本文選題：干燥綜合征 + 三平面定量組織速度成像��； 參考：《昆明醫(yī)科大學》2015年碩士論文

【摘要】：目的：采用實時三平面(real-time three-plane, RT-3PE)定量組織速度成像(Quantitative tissue velocity imaging, QTVI)及應變率成像(Strain rate imaging, SRI)技術(shù),測量正常人和干燥綜合征患者舒張期左室壁運動速度及左室心肌應變、應變率,評價不同類型的干燥綜合征患者的左室舒張功能,探討該技術(shù)對干燥綜合征患者心臟功能變化的初步診斷價值。對象：選擇2014年6月至2015年2月于昆明醫(yī)科大學第一附屬醫(yī)院風濕免疫科住院患者。根據(jù)2002年美國-歐洲干燥綜合征分類標準共識確診為干燥綜合征的患者27例。再按是否合并類風濕性關節(jié)炎,分為原發(fā)性干燥綜合征患者(原發(fā)組)及繼發(fā)性干燥綜合征組(繼發(fā)組)兩個亞組,原發(fā)組15例,繼發(fā)組12例,健康對照組30例。排除標準：1)各種先天性心臟病、肥厚型心肌病、嚴重的瓣膜病、冠狀動脈粥樣硬化性心臟病、原發(fā)性高血壓病等其它心臟病變；2)代謝性疾�。禾悄虿�、血脂代謝異常者；3)三平面圖像質(zhì)量差,無法獲取資料信息者。方法：選用美國GE E9彩色多普勒超聲診斷儀,M5S探頭,安靜狀態(tài)下獲取二維灰階圖像,測量左室各常規(guī)參數(shù),M-型超聲測量左室射血分數(shù)(LVEF, left ventricular ejection fraction),應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(Ep)及舒張晚期峰值血流速度(Ap),并計算Ep/Ap。運用4V探頭,獲取心尖四腔觀RT-3PE圖像,采用RT-3PEQTVI和RT-3PE SRI技術(shù)獲取并儲存圖像,脫機分析左室12節(jié)段心肌的舒張早期峰值速度(Ve),舒張晚期峰值速度(Va),舒張早期峰值應變率(SRe),舒張晚期峰值應變率(SRa),計算左室平均Ve, Va, Ve/Va,左室SRe/SRa,利用SPSS17.0統(tǒng)計軟件對不同分組的干燥綜合征患者所對應室壁的各舒張期峰值、應變峰值進行比較分析。結(jié)果：1.與正常組比較,干燥綜合征患者心臟結(jié)構(gòu)、左室收縮功能指標差異無統(tǒng)計學意義(P0.05)。2.本研究應用脈沖多普勒超聲獲得二尖瓣口血流頻譜,計算Ep/Ap,正常對照組和干燥綜合征組比較差異均無統(tǒng)計學意義。3.運用RT-3PEQTVI技術(shù)：3.1與正常組對比：原發(fā)組后間隔基底段Ve減小,差異有統(tǒng)計學意義外,其余11個節(jié)段的Ve,12個節(jié)段的Ve/Va, mVe, mVe/mVa無明顯降低,Va, mVa無明顯升高,差異無統(tǒng)計學意義。繼發(fā)組12個節(jié)段Ve, Ve/Va, mVe, mVe/mVa降低,Va, mVa升高,差異有統(tǒng)計學意義。3.2與原發(fā)組比較：繼發(fā)組12個節(jié)段Ve, Ve/Va, mVe, mVe/mVa降低；Va,mVa升高,差異有統(tǒng)計學意義。4.運用RT-3PE SRI技術(shù)：4.1與正常組對比：原發(fā)組12個節(jié)段SRe和SRa, SRe/SRa無明顯變化,差異無統(tǒng)計學意義。繼發(fā)組12個節(jié)段SRa差異無統(tǒng)計學意義,SRe, SRe/SRa降低,差異有統(tǒng)計學意義。4.2與原發(fā)組對比：繼發(fā)組12個節(jié)段除SRa無明顯變化,差異無統(tǒng)計學意義外,SRe, SRe/SRa有明顯變化,差異有統(tǒng)計學意義。結(jié)論：1.干燥綜合征患者左室舒張功能的改變早于收縮功能異常和左室形態(tài)改變。2.本次研究應用脈沖多普勒超聲獲得二尖瓣口血流頻譜,計算Ep/Ap,該指標評價左室舒張功能不敏感。3. RT-3PE QTVI與RT-3PE SRI技術(shù)評價干燥綜合征患者的左室舒張功能早于并優(yōu)于單純的Ep/Ap峰方法。4. RT-3PE SRI技術(shù)中SRe, SRe/SRa均可作為左室舒張功能受損評價指標。RT-3PE QTVI技術(shù)中Ve, Va, Ve/Va, mVe, mVa, mVe/mVa均可作為左室舒張功能受損評價指標。5. RT-3PE QTVI技術(shù)與RT-3PE SRI技術(shù)對干燥綜合征患者的左室舒張功能評價相關指標對比,RT-3PE QTVI指標Ve較為敏感,RT-3PE QTVI優(yōu)于RT-3PE SRI技術(shù)。
[Abstract]:Objective: to measure the velocity of left ventricular wall movement and left ventricular myocardial strain and strain rate in normal and Sjogren syndrome patients by using real-time three plane (real-time three-plane, RT-3PE) quantitative tissue velocity imaging (Quantitative tissue velocity imaging, QTVI) and strain rate imaging (Strain rate imaging, SRI). The left ventricular diastolic function of the patients with Sjogren syndrome and the preliminary diagnostic value of this technique on cardiac function changes in patients with Sjogren syndrome. Object: from June 2014 to February 2015 at the First Affiliated Hospital of Kunming Medical University, patients in the Department of Rheumatology, according to the consensus of the United States European Sjogren syndrome classification standard in 2002. 27 patients with Sjogren syndrome were divided into two subgroups, primary Sjogren syndrome (primary group) and secondary Sjogren syndrome group (secondary group), 15 cases in primary group, 12 in secondary group, 30 in healthy control group, and 30 in healthy control group. 