摘要
目的应用二维斑点追踪(2D-STI)与实时三维超声心动图(RT-3DE)评价不同病程活动期类风湿性关节炎(RA)患者左室收缩同步性,对比两种方法在评价左室收缩同步性方面的差异。方法选取我院90例活动期RA患者,根据病程将RA患者分为3组,每组各30例:A组,病程1~5年;B组,5年<病程≤10年;C组,病程>10年;另选同期30例健康志愿者作为对照组。应用2D-STI获得各组左室收缩功能参数即左室整体纵向应变(LVGLS)、左室整体环向应变(LVGCS),以及同步性参数即左室纵向应变及环向应变达峰时间标准差(Tls-SD、Tcs-SD);应用RT-3DE获得同步性参数即左室16节段达最小收缩容积时间的标准差(Tmsv-16-SD)及最大时间差(Tmsv-16-Dif)、经R-R间期校正后的左室16节段达最小收缩容积时间的标准差占心动周期的百分比(Tmsv-16-SD%)及最大时间差占心动周期的百分比(Tmsv-16-Dif%);比较各组上述参数差异;分析Tls-SD、Tcs-SD与Tmsv-16-SD、Tmsv-16-Dif的相关性。并对2D-STI与RT-3DE所测同步性参数进行重复性检验。结果 A组、B组、C组两两比较显示,随着病程增加,LVGLS逐渐降低,而Tcs-SD和TIs-SD逐渐延长,差异均有统计学意义(均P<0.05);A、B、C组与对照组比较,Tmsv-16-SD、Tmsv-16-Dif、Tmsv-16-SD%、Tmsv-16-Dif%均逐渐延长,差异均有统计学意义(均P<0.05)。Tls-SD与Tmsv-16-SD、Tmsv-16-Dif均呈正相关(r=0.307、0.345,均P<0.01),Tcs-SD与Tmsv-16-SD、Tmsv-16-Dif均呈正相关(r=0.340、0.359,均P<0.01)。2DSTI与RT-3DE对左室同步性指标的测量均具有较好的一致性,其中Tmsv-16-SD%重复性最好(观察者内ICC=0.985,观察者间ICC=0.977,均P<0.001)。结论 2D-STI与RT-3DE均能够检测出RA患者左室同步性的变化,均可定量评价左室收缩同步性,但是RT-3DE检测左室同步性变化更为敏感。
ObjectiveTo evaluate the changes of left ventricular systolic synchronization in patients with rheumatoid arthritis(RA)in different course by two-dimensional speckle tracking imaging(2 D-STI)and real-time three-dimensional echocardiography(RT-3 DE),and to compare the differences between the two methods in evaluating left ventricular systolic synchronization.Methods A total of 90 RA patients in our hospital were selected.According to the course of disease,RA patients were divided into three groups(A,B and C),according to 1~5 years,5~10 years and more than 10 years,with 30 patients in each group.Another 30 healthy volunteers of the same period were selected as the control group.Conventional echocardiography,2 D-STI and RT-3 DE were performed in all subjects.The left ventricular global longitudinal strain(LVGLS),left ventricular global circumferential strain(LVGCS),left ventricular longitudinal strain and circumferential strain reaching peak time standard deviation(Tls-SD,Tcs-SD)were obtained by 2 D-STI.The synchronization parameters were obtained by RT-3 DE,such as left ventricular 16-segment standard deviation(Tmsv-16-SD)and maximum time difference(Tmsv-16-Dif),the percentage of standard deviation(Tmsv-16-SD%)and the percentage of maximum difference(Tmsv-16-Dif%)of the time for the 16 segments of the left ventricle to reach the minimum systolic volume after R-R interval correction.The differences of the above parameters in each group were compared,the correlation analysis of Tls-SD and Tcs-SD with Tmsv-16-SD and Tmsv-16-Dif were carried out and the repeatability tests were performed for Tls-SD,Tcs-SD,Tmsv-16-SD,Tmsv-16-Dif,Tmsv-16-SD% and Tmsv-16-Dif%.Results Pair-wise comparison among group A,group B and group C showed that with course of disease increased,the LVGLS gradually decreased,while Tcs-SD and Tls-SD gradually extended,with statistically significant difference(all P<0.05).Compared with the control group,Tmsv-16-SD,Tmsv-16-Dif,Tmsv-16-SD% and Tmsv-16-Dif% in group A,B and C were gradually extended,and the differences were statistically significant(all P<0.05).Tls-SD was positively correlated with Tmsv-16-SD and Tmsv-16-Dif(r=0.307,0.345,both P<0.01)and Tcs-SD was positively correlated with Tmsv-16-SD and Tmsv-16-Dif(r=0.340,0.359,both P<0.01).2 D-STI and RT-3 DE had good consistency in the measurement of left ventricular synchronization indexes,and Tmsv-16-SD% had the best repeatability(ICCwithin observer=0.985,ICCbetween observers=0.977,both P<0.001).ConclusionBoth 2 D-STI and RT-3 DE can detect the changes of left ventricular synchronicity in RA patients,and can quantitatively evaluate left ventricular systolic synchronicity.However,RT-3 DE is more sensitive to the changes of left ventricular synchronicity.
作者
朱巧玲
郭泰
芦芳
ZHU Qiaoling;GUO Tai;LU Fang(Shanxi Medical University,Taiyuan 030001,China)
出处
《临床超声医学杂志》
CSCD
2020年第8期590-595,共6页
Journal of Clinical Ultrasound in Medicine
关键词
超声心动描记术
三维
实时
斑点追踪
二维
类风湿性关节炎
心室
左
同步性
Echocardiography
three-dimensional
real-time
Speckle tracking
two-dimensional
Rheumatoid arthritis
Ventricle
left
Synchronicity
