摘要
目的研究急性心肌梗死(AMI)患者三维斑点追踪参数测定对左心室重构的评估价值。方法选择2014年3月至2017年10月期间在西安交通大学附属红会医院接受急诊经皮冠状动脉介入术(PCI)治疗的80例AMI患者,并根据PCI术后6~9个月的超声心动图随访来判断左心室重构,分为重构组(n=46)和非重构组(n=34);另取同期体检的健康志愿者作为对照组(n=50)。PCI术后24 h比较三组受检者间的超声心动图参数、三维斑点追踪参数、血清左心室重构指标的差异。结果 PCI术后24 h,重构组、非重构组患者和对照组的左心室舒张末期容积(LVEDV)[(106.51±22.32) mL vs (105.94±19.83) mL vs (89.32±11.38) mL]、左心室收缩末期容积(LVESV)[(50.73±8.73) mL vs(51.42±7.81) mL vs (43.58±7.65) mL]及血清I型C端胶原前肽(PICP)[(11.94±1.85) ng/mL vs (8.93±1.32) ng/mL vs (4.24±0.62) ng/mL]、Ⅲ型N端胶原前肽(PIIINP)[(39.59±6.52) ng/mL vs (27.63±4.47) ng/mL vs (8.95±1.32) ng/mL]、成纤维细胞生长因子23 (FGF23)[(896.55±95.62) pg/mL vs (747.68±92.35) pg/mL vs (465.62±62.93) pg/mL]、基质金属蛋白酶9(MMP9)[(57.69±8.52) ng/mL vs (43.58±6.31) ng/mL vs (22.47±3.75) ng/mL]比较,重构组、非重构组患者的含量均明显高于对照组,而左心室射血分数(LVEF)[(49.51±6.52)%vs (50.12±7.72)%vs (62.58±8.72)%]、整体长轴应变(GLS)[(9.51±1.13) vs (12.31±1.62) vs (15.58±2.25)]、整体径向应变(GRS)[(29.49±5.41) vs (32.12±5.56) vs (38.72±6.23)]、整体环形应变(GCS)[(9.01±1.13) vs (11.83±1.62) vs (14.32±1.96)]、整体面积应变(GAS)[(13.82±1.89) vs (21.44±3.25) vs(28.79±4.52)]水平比较,重构组、非重构组患者的上述各项指标的水平均明显低于对照组,差异均有统计学意义(P<0.05),而重构组患者的LVEDV、LVESV、LVEF水平与非重构组比较则差异均无统计学意义(P>0.05),但GLS、GRS、GCS、GAS水平均明显低于非重构组,血清PICP、PIIIINP、FGF23、MMP9含量均明显高于非重构组,差异均具有统计学意义(P<0.05);GLS、GRS、GCS、GAS水平与血清PICP、PIIIINP、FGF23、MMP9含量呈负相关(P<0.05)。结论 AMI患者PCI术后24 h的三维斑点追踪参数测定有助于左心室重构的早期评价。
Objective To study the value of three-dimensional speckle tracking parameters in evaluating left ventricular remodeling in patients with acute myocardial infarction(AMI). Methods Eighty patients with AMI who received emergency percutaneous coronary intervention(PCI) in Red Cross Hospital Affiliated to Xi ’an Jiaotong University from March 2014 to October 2017 were divided into remodeling group(n=46) and non-remodeling group(n=34) according to echocardiographic follow-up of 6 to 9 months after PCI. Healthy volunteers in the same period were selected as control group(n=50). At 24 hours after PCI, the differences of echocardiographic parameters, three-dimensional speckle tracking parameters, and serum left ventricular remodeling indexes were compared among the three groups.Results At 24 hours after PCI, Left ventricular end-diastolic volume(LVEDV), left ventricular end-systolic volume(LVESV), serum procollagen I C-terminal propeptide(PICP), procollagen III N-terminal propeptide(PIIIINP), fibroblast growth factor 23(FGF23), mtrix metalloproteinase 9(MMP9) in the remodeling group and non-remodeling group were significantly higher than those in control group(P<0.05): LVEDV,(106.51±22.32) mL vs(105.94±19.83) mL vs(89.32±11.38) m L;LVESV,(50.73±8.73) m L vs(51.42±7.81) m L vs(43.58±7.65) m L;PICP,(11.94±1.85) ng/m L vs(8.93±1.32) ng/mL vs(4.24 ± 0.62) ng/mL, PIIINP,(39.59 ± 6.52) ng/mL vs(27.63 ± 4.47) ng/mL vs(8.95 ± 1.32) ng/mL;FGF23,(896.55 ±95.62) pg/mL vs(747.68±92.35) pg/mL vs(465.62±62.93) pg/mL;MMP9,(57.69±8.52) ng/mL vs(43.58±6.31) ng/mL vs(22.47 ± 3.75) ng/mL. Left ventricular ejection fraction(LVEF), global longitudinal strain(GLS), global radial strain(GRS), global circumferential strain(GCS), global area strain(GAS) levels in remodeling group and non-remodeling group were significantly lower than those in control group(P<0.05): LVEF,(49.51±6.52)% vs(50.12±7.72)% vs(62.58±8.72)%;GLS,(9.51±1.13) vs(12.31±1.62) vs(15.58±2.25);GRS,(29.49±5.41) vs(32.12±5.56) vs(38.72±6.23);GCS,(9.01±1.13) vs(11.83±1.62) vs(14.32±1.96);GAS,(13.82±1.89) vs(21.44±3.25) vs(28.79±4.52). There was no significant difference in the levels of LVEDV, LVESV, and LVEF between remodeling group and non-remodeling group(P>0.05), the levels of GLS, GRS, GCS, and GAS of remodeling group were significantly lower than those in non-remodeling group(P<0.05), and the levels of serum PICP, PIIIINP, FGF23, and MMP9 of remodeling group were significantly higher than those of non-remodeling group(P<0.05). The levels of GLS, GRS, GCS, and GAS were negatively correlated with the levels of serum PICP, PIIIINP, FGF23, and MMP9(P<0.05). Conclusion The measurement of three-dimensional speckle tracking parameters at 24 hours after PCI in patients with AMI is helpful for the early evaluation of left ventricular remodeling.
作者
张丹
武翊纶
李瑞琼
ZHANG Dan;WU Yi-lun;LI Rui-qiong(Department of Ultrasound,Red Cross Hospital Affiliated to Xi 'an Jiaotong University,Xi 'an 710054,Shaanxi,CHINA;Emergency Department,the Second People's Hospital in Shaanxi Province,Xi 'an 710005,Shaanxi,CHINA)
出处
《海南医学》
CAS
2019年第11期1425-1428,共4页
Hainan Medical Journal
基金
2014年陕西省科技计划项目(编号:2014K12-16)
关键词
急性心肌梗死
左心室重构
超声心动图
三维斑点追踪超声
胶原
Acute myocardial infarction
Left ventricular remodeling
Echocardiography
Three-dimensional speckle tracking ultrasound
Collagen
