發(fā)布時(shí)間：2018-04-18 13:43

  本文選題：三維斑點(diǎn)追蹤技術(shù) + 房顫�。� 參考：《鄭州大學(xué)》2014年碩士論文

【摘要】：目的 應(yīng)用三維斑點(diǎn)追蹤技術(shù)（Three-dimension speckle tracking imaging,3D-STI）初步研究陣發(fā)性房顫患者、持續(xù)性房顫患者左房功能變化，探討房顫（Atrialfibrillation, AF）對左房功能的影響，評價(jià)該技術(shù)在檢測AF患者左房功能中的應(yīng)用價(jià)值。 方法 選取二維圖像清晰的37例陣發(fā)性房顫患者（AF1組）、43例持續(xù)性房顫患者（AF2組）及40例健康體檢者（對照組），采集全容積左室心尖四腔和兩腔切面圖像并存儲，運(yùn)用3D-STI進(jìn)行分析。測量并比較：①左房16節(jié)段收縮期縱向、徑向、圓周和面積峰值應(yīng)變（PLS、PRS、PCS、PAS），左室收縮期左房整體縱向、徑向、圓周和面積應(yīng)變（GLSs、GRSs、GCSs、GASs），以及左房收縮期整體縱向、徑向、圓周和面積應(yīng)變（GLSa、GRSa、GCSa、GASa）等收縮功能參數(shù)；②左房16節(jié)段縱向、徑向、圓周和面積應(yīng)變達(dá)峰時(shí)間（TLS、TRS、TCS、TAS），左房整體縱向、徑向、圓周和面積應(yīng)變達(dá)峰時(shí)間（GTLS、GTRS、GTCS、GTAS），以及左房縱向、徑向、圓周和面積應(yīng)變達(dá)峰時(shí)間標(biāo)準(zhǔn)差（TLS-SD、TRS-SD、TCS-SD、TAS-SD）等非同步參數(shù)。分析3D-STI參數(shù)與左房整體功能（LAEF）的相關(guān)性。繪制3D-STI收縮功能參數(shù)與非同步參數(shù)ROC曲線。采用心率對時(shí)間參數(shù)進(jìn)行校正。 結(jié)果 1.隨著AF程度的加重，左房心肌局部收縮功能下降，AF1組、AF2組大部分節(jié)段PLS、PRS、PCS、PAS低于對照組，差異有統(tǒng)計(jì)學(xué)意義（P0.05）。 2. AF患者左房儲存功能及助力泵功能受損，AF1組、AF2組GLSs、GRSs、GCSs、GASs較對照組減低，差異有統(tǒng)計(jì)學(xué)意義（P0.05）；AF1組GLSa、GASa較對照組減低，差異有統(tǒng)計(jì)學(xué)意義（P0.05），AF1組GRSa、GCSa低于對照組，差異沒有統(tǒng)計(jì)學(xué)意義（P0.05）。 3.隨著AF發(fā)作頻率及持續(xù)時(shí)間的增加，房壁運(yùn)動(dòng)異常程度加重，出現(xiàn)左房心肌的非同步性運(yùn)動(dòng)，AF1組、AF2組TLS、TRS、TCS、TAS以及GTLS、GTRS、GTCS、GTAS較對照組延遲，差異有統(tǒng)計(jì)學(xué)意義（P0.05）；AF1組、AF2組TLS-SD、TRS-SD、TCS-SD、TAS-SD較對照組增高，差異有統(tǒng)計(jì)學(xué)意義（P0.05）。 4.3D-DTI參數(shù)GLSs、GRSs、GCSs和GASs間具有較好的相關(guān)性，反應(yīng)左房儲存功能的GLSs、GRSs、GCSs、GASs指標(biāo)及反應(yīng)左房心肌運(yùn)動(dòng)不同步性的TLS-SD、TRS-SD、TCS-SD、TAS-SD指標(biāo)均與LAEF具有較好相關(guān)性。 5.3D-STI整體應(yīng)變參數(shù)GLSs、GRSs、GCSs和GASs的ROC曲線下面積分別為0.978、0.820、0.872、0.891；非同步參數(shù)TLS-SD、TRS-SD、TCS-SD和TAS-SD的ROC曲線下面積分別為0.771、0.576、0.730、0.738。縱向應(yīng)變指標(biāo)對于AF患者左房功能的診斷效能高于徑向、圓周和面積應(yīng)變。 結(jié)論 AF患者在病變早期即出現(xiàn)心肌損害，隨著AF發(fā)作頻率及持續(xù)時(shí)間的加重，，左房壁心肌各節(jié)段的運(yùn)動(dòng)進(jìn)一步出現(xiàn)異常，在3D-STI中表現(xiàn)為應(yīng)變值逐漸減低，并且出現(xiàn)了非同步運(yùn)動(dòng)。3D-STI能檢測AF患者的房壁心肌運(yùn)動(dòng)異常，定量評價(jià)AF患者左房心肌收縮功能及同步性的變化。
[Abstract]:PurposeThree-Dimension speckle tracking imaging3D-STI was used to study the changes of left atrial function in patients with paroxysmal atrial fibrillation and persistent atrial fibrillation. The effects of AF on left atrial function were investigated and the value of the technique in detecting left atrial function in patients with AF was evaluated.MethodThirty-seven patients with paroxysmal atrial fibrillation (PAF) and 40 healthy controls (control group, n = 37) and 40 healthy controls (n = 40) were collected and stored in full-volume left ventricular apical four chamber and two-chamber section. The results were analyzed by 3D-STI.To measure and compare the systolic longitudinal, radial, circumferential and area peak strain of left atrium in 16 segments of the left atrium at 1: 1. The peak strain of PLSN, PRSN, PCS, PASA, the whole longitudinal, radial, circumferential and area strain of left ventricular systolic phase in left atrium were measured and compared, and the whole longitudinal and radial of left atrial systolic phase were measured and compared, and the whole longitudinal and radial of left atrial systolic phase were