本文選題：斑點追蹤 + 慢性腎臟病　； 參考：《浙江中醫(yī)藥大學(xué)》2014年碩士論文

【摘要】：目的通過二維斑點追蹤技術(shù)(STI)探討慢性腎臟病(CKD)患者心內(nèi)外膜在不同時相的旋轉(zhuǎn)與扭轉(zhuǎn)運動。從時間、空間兩個方面對不同分期的CKD患者心功能進(jìn)行評價,了解其最初發(fā)生改變的部位及時相。 方法根據(jù)慢性腎臟病臨床實踐指南(K/DOQI)中的腎功能分期標(biāo)準(zhǔn),將1-3期CKD患者設(shè)為CKD1組,4-5期CKD患者設(shè)為CKD2組,每組各25例,正常對照組25例。先行常規(guī)超聲心動圖檢查,獲取常規(guī)測值左室射血分?jǐn)?shù)(LVEF).心率(HR)、左房前后徑(LA)、左室舒張末期內(nèi)徑(LVIDd).等容舒張時間(IVRT).二尖瓣口前向血流E峰、A峰速度,二尖瓣環(huán)的組織運動e峰、a峰、Sm速度等。運用STI技術(shù)測量一個心動周期內(nèi)心底及心尖水平的心內(nèi)外膜旋轉(zhuǎn)的方向與角度,并計算出心內(nèi)外膜整體扭轉(zhuǎn)角度,利用公式解旋率=(AVC點旋轉(zhuǎn)角度-MVO點旋轉(zhuǎn)角度)/AVC點旋轉(zhuǎn)角度*100%IVRT算出解旋率。將3組研究對象的常規(guī)超聲測值以及運用STI技術(shù)測量3組研究對象在不同時相的心內(nèi)外膜旋轉(zhuǎn)角度、扭轉(zhuǎn)角度、解旋率進(jìn)行比較。應(yīng)用相關(guān)性分析探討左室心內(nèi)外膜的旋轉(zhuǎn)及扭轉(zhuǎn)角度與LVEF的關(guān)系,左室心內(nèi)外膜的解旋率與E/A比值、IVRT的關(guān)系。 結(jié)果超聲常規(guī)測值：CKD1、2組的IVRT延長,LA增大,A峰速度增快,E/A值減小,e峰速度減慢,a峰速度增快,e/a值減小,E/e值增大,差異有統(tǒng)計學(xué)意義。除此之外,CKD2組的LVIDd增大,LVEF減低,E峰速度減慢,Sm減低。STI測值：①等容收縮期：3組研究對象的基底段與心尖段心內(nèi)外膜的旋轉(zhuǎn)角度均無明顯改變。②射血期：CKD1、2組心內(nèi)膜的旋轉(zhuǎn)角度在基底段與心尖段均減小；CKD2組心外膜的旋轉(zhuǎn)角度在基底段與心尖段減小,CKD1組無改變。CKD1組與CKD2組間心尖段心外膜的旋轉(zhuǎn)角度差異有統(tǒng)計學(xué)意義(P0.05)。③等容舒張期末：CKD1、2組心內(nèi)膜的解旋率在基底段與心尖段均減�。籆KD1、2組心外膜的解旋率在基底段同樣減小。④左室心內(nèi)外膜扭轉(zhuǎn)角度及解旋率的比較：CKD1、2組的心內(nèi)膜扭轉(zhuǎn)角度均減小；CKD2組的心外膜扭轉(zhuǎn)角度也減小；CKD1、2組心內(nèi)膜的解旋率同樣減小,而心外膜的解旋率,三組間均無統(tǒng)計學(xué)差異。相關(guān)性分析：左室內(nèi)膜與外膜的扭轉(zhuǎn)角度與LVEF均呈正相關(guān)(依次：r=0.645,r=0.395,P0.001),且內(nèi)膜大于外膜；基底段的心內(nèi)外膜旋轉(zhuǎn)角度與LVEF呈負(fù)相關(guān),而心尖段心內(nèi)膜旋轉(zhuǎn)角度與LVEF呈中度正相關(guān)；左室心內(nèi)膜解旋率與E/A比值呈正相關(guān),而左室心內(nèi)膜與心外膜的解旋率均與IVRT呈負(fù)相關(guān)。 結(jié)論STI技術(shù)在LVEF下降之前較早發(fā)現(xiàn)CKD患者左室旋轉(zhuǎn)及扭轉(zhuǎn)運動異常,并且可以評價CKD患者心功能最初改變的具體時相(射血期與等容舒張期末)以及具體方位(由心內(nèi)膜向心外膜改變)。
[Abstract]:Objective to investigate the rotational and torsional motion of the cardiac internal and external membrane in patients with chronic kidney disease (CKD) at different phases by using two dimensional speckle tracing technique (STI). The heart function of CKD patients with different stages was evaluated in terms of time and space. Methods according to the standard of renal function staging in the clinical practice guide of chronic kidney disease (KR / DOQI), the patients with stage 1-3 CKD were divided into CKD1 group, stage 4-5 CKD group and CKD2 group with 25 cases in each group and 25 cases in normal control group. Routine echocardiography was performed to obtain the values of left ventricular ejection fraction (LVEF). HRV, left atrial anterior and posterior diameter, left ventricular end diastolic diameter and LVIDdV. The isovolumic relaxation time was equal to that of IVRTT. The velocity of E peak A and S m velocity of mitral annulus were observed. The STI technique was used to measure the direction and angle of the rotation of the epicardial membrane at the heart bottom and apical level in a cardiac cycle, and to calculate the angle of the whole torsion of the epicardial membrane. The rotation angle of AVC point and the rotation angle of AVC point and the rotation angle of AVC point are calculated by the formula unspin rate and the rotation angle of AVC point and the rotation angle of AVC point and 100IVRT. The conventional ultrasonic measurements of the three groups of subjects and the STI technique were used