實時三平面定量組織速度成像及實時三平面應(yīng)變率成像技術(shù)評價尿毒癥患者左室舒張功能及其與PTH的相關(guān)性研究
發(fā)布時間：2018-07-23 14:01
【摘要】：目的 尿毒癥性心肌損害是尿毒癥的主要并發(fā)癥，，其心肌的病理變化是由肥厚到擴(kuò)張的過程，最終導(dǎo)致心功能不全。實時三平面(RT-3PE, real-time three-plane)定量組織速度成像（QTVI, Quantitative tissue velocity imaging）及RT-3PE應(yīng)變率成像（SRI, Strain rate imaging）技術(shù)是近幾年發(fā)展起來的新技術(shù)，可用于局部心肌運(yùn)動的定量分析，反映心肌發(fā)生病變的程度，早期評估心臟功能。由于尿毒癥患者舒張功能減低較收縮功能減低發(fā)生早，因此，本研究的主要目的在于：1、采用RT-3PEQTVI和RT-3PE SRI技術(shù)測量正常人和尿毒癥患者舒張期左室壁運(yùn)動速度及左室心肌應(yīng)變率，評價尿毒癥患者的左室舒張功能；2、分析左室舒張功能參數(shù)與血清甲狀旁腺激素（PTH, parathyroid hormone）水平的相關(guān)性。從而為臨床早期診斷尿毒癥心肌病提供有意義的參數(shù)指標(biāo)。 資料與方法 研究對象包括33例正常人（正常組）和30例尿毒癥患者（尿毒癥組）。收集尿毒癥患者近一周的PTH檢驗結(jié)果。儀器選用GE vivid7彩色多普勒超聲診斷儀，探頭選用M3S及3V探頭，安靜狀態(tài)下獲取胸骨旁左室長軸標(biāo)準(zhǔn)切面二維灰階圖像及心尖四腔觀RT-3PE圖像，應(yīng)用雙平面Simpson方法測量左室射血分?jǐn)?shù)（LVEF,left ventricular ejection function），應(yīng)用脈沖多普勒超聲獲得二尖瓣口血流頻譜，測量舒張早期峰值血流速度（E）及舒張晚期峰值血流速度（A），并計算E/A。脫機(jī)分析測量左室各常規(guī)參數(shù)及左室各節(jié)段心肌的舒張早期峰值速度（Ve）、舒張晚期峰值速度（Va）、舒張早期峰值應(yīng)變率（SRe）、舒張晚期峰值應(yīng)變率（SRa）。計算Ve/Va、SRe/SRa、左室平均Ve、左室平均SRe。 結(jié)果 1.與正常對照組比較：尿毒癥組中LAD、LVEDD增大， IVSTD及LVPWTD增厚，血清PTH水平明顯升高，心包積液（PE, pericardial effusion）的發(fā)生率顯著升高，差異具有統(tǒng)計學(xué)意義（P＜0.05）；尿毒癥組二尖瓣口血流頻譜E峰明顯降低，A峰升高，E/A比值顯著降低，差異具有統(tǒng)計學(xué)意義（P＜0.05）。 2.與正常對照組比較：尿毒癥組各室壁基底段、中間段Ve明顯降低，Va升高，Ve/Va顯著降低，差異有統(tǒng)計學(xué)意義（P＜0.05）；尿毒癥組各室壁基底段、中間段SRe明顯降低，SRe/SRa顯著降低，差異有統(tǒng)計學(xué)意義（P＜0.05）。而SRa測值部分升高、部分降低，差異無統(tǒng)計學(xué)意義（P0.05）。 3.與正常對照組比較：尿毒癥組左心室壁平均Ve、平均SRe均顯著降低，差異有統(tǒng)計學(xué)意義（P＜0.05）。尿毒癥組左心室壁平均Ve及平均SRe均與PTH呈負(fù)相關(guān)性。 結(jié)論 1. RT-3PE QTVI與RT-3PE SRI技術(shù)能夠準(zhǔn)確評價正常人和尿毒癥患者的左室舒張功能，為臨床早期診斷、治療尿毒癥心肌病提供了重要依據(jù)。 2.正常組左室心肌于舒張期的運(yùn)動具有一定規(guī)律性，即各室壁基底段運(yùn)動速度均大于中間段。 3.左室舒張功能參數(shù)與血PTH水平具有良好的相關(guān)性，可作為評估尿毒癥患者左室舒張功能的可靠指標(biāo)。
[Abstract]:Objective Myocardial damage caused by uremia is the main complication of uremia. The pathological changes of myocardium are from hypertrophy to dilatation, leading to cardiac insufficiency. Real-time triplane (RT-3PE) quantitative tissue velocity imaging (QTVI, Quantitative tissue velocity imaging) and RT-3PE strain rate imaging (SRI, Strain rate imaging) are new techniques developed in recent years. They can be used in quantitative analysis of regional myocardial motion and reflect the degree of myocardial lesion. Early assessment of cardiac function. Since the reduction of diastolic function occurred earlier than that of systolic function in uremic patients, the main purpose of this study was to measure the left ventricular wall motion velocity and the left ventricular strain rate in normal subjects and uremic patients during diastolic period by using RT-3PEQTVI and RT-3PE SRI techniques. To evaluate left ventricular diastolic function (LVDF) in patients with uremia and to analyze the correlation between left ventricular diastolic function parameters and serum parathyroid hormone (PTH, parathyroid hormone) level. Therefore, it provides a valuable parameter index for early diagnosis of uremic cardiomyopathy. Materials and methods 33 normal subjects and 30 uremic patients (uremia group) were studied. To collect the PTH test results of uremia patients for nearly a week. GE vivid7 color Doppler ultrasound diagnostic instrument and M3S and 3V probes were used to obtain 2D gray-scale images and four-chamber RT-3PE images of the parasternal left ventricular long axis in quiet state. Left ventricular ejection fraction (LVEF) was measured by biplane Simpson method. Mitral valve flow spectrum was obtained by pulsed Doppler ultrasound. Peak diastolic velocity (E) and late diastolic peak flow velocity (A),) were measured and E / A was calculated. Measurement of early diastolic peak velocities (Ve), late diastolic peak velocities (Va), early peak strain rate (SRe), late diastolic peak strain rate (SRa). VAR SReP SRA, left ventricular mean Veg, left ventricular mean SRea were calculated. Result 1. In uremia group, LVEDD increased, IVSTD and LVPWTD thickened, serum PTH level increased, and the incidence of (PE, pericardial effusion) in pericardial effusion increased significantly (P < 0. 05). In uremia group, the E peak of mitral orifice blood flow spectrum was significantly decreased and the ratio of E / A increased significantly (P < 0. 05), and the ratio of E / A was significantly decreased (P < 0. 05). Compared with the normal control group, the basal segment of the ventricular wall and the middle segment of the uremia group were significantly lower than those of the control group (P < 0. 05), and the SRe of the basal segment and the middle segment of the ventricular wall in the uremic group were significantly lower than those in the control group. The difference was statistically significant (P < 0.05). However, the SRa values increased partly and decreased partly, and the difference was not statistically significant (P0.05). Compared with the control group, the mean Veg and average SRe of left ventricular wall in uremia group were significantly lower than those in normal control group (P < 0. 