【摘要】：目的:研究速度向量成像技術(shù)(VVI)新參數(shù)評(píng)估左心室舒張功能障礙及嚴(yán)重程度的可行性;探討新參數(shù)評(píng)估左心室舒張功能障礙的診斷效能;并進(jìn)一步研究診斷效能較好的參數(shù)測量位置的選擇及新參數(shù)與影響因素年齡的相關(guān)性。方法:納入因心血管癥狀就診于我院的門診及住院患者共129例,根據(jù)2016年由ASE和EACVI聯(lián)合發(fā)布的左心室舒張功能評(píng)估指南分為兩組,即左心室舒張功能正常組(30例)和左心室舒張功能障礙組(99例),后者根據(jù)嚴(yán)重程度又細(xì)分為左心室舒張功能I級(jí)障礙組57例、II級(jí)障礙組37例、III級(jí)障礙組5例。同期選取就診我院的健康體檢者124例作為對(duì)照組。所有受試者行超聲心動(dòng)圖檢查,留存心尖四腔心、三腔心及兩腔心二維動(dòng)態(tài)圖像,利用機(jī)器內(nèi)置的VVI軟件進(jìn)行后處理。記錄左心室縱向心肌層相應(yīng)指標(biāo):舒張?jiān)缙谧笮氖铱v向各節(jié)段心肌峰值速度(Ev)的平均值(G-MEv)、二尖瓣環(huán)6個(gè)心肌節(jié)段Ev的平均值(6MEv)、心尖四腔心切面二尖瓣環(huán)側(cè)壁Ev和室間隔Ev及兩者的平均值(2MEv),并記錄舒張?jiān)缙诙獍戥h(huán)6個(gè)心肌節(jié)段峰值應(yīng)變率(Esr)的平均值(6MEsr),根據(jù)舒張?jiān)缙诙獍昕谘鞣逯邓俣?E),6MEv,6MEsr,計(jì)算E/6MEv和E/6MEsr。結(jié)果:1.左心室舒張功能障礙組的6MEv和6MEsr均較對(duì)照組減小(P0.05),但上述參數(shù)在左心室舒張功能I級(jí)障礙組、II級(jí)障礙組、III級(jí)障礙組兩兩間比較差異無統(tǒng)計(jì)學(xué)意義。左心室舒張功能III級(jí)障礙組的E/6MEv和E/6MEsr均較對(duì)照組、I級(jí)障礙組、II級(jí)障礙組增大(P0.05),左心室舒張功能II級(jí)障礙組的E/6MEv和E/6MEsr也均較對(duì)照組、I級(jí)障礙組增大(P0.05),但左心室舒張功能I級(jí)障礙組的E/6MEv和E/6MEsr與對(duì)照組比較差異無統(tǒng)計(jì)學(xué)意義。與對(duì)照組比較,左心室舒張功能障礙組(合計(jì)值)、左心室舒張功能正常組的6MEv和6MEsr均減小,E/6MEv和E/6MEsr均增大(P0.05)。2.6MEv、6MEsr、E/6MEv和E/6MEsr的ROC曲線下面積分別為0.95、0.80、0.79、0.62,P均0.05。6MEv診斷舒張功能障礙的閾值為4.9cm/s;6MEsr診斷舒張功能障礙的閾值為1.3s-1;E/6MEv和E/6MEsr診斷II級(jí)障礙及以上的閾值分別為17、53cm,診斷III級(jí)障礙的閾值分別為21、77cm。3.6MEv、6MEsr、E/6MEv、E/6MEsr與左心室舒張功能障礙的相關(guān)系數(shù)rp分別為-0.77、-0.52、0.51、0.20,P均0.01。4.左心室舒張功能障礙組的側(cè)壁Ev、室間隔Ev、2MEv、6MEv和G-MEv與對(duì)照組比較均具有差異性(P0.05),但上述參數(shù)在左心室舒張功能I級(jí)障礙組、II級(jí)障礙組、III級(jí)障礙組兩兩間比較差異均不具有統(tǒng)計(jì)學(xué)意義。5.側(cè)壁Ev、室間隔Ev、2MEv、6MEv及G-MEv的ROC曲線下面積分別為0.85、0.87、0.89、0.95、0.95,P均0.0001;相應(yīng)的診斷舒張功能障礙的閾值分別為4.6cm/s、5.8cm/s、4.9cm/s、4.9cm/s、4.0cm/s。6.在對(duì)照組中,6MEv、6MEsr、E/6MEv與年齡均有不同程度的相關(guān)性(P0.05);但在左心室舒張功能障礙組中,三者與年齡的相關(guān)性均不具有統(tǒng)計(jì)學(xué)意義。而在兩組中,E/6MEsr與年齡的相關(guān)性均不具有統(tǒng)計(jì)學(xué)意義。結(jié)論:1.VVI新參數(shù)在左心室舒張功能評(píng)估方面具有臨床應(yīng)用價(jià)值,能早期識(shí)別心肌功能異常。2.6MEv或6MEsr僅能評(píng)估左心室舒張功能障礙,如若進(jìn)一步評(píng)價(jià)其嚴(yán)重程度,需要結(jié)合E/6MEv或E/6MEsr綜合評(píng)定。3.6MEv相對(duì)于6MEsr、E/6MEv、E/6MEsr是一個(gè)較好的指標(biāo),診斷左心室舒張功能障礙效能較優(yōu)。4.2MEv是一個(gè)相對(duì)較好反映左心室舒張功能的測量位點(diǎn);但當(dāng)多節(jié)段心肌功能異常時(shí),G-MEv是較好的測量位點(diǎn)。5.在評(píng)價(jià)左心室舒張功能時(shí),應(yīng)注意年齡對(duì)VVI新參數(shù)的影響。
[Abstract]:Objective: To study the feasibility of new parameters of velocity vector imaging (VVI) in assessing left ventricular diastolic dysfunction and severity, to explore the diagnostic efficacy of new parameters in assessing left ventricular diastolic dysfunction, and to further study the choice of parameters with better diagnostic efficacy and the correlation between new parameters and influencing factors. A total of 129 outpatients and inpatients with cardiovascular symptoms were enrolled in our hospital. According to the assessment guidelines of left ventricular diastolic function issued jointly by ASE and EACVI in 2016, they were divided into two groups: normal left ventricular diastolic function group (30 cases) and left ventricular diastolic dysfunction group (99 cases). The latter was further divided into left ventricular diastolic function I according to the severity. Fifty-seven patients with grade I disorder, 37 patients with grade II disorder and 5 patients with grade III disorder were enrolled in the study. 