to measure the rotation angle, torsion angle and unspin rate of the inner and outer heart membrane of the three groups of subjects at different time phases. The correlation analysis was used to study the relationship between the rotation and torsion angle of the left ventricular endocardial membrane and LVEF, and the relationship between the left ventricular endocardial membrane unrotation rate and the E / A ratio. Results the IVRT prolongation LA increased and the E / A value decreased in the normal ultrasound group. The peak velocity increased and the E / a value decreased. The difference was statistically significant. In addition, in CKD2 group, there was no significant change in the rotation angle of the basal segment and the apical part of the epicardial membrane between the basal segment and the apical segment of the subjects in the study group: 1 / 1 isovolumic systolic phase. 2. 2. At ejection stage, the rotation angle of the epicardial membrane was not significantly changed in the two groups. Membrane rotation angle decreased in basal segment and apical segment; epicardial rotation angle in CKD2 group decreased in basal segment and apical segment. There was significant difference in epicardial rotation angle between CKD1 group and CKD2 group. Comparison of endocardial unwinding rate in basal and apical segments of the left ventricular endocardial torsion angle and resolution rate in the basal segment and the basal segment of the CKD _ 1 / 2 group A comparison of endocardial torsion rate in the left ventricular endocardial torsion angle and resolution rate in the left ventricular endocardial membrane of the two groups at the end of diastolic period: both in basal segment and at the apical segment of the heart; comparison of the endocardial torsion angle and resolution rate in the basal segment In CKD2 group, the angle of epicardial torsion was also decreased, and the endocardial unwinding rate was also decreased in CKD1 + 2 group. However, there was no statistical difference between the three groups in epicardial spin rate. Correlation analysis showed that the torsion angle between left ventricular intima and adventitia was positively correlated with LVEF (1: r = 0. 645A 0.395U P 0.001, and the endomembrane rotation angle of basal segment was negatively correlated with LVEF, while that of apical segment was positively correlated with LVEF), and that between endocardial rotation angle of basal segment was negatively correlated with LVEF, and that between endocardial rotation angle of apical segment and LVEF was moderately positive. There was a positive correlation between endocardial spin rate and E / A ratio, but a negative correlation between endocardial and epicardial spin rate and IVRT. Conclusion the abnormal left ventricular rotation and torsion in patients with CKD were detected by STI technique before the decrease of LVEF. It can also be used to evaluate the specific phase (ejection phase and isovolumic diastolic end) and the specific orientation (from endocardial to epicardial changes) of cardiac function in patients with CKD.
【學(xué)位授予單位】：浙江中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R692;R445.1

【參考文獻(xiàn)】

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本文編號：1829946