05). There was a negative correlation between mean ve and SRe of left ventricular wall and PTH in uremia group. Conclusion 1. RT-3PE QTVI and RT-3PE SRI techniques can accurately evaluate left ventricular diastolic function in normal persons and uremic patients, and provide an important basis for early clinical diagnosis and treatment of uremic cardiomyopathy. 2. In normal group, the movement of left ventricular myocardium during diastolic phase is regular, that is, the velocity of basal segment of each ventricular wall is higher than that of middle segment. The parameters of left ventricular diastolic function have good correlation with the level of PTH, which can be used as a reliable index to evaluate left ventricular diastolic function in uremic patients.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R692.5;R445.1
本文編號：2139638
[Abstract]:Objective Myocardial damage caused by uremia is the main complication of uremia. The pathological changes of myocardium are from hypertrophy to dilatation, leading to cardiac insufficiency. Real-time triplane (RT-3PE) quantitative tissue velocity imaging (QTVI, Quantitative tissue velocity imaging) and RT-3PE strain rate imaging (SRI, Strain rate imaging) are new techniques developed in recent years. They can be used in quantitative analysis of regional myocardial motion and reflect the degree of myocardial lesion. Early assessment of cardiac function. Since the reduction of diastolic function occurred earlier than that of systolic function in uremic patients, the main purpose of this study was to measure the left ventricular wall motion velocity and the left ventricular strain rate in normal subjects and uremic patients during diastolic period by using RT-3PEQTVI and RT-3PE SRI techniques. To evaluate left ventricular diastolic function (LVDF) in patients with uremia and to analyze the correlation between left ventricular diastolic function parameters and serum parathyroid hormone (PTH, parathyroid hormone) level. Therefore, it provides a valuable parameter index for early diagnosis of uremic cardiomyopathy. Materials and methods 33 normal subjects and 30 uremic patients (uremia group) were studied. To collect the PTH test results of uremia patients for nearly a week. GE vivid7 color Doppler ultrasound diagnostic instrument and M3S and 3V probes were used to obtain 2D gray-scale images and four-chamber RT-3PE images of the parasternal left ventricular long axis in quiet state. Left ventricular ejection fraction (LVEF) was measured by biplane Simpson method. Mitral valve flow spectrum was obtained by pulsed Doppler ultrasound. Peak diastolic velocity (E) and late diastolic peak flow velocity (A),) were measured and E / A was calculated. Measurement of early diastolic peak velocities (Ve), late diastolic peak velocities (Va), early peak strain rate (SRe), late diastolic peak strain rate (SRa). VAR SReP SRA, left ventricular mean Veg, left ventricular mean SRea were calculated. Result 1. In uremia group, LVEDD increased, IVSTD and LVPWTD thickened, serum PTH level increased, and the incidence of (PE, pericardial effusion) in pericardial effusion increased significantly (P < 0. 05). In uremia group, the E peak of mitral orifice blood flow spectrum was significantly decreased and the ratio of E / A increased significantly (P < 0. 05), and the ratio of E / A was significantly decreased (P < 0. 05). Compared with the normal control group, the basal segment of the ventricular wall and the middle segment of the uremia group were significantly lower than those of the control group (P < 0. 05), and the SRe of the basal segment and the middle segment of the ventricular wall in the uremic group were significantly lower than those in the control group. The difference was statistically significant (P < 0.05). However, the SRa values increased partly and decreased partly, and the difference was not statistically significant (P0.05). Compared with the control group, the mean Veg and average SRe of left ventricular wall in uremia group were significantly lower than those in normal control group (P < 0. 05). There was a negative correlation between mean ve and SRe of left ventricular wall and PTH in uremia group. Conclusion 1. RT-3PE QTVI and RT-3PE SRI techniques can accurately evaluate left ventricular diastolic function in normal persons and uremic patients, and provide an important basis for early clinical diagnosis and treatment of uremic cardiomyopathy. 2. In normal group, the movement of left ventricular myocardium during diastolic phase is regular, that is, the velocity of basal segment of each ventricular wall is higher than that of middle segment. The parameters of left ventricular diastolic function have good correlation with the level of PTH, which can be used as a reliable index to evaluate left ventricular diastolic function in uremic patients.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R692.5;R445.1
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本文編號：2139638
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