor gene, enhance the sensitivity of sympathetic adrenergic system; also can reduce peripheral vascular resistance, improve cardiac output.Heron MI laboratory studies show that thyroid hormones have a certain effect on the growth of small coronary artery, thyroid dysfunction could inhibit the growth of small arteries, hyperthyroidism, on the contrary. The animal experiments indicated that thyroid hormone can reduce myocardial calcium transport protein in neonatal rats with abnormal expression, direct inhibition of enzyme activity, leading to Ca2+ overload in myocardial cells, resulting in decreased systolic and diastolic function.
Objective: To investigate the global and regional left ventricular systolic function in patients with hypothyroidism changes of left ventricular systolic function of children with hypothyroidism were detected in this study using two-dimensional speckle tracking, and to explore its clinical value.
Methods: two dimensional speckle tracking imaging (two dimension, speckle-trackingimaging, 2D-STI) is based on the two-dimensional and the region of interest selected a certain range in the heart wall in the cardiac cycle. With the analysis, location and movement of gray scale automatic frame by frame to track the ROI pixel according to the heart muscle tissue and compared with the software. The first frame image position, calculate the ROI segments of.2D-STI deformation compared with traditional ultrasonic technology, is not affected by the direction of acoustic beam and wall motion direction angle, angle dependence, can more accurately reflect left ventricular systolic and diastolic function. Automatic functional imaging studies the application of (automated function imaging, AFI) is a practical imaging analysis software can quickly obtain the speckle tracking analysis of abnormal wall motion data and bovine eye.
This study selected 30 cases in our hospital diagnosed 35 cases of hypothyroidism patients and matched with the age of children with normal children. Two subjects were excluded other diseases. The application of AFI analysis software of the measurement of left ventricular segmental longitudinal systolic peak strain (longitudinal peak systolic strain, LPSS), and the total systolic strain (section GLS), the average total strain (GLS-Avg), 18 segments of the strain curve and the bull's-eye map.
Results: (1) comparison of left ventricular systolic function parameters: conventional hypothyroidism group left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS%) compared with the normal control group, the difference was not statistically significant (P0.05). (2) left ventricular peak systolic longitudinal strain (LPSS). Compared with the normal control group children with hypothyroidism left ventricular anterior basal segment, the side wall of the apical segment, septal basal segment, middle segment, posterior wall peak systolic longitudinal strain was significantly decreased (P0.05). (3) compare the left ventricular systolic strain and the total section average total strain: left ventricular systolic strain (GLS) significantly compared with the normal group (P0.05).
Conclusion: AFI can accurately use technology in this research, the rapid detection myocardialsystolic function change, has good feasibility and accuracy, is a effective means for the assessment of left ventricular function in clinic. The results of the study show that children with hypothyroidism change of left ventricular global and regional systolic function, AFI can early detect subtle the changes of cardiac function in patients with hypothyroidism, timely feedback to the clinic, is of great significance to guide the clinical medication.

【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R445.1;R725.8

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