發(fā)布時(shí)間：2018-03-22 02:36

  本文選題：斑點(diǎn)追蹤成像技術(shù)　切入點(diǎn)：亞臨床甲減　出處：《吉林大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:運(yùn)用二維斑點(diǎn)追蹤成像技術(shù)評(píng)價(jià)亞臨床甲減患者的左心室和右心室收縮及舒張功能改變,早期發(fā)現(xiàn)其心臟功能的損害。材料及方法:亞臨床甲減組(SCH組):選取2016年1月-2016年12月來我院確診為亞臨床甲減患者34例,其中女性23例,男性11例,年齡35-50歲,平均年齡(40.1±1.6)歲。正常對(duì)照組:選取性別、年齡相匹配的健康者20例作為對(duì)照。其中女性14例,男性6例,年齡35-45歲,平均年齡(39.9±2.8)歲。各組患者于靜息狀態(tài)下行常規(guī)超聲心動(dòng)圖檢查,并分別獲取6個(gè)標(biāo)準(zhǔn)切面的二維灰階動(dòng)態(tài)圖像(胸骨旁左室二尖瓣短軸切面、胸骨旁左室乳頭肌短軸切面、胸骨旁左室心尖短軸切面及心尖四腔切面、心尖三腔切面、心尖兩腔切面),幀頻大于100幀/秒,每個(gè)切面記錄3個(gè)心動(dòng)周期以上。測(cè)量常規(guī)超聲心動(dòng)圖相關(guān)參數(shù):左室舒張末內(nèi)徑(LVIDd)、左室收縮末內(nèi)徑(LVIDs)、舒張末室間隔厚度(IVSd)、舒張末左室后壁厚度(LVPWd)、右室舒張末內(nèi)徑(RVIDd)、右室收縮末內(nèi)徑(RVIDs)、右室舒張末面積(RVEDA)、右室收縮末面積(RVESA),計(jì)算出右室面積變化率(RVFAC),采用Simpson法測(cè)量左室射血分?jǐn)?shù)(LVEF)。使用M型超聲測(cè)量三尖瓣環(huán)收縮期位移(TAPSE)。利用qlab9.0軟件cmq程序后處理獲取的圖像,分析測(cè)量各組患者的左心室收縮期整體縱向應(yīng)變(glss)、圓周應(yīng)變(gcss)、縱向應(yīng)變率(lrs)、圓周應(yīng)變率(crs)及右心室整體縱向應(yīng)變(glss)、縱向應(yīng)變率(lrs)。選擇tmad選項(xiàng),測(cè)量各組患者室間隔-側(cè)壁點(diǎn)連線中點(diǎn)最大位移(tmadmidpt)及室間隔-側(cè)壁點(diǎn)連線中點(diǎn)最大位移占左室長(zhǎng)徑百分比(tmadmidpt%)。結(jié)果:(1)sch組與對(duì)照組一般情況比較sch組與對(duì)照組相比,年齡、性別、三碘甲狀原氨酸(ft3)、甲狀腺素(ft4)未見明顯差異,無統(tǒng)計(jì)學(xué)意義(p0.05)。促甲狀腺激素(tsh)、心率、血壓與對(duì)照組相比差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。(2)sch組與對(duì)照組常規(guī)超聲及tmad情況比較sch組與對(duì)照組相比,lvidd、lvids、ivsd、lvpwd、rvidd、rvids、rveda、rvesa、rvfac、lvef、tmad差異均無統(tǒng)計(jì)學(xué)意義(p0.05)。但是midpt、tmadmidpt%與對(duì)照組相比差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。(3)sch組與對(duì)照組左心室心肌應(yīng)變及應(yīng)變率比較sch組與對(duì)照組比較,左心室的glss、gcss均減低,差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。各節(jié)段收縮期、舒張?jiān)缙诩笆鎻埻砥诳v向、圓周峰值應(yīng)變率(lrse、lrsa、lrss、crse、crsa、crss)與對(duì)照組相比減低,差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。(4)sch組與對(duì)照組右心室心肌應(yīng)變及應(yīng)變率比較sch組與對(duì)照組相比較,右心室的glss及各節(jié)段收縮期、舒張?jiān)缙诩笆鎻埻砥诜逯祽?yīng)變率(lrse、lrsa、lrss)減低,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1.常規(guī)超聲心動(dòng)圖檢查不能評(píng)估早期亞臨床甲減患者心臟功能受損情況。2.二維斑點(diǎn)追蹤成像技術(shù)能夠發(fā)現(xiàn)早期亞臨床甲減患者左心室的收縮及舒張功能受損,為臨床及時(shí)干預(yù)治療提供可靠依據(jù)。3.亞臨床甲減患者的右心室收縮及舒張功能受損。
[Abstract]:Objective: to evaluate the changes of left and right ventricular systolic and diastolic function in subclinical hypothyroidism patients with two dimensional speckle tracing imaging. Materials and methods: subclinical hypothyroidism group (SCH group): 34 patients with subclinical hypothyroidism were selected from January 2016 to December 2016, including 23 females, 11 males aged 35-50 years. The average age was 40.1 鹵1.6 years. Normal control group: 20 healthy subjects with gender and age matched were selected as control group. 14 female, 6 male, aged 35-45 years, were selected as control group. The mean age was 39.9 鹵2.8 years. The patients in each group underwent routine echocardiography in resting state, and obtained 6 standard gray-scale dynamic images of left ventricular mitral valve, parasternal papillary muscle and left ventricular papillary muscle. Left ventricular apical short axis section, apical four-chamber section, apical three-chamber section, apical two-chamber section, frame frequency more than 100 frames per second, parasternal apical short axis section, apical four-chamber section, apical three-chamber section, apical two-chamber section. More than 3 cardiac cycles were recorded on each section. Parameters related to conventional echocardiography were measured: left ventricular end-diastolic diameter (LVIDdN), left ventricular end-systolic diameter (LVIDsN), end-diastolic septal thickness (IVSdN), left ventricular posterior wall thickness (LVPWdN), right ventricular enddiastolic dimension (RV). The right ventricular end-diastolic area (RVEDAA) and the right ventricular end-systolic area (RVESAA) were calculated. The left ventricular ejection fraction (LVEF) was measured by Simpson method. The tricuspid annular systolic displacement was measured by M-mode