【摘要】：目的原發(fā)性高血壓主要體現(xiàn)為體循環(huán)動(dòng)脈血壓的增高,對(duì)心臟的損害主要體現(xiàn)為引起左心室重構(gòu)、進(jìn)而導(dǎo)致收縮功能的減低。本文通過應(yīng)用二維斑點(diǎn)追蹤成像技術(shù)(STI)獲取高血壓病人各節(jié)段心肌的二維應(yīng)變值,比較不同構(gòu)型的心肌在不同方向上的應(yīng)變和扭轉(zhuǎn),探討左心室心肌構(gòu)型與收縮功能的關(guān)系。 方法選取原發(fā)性高血壓病人132例,除外糖尿病、心率失常等其他疾病的病人。依據(jù)Ganau分類法,將其分為4組：正常構(gòu)型組(NG組38例)、向心性重構(gòu)組(CR組35例)、向心性肥厚組(CH組31例),離心性肥厚組(EH組28例)。另選年齡、性別與之相匹配的健康志愿者34名作為正常對(duì)照組(NC組)。 對(duì)入選者行超聲心動(dòng)圖檢查,獲取以下指標(biāo)：1.左室構(gòu)型指標(biāo)：室壁厚度、左室內(nèi)徑：2.左室收縮功能指標(biāo),包括：常規(guī)指標(biāo)：左室射血分?jǐn)?shù)(LVEF)、短軸縮短率(FS)；二維應(yīng)變指標(biāo):左室收縮期峰值縱向應(yīng)變(SL)、周向應(yīng)變(SC)、徑向應(yīng)變(SR)、旋轉(zhuǎn)角度(Rot),并計(jì)算扭轉(zhuǎn)角度(Twist)。 結(jié)果1.高血壓組(132例)與正常對(duì)照組比較：前者的左室壁厚度、重量高于后者,而LVEF均在正常范圍內(nèi)；收縮期應(yīng)變指標(biāo)SL顯著降低(P0.05),二尖瓣及乳頭肌水平的SC、乳頭肌水平的SR及左室Twist無(wú)明顯變化。 2.高血壓各構(gòu)型組與對(duì)照組比較：NG組、CR組的SL低于對(duì)照組,而二尖瓣水平和乳頭肌水平的SC、SR無(wú)明顯下降；CH組和EH組SL、SC及二尖瓣水平和乳頭肌水平的SR與NG組、CR組比較均下降(P0.05)。心尖水平的SR在NG、CR、CH組中呈遞增趨勢(shì),在EH組中略有降低,但仍比對(duì)照組高。Twist在NG組、CR組比對(duì)照組略增高,在CH組和EH組中卻與對(duì)照組相近。 結(jié)論二維斑點(diǎn)追蹤成像技術(shù)能夠準(zhǔn)確獲取高血壓病人左心室各方向的運(yùn)動(dòng)指標(biāo)、檢測(cè)出各構(gòu)型組室壁運(yùn)動(dòng)的細(xì)微差異。高血壓病人雖能保持左心室的正常泵功能,但心肌的收縮功能已經(jīng)受到損害,表現(xiàn)為各構(gòu)型組不同方向的應(yīng)變值都有不同程度的減低。室壁肥厚之前,主要體現(xiàn)為縱向應(yīng)變的下降；室壁肥厚以后,左室的縱向應(yīng)變、周向應(yīng)變、二尖瓣水平和乳頭肌水平的徑向應(yīng)變都有降低。在所有構(gòu)型組中心尖段的徑向應(yīng)變是呈增高趨勢(shì),而左室扭轉(zhuǎn)的波動(dòng)幅度較低,這可能是左室泵功能保持正常的重要因素。
[Abstract]:Objective essential hypertension mainly reflects the increase of arterial blood pressure of systemic circulation, and the damage to the heart mainly results in left ventricular remodeling, which leads to the decrease of systolic function. Two-dimensional speckle tracing imaging (STI) was used to obtain the two-dimensional strain values of each segment of myocardium in hypertensive patients. The strain and torsion of myocardium with different configurations in different directions were compared, and the relationship between left ventricular myocardial configuration and systolic function was discussed. Methods 132 patients with essential hypertension, including diabetes, arrhythmia and other diseases were selected. According to Ganau classification, it was divided into 4 groups: normal configuration group (NG group, 38 cases), concentric remodeling group (CR group, 35 cases), concentric hypertrophy group (CH group, 31 cases) and centrifugal hypertrophy group (EH group, 28 cases). Another 34 healthy volunteers of age and gender were selected as normal control group (NC group). The following indexes were obtained by echocardiography: 1. Left ventricular wall thickness, left ventricular diameter: 2. Left ventricular systolic function index, including: conventional index: left ventricular ejection fraction (LVEF), short axis shortening rate (FS); two-dimensional strain index: left ventricular systolic peak longitudinal strain (SL), radial strain (SC), radial strain (SR), rotation angle (Rot), and calculate torsion angle (Twist). Result 1. The left ventricular wall thickness and weight of the hypertension group (132 cases) were higher than that of the control group, while LVEF was within the normal range. The systolic strain index (SL) was significantly decreased (P0.05), but there was no significant change in SR and left ventricular Twist in SC, of mitral valve and papillary muscle. 2. Compared with the control group, the SL of NG group, CR group was lower than that of control group, but SC,SR of mitral valve level and papillary muscle level had no significant decrease, SR and NG group of CH group and EH group and SR group and NG group of mitral valve level and papillary muscle level in CH group and EH group were lower than those in CR group (P0.05). The apical level of SR increased in NG,CR,CH group, decreased slightly in EH group, but still higher than that in control group. Twist in NG group, CR group was slightly higher than control group, but similar in CH group and EH group. Conclusion Two-dimensional speckle tracing imaging can accurately obtain the left ventricular motion indexes in all directions of hypertensive patients, and detect the subtle differences of ventricular wall motion in each configuration group. Although hypertensive patients can maintain the normal pump function of the left ventricle, the contractile function of the myocardium has been damaged, which shows that the strain values in different directions of each configuration group are decreased to varying degrees. The longitudinal strain, the circumferential strain, the radial strain of the mitral valve and the papillary muscle were all decreased after the hypertrophy of the ventricular wall before the hypertrophy of the ventricular wall, and the longitudinal strain, the circumferential strain, the radial strain of the mitral valve and the papillary muscle were all decreased after the hypertrophy of the ventricular wall. The radial strain of the central apical segment of all the configurations showed an increasing trend, while the fluctuation of left ventricular torsion was relatively low, which may be an important factor in maintaining the normal left ventricular pump function.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R544.11;R445.1

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