1) all kinds of congenital heart disease, hypertrophic cardiomyopathy, severe valve Membrane disease, coronary atherosclerotic heart disease, primary hypertension and other heart diseases; 2) metabolic diseases: diabetes, abnormal blood lipid metabolism; 3) the poor quality of the three plane images. Methods: the American GE E9 color Doppler hyperacoustic diagnostic apparatus, the M5S probe, and the two dimensional gray scale under quiet state The left ventricular parameters were measured in the image. The left ventricular ejection fraction (LVEF, left ventricular ejection fraction) was measured by M- ultrasound. The mitral valve flow spectrum was obtained by pulsed Doppler ultrasound. The early diastolic peak blood flow velocity (Ep) and the late diastolic peak blood flow velocity (Ap) were measured, and 4V probes were used to obtain the four cavities of the apex. RT-3PE images, RT-3PEQTVI and RT-3PE SRI techniques were used to obtain and store images. The early diastolic peak velocity (Ve), late diastolic peak velocity (Va), early diastolic peak strain rate (SRe) and late diastolic peak strain rate (SRa) were analyzed. The left ventricular mean Ve, Va, Ve/Va, left ventricular SRe/SRa were calculated. Compared with the normal group, 1. compared with the normal group, there was no significant difference in cardiac structure and left ventricular systolic function index in patients with Sjogren syndrome (P0.05).2. in this study, pulse Doppler ultrasound was used to obtain mitral valve flow frequency The difference between the normal control group and the Sjogren syndrome group was no significant difference between the normal control group and the Sjogren syndrome group.3. using RT-3PEQTVI technique: 3.1 compared with the normal group, the Ve decreased in the basal segment of the primary group, and the difference was statistically significant. The Ve of the other 11 segments, the Ve/Va of the 12 segments, mVe, mVe/mVa did not decrease obviously, and the Va, mVa did not rise obviously, and the difference was poor. There was no statistical significance. 12 segments of secondary group Ve, Ve/Va, mVe, mVe/mVa, Va, mVa increased, and the difference was statistically significant between.3.2 and the original group: secondary group 12 segments Ve, Ve/Va, mVe, mVe/mVa decrease; Va, the difference was statistically significant: 4.1 of the normal group: 12 segments of the primary group There was no significant difference between SRa and SRe/SRa. There was no statistical difference between the 12 segments of secondary group, SRe, SRe/SRa decreased, and the difference was statistically significant between.4.2 and the original group: there was no significant difference between the secondary group and the secondary group except SRa, there was no significant difference between SRe and SRe/SRa, the difference was statistically significant. The difference was statistically significant. 1. the changes of left ventricular diastolic function in patients with Sjogren syndrome were earlier than systolic dysfunction and left ventricular shape change.2.. This study used pulsed Doppler ultrasound to obtain mitral valve flow spectrum and calculated Ep/Ap. This index was used to evaluate left ventricular diastolic dysfunction.3. RT-3PE QTVI and RT-3PE SRI to evaluate the left ventricle of patients with Sjogren syndrome. The diastolic function is earlier than that of the simple Ep/Ap peak method.4. RT-3PE SRI technique, SRe, SRe/SRa can be used as a marker of left ventricular diastolic function damage evaluation.RT-3PE QTVI technology, Ve, Va, Ve/Va, mVe, etc. The relative indexes of left ventricular diastolic function were compared, RT-3PE QTVI index Ve was more sensitive, and RT-3PE QTVI was superior to RT-3PE SRI technology.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R593.2

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本文編號：2010804