124 healthy subjects were selected as the control group. All subjects were examined by echocardiography, and two-dimensional dynamic images of apical four-chamber, three-chamber and two-chamber heart were preserved. Corresponding indices: Mean value of peak velocity (Ev) of left ventricular longitudinal segments (G-MEv), mean value of six segments of mitral annulus (6MEv), mean value of side wall Ev of mitral annulus (Ev) and mean value of ventricular septum Ev (2MEv) of both (2MEv) on apical four-chamber view, and peak strain rate (Esr) of six segments of mitral annulus in early diastolic period were recorded. E/6MEv and E/6MEsr were calculated according to the peak velocity of mitral orifice flow (E), 6MEv and 6MEsr. Results: 1. The 6MEv and 6MEsr in the left ventricular diastolic dysfunction group were significantly lower than those in the control group (P 0.05), but the above parameters were not statistically significant in the left ventricular diastolic dysfunction group I, II and III. The E/6MEv and E/6MEsr of the patients with grade III left ventricular diastolic dysfunction were both higher than those of the control group, the E/6MEv and E/6MEsr of the patients with grade I left ventricular diastolic dysfunction were higher than those of the control group (P 0.05), but the E/6MEv and E/6MEsr of the patients with grade I left ventricular diastolic dysfunction were higher than those of the control group (P 0.05). Compared with the control group, left ventricular diastolic dysfunction group (total value), left ventricular diastolic function group 6MEv and 6MEsr decreased, E/6MEv and E/6MEsr increased (P 0.05). 2.6MEv, 6MEsr, E/6MEv and E/6MEsr ROC curves below the integral were 0.95, 0.80, 0.79, 0.62, P 0.05.6MEv diagnostic threshold for diastolic dysfunction. The diagnostic thresholds of E/6MEsr and E/6MEsr were 17,53 cm and above, respectively. The diagnostic thresholds of E/6MEsr and E/6MEsr were 21,77 cm.3.6 MEv, 6 MEsr, E/6MEsr, and the correlation coefficients of E/6MEsr with left ventricular diastolic dysfunction RP were - 0.77, - 0.52, 0.51, 0.20, P 0.01.4, respectively. Side wall Ev, interventricular septum Ev, 2MEv, 6MEv and G-MEv in the diastolic dysfunction group were significantly different from those in the control group (P 0.05), but the above parameters were not statistically significant in the left ventricular diastolic dysfunction group I, II and III. The corresponding thresholds for diastolic dysfunction were 4.6 cm/s, 5.8 cm/s, 4.9 cm/s, 4.0 cm/s, and 4.0 cm/s, respectively. The correlation between E/6MEsr and age was not statistically significant in both groups. Conclusion: 1. The new parameters of VVI have clinical value in assessing left ventricular diastolic function and can identify early abnormal myocardial function. Combined with E/6MEv or E/6MEsr, 3.6MEv was a better index for diagnosing left ventricular diastolic dysfunction than 6MEsr, E/6MEsr and E/6MEsr. 4.2MEv was a relatively good site for measuring left ventricular diastolic function, but G-MEv was a better site for evaluating left ventricular diastolic function in patients with multi-segmental abnormalities. In diastolic function, we should pay attention to the effect of age on new parameters of VVI.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.6;R540.45

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