ultrasound. Qlab9.0 software cmq program post-processing of the image, The whole longitudinal strain of left ventricle was measured in each group. The whole longitudinal strain of left ventricle was measured, and the tmad option was chosen to select the tmad option, and the whole longitudinal strain of the right ventricle was measured by using the tmad option, and the whole longitudinal strain of the right ventricle was measured by using the method of measuring the whole longitudinal strain of the left ventricle, the circumferential strain, the circumferential strain rate, the circular strain rate and the right ventricular global longitudinal strain. The maximal displacement of midpoint on the line between ventricular septal and lateral wall points and the percentage of midpoint displacement of ventricular septal to lateral wall point in left ventricular length were measured in each group. Results compared with the control group, the age and sex of the sch group were higher than that of the control group. There was no significant difference in triiodothyronine ft3, thyroxine tsh4, and there was no significant difference between them (P 0.05). TSH, heart rate, TSH, TSH, TSH, TSH, TSH, TSH, TSH, TSH, TSH, TSH, The difference of blood pressure between the control group and the control group was significant (p 0.05). There was no significant difference between the sch group and the control group in conventional ultrasound and tmad. There was no significant difference between the sch group and the control group in the lvpwdsivsdl / lvpwddftmad. However, there was no significant difference between the sch group and the control group in the rate of midmidpt% and in the control group (P 0.05), but there was no significant difference between the sch group and the control group in the blood pressure (P < 0.05), but there was no significant difference between the sch group and the control group (P > 0.05) in the comparison between the sch group and the control group. Comparison of strain and strain rate of left Ventricular Myocardium in the sch group and the control group, the comparison between the sch group and the control group was made. The GCSs of the left ventricle were significantly lower than those of the control group (P < 0.05). The peak strain rate of the left ventricle in the systolic, early diastolic and late diastolic stages was significantly lower than that in the control group, and the peak strain rate of the left ventricle was significantly lower than that in the control group. The difference was statistically significant in the right ventricular myocardial strain and strain rate in the sch group and the control group. Compared with the control group, the glss of the right ventricle and the peak strain rate of the early diastolic and late diastolic segments in the sch group were lower than those in the control group, and that in the sch group was lower than that in the control group. Conclusion: 1. Conventional echocardiography can not evaluate cardiac dysfunction in patients with early subclinical hypothyroidism .2.Two-dimensional speckle tracing imaging can find left ventricle in patients with early subclinical hypothyroidism. Impaired systolic and diastolic function, To provide a reliable basis for clinical intervention in patients with subclinical hypothyroidism of the right ventricular systolic and diastolic function damage.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R581.2;R540.45

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5 侯揚(yáng);2型糖尿病合并亞臨床甲狀腺功能減退患者炎癥因子水平測(cè)定及意義[D];山西醫(yī)科大學(xué);2015年

6 黃婧;亞臨床甲減大鼠骨代謝改變及左旋甲狀腺素療效觀察[D];甘肅中醫(yī)藥大學(xué)(原名：甘肅中醫(yī)學(xué)院);2015年

7 李菲;老年2型糖尿病患者顱內(nèi)動(dòng)脈粥樣硬化與亞臨床甲狀腺功能減退癥的關(guān)系[D];承德醫(yī)學(xué)院;2015年

8 吳璇;亞臨床甲狀腺功能減退癥的研究進(jìn)展[D];重慶醫(yī)科大學(xué);2015年

9 趙陽;糖尿病合并亞臨床甲減與代謝綜合征的相關(guān)性研究[D];新疆醫(yī)科大學(xué);2016年

10 唐若曦;新疆漢維兩族2型糖尿病患者合并亞臨床甲減的臨床特點(diǎn)分析[D];新疆醫(yī)科大學(xué);2016年

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