measured.Systolic function parameters such as circumference and area strain GLSaG Sag GCSa-GASa2 left atrial 16 segments longitudinal, radial, circumferential and area strain peak time (TLS) TRST TCSTASU, left atrium overall longitudinal, radial, circumferential and area strain peak time GTLSGTRSTRSGTCSC GTASN, and left atrium longitudinal, radial, radial, and area strain peak time GTLSGTRSGTCSTTASN, and left atrial longitudinal, radial, radial, and area strain peak time GTLSGTRSGTCSTTASU, and left atrium longitudinal, radial, radial, and area strain peak time.The standard deviation of peak time of circumference and area strain is TLS-SDN TRS-SDN TCS-SD-TAS-SDS and other asynchronous parameters.To analyze the correlation between 3D-STI parameters and left atrial global function (Laff).Draw ROC curve of 3D-STI contraction function parameter and asynchronous parameter.Time parameters were corrected by heart rate.Result1.With the aggravation of AF, the regional systolic function of left atrial myocardium decreased in AF1 group.2.Left atrial storage function and pump function in AF1 group were significantly lower than those in control group (P 0.05). The difference was statistically significant (P 0.05). There was significant difference between AF1 group and control group (P 0.05). The GRSaGCSa of AF1 group was lower than that of control group (P 0.05), but the difference was not significant (P 0.05).3.With the increase of AF attack frequency and duration, the abnormal degree of atrial wall motion increased, and the TLSS-TRS TCSTAS and GTLS+ GTRCSCSTTAS in AF1 group were delayed compared with the control group, the difference was statistically significant (P0.05AF1 group AF2 group TLS-SDTRS-SDT TCSDS-TAS-SD increased compared with the control group.The difference was statistically significant (P 0.05).There was a good correlation between GCSs and GASs parameters of 4.3D-DTI parameters. GASs of GCSs and TLS-SDS-SDS-SDT TAS-SD, which reflected the storage function of left atrium, and TLS-SDS-SDS-SD-TAS-SD, which reflected the different motion of left atrium, were all correlated well with LAEF.The area under the ROC curve of the whole strain parameter of 5.3D-STI GLSS-GRSs and GASs is 0.978t 0.820 0.872U 0.891respectively, and the area under the ROC curve of TLS-SDS-SDS-SD and TAS-SD is 0.771U 0.5760.7300.738381.The area under the ROC curve is 0.771U 0.5760.7300.7381.The area under the ROC curve of TLS-SDS-SDCS-SD and TAS-SD is 0.771U 0.5760.7300.7381. respectively.The diagnostic efficacy of longitudinal strain index for left atrial function in AF patients was higher than that in radial, circumferential and area strain.ConclusionMyocardial damage occurred in the early stage of AF. With the exacerbation of AF attack frequency and duration, the motion of each segment of left atrial wall was further abnormal, and the strain value decreased gradually in 3D-STI.Asynchronous exercise. 3D-STI could detect the abnormal myocardial motion in AF patients, and quantitatively evaluate the changes of left atrial systolic function and synchronism in patients with AF.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R445.1;R541.75

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