超声心动图评价红斑狼疮患者右心功能损伤的可行性研究

Study on the feasibility of evaluating right ventricular function injury in SLE patients by echocardiography

目的探讨超声心动图评价系统性红斑狼疮(SLE)患者右心功能损伤的可行性和敏感性。方法将57例研究对象分为4组,即Ⅰ组(对照组):超声心动图及查体均正常的体检者18例;Ⅱ组:左室收缩、舒张功能均正常的SLE患者18例;Ⅲ组:左室收缩功能正常、舒张功能减低的SLE患者13例;Ⅳ组:SLE并发肺动脉高压的患者8例。用脉冲多普勒采集三尖瓣口舒张期血流频谱,计算舒张早期和晚期速度的比值(TrE/A);用组织多普勒采集三尖瓣环右室游离壁舒张早期峰值速度(Em)、舒张晚期峰值速度(Am),并计算Em/Am值。根据公式(ICT+IRT)/ET计算右心Tei指数,并测量右室射血分数(RVEF)。结果Ⅰ、Ⅱ、Ⅲ、Ⅳ组的右心Tei指数依次增大,分别为0.25±0.062、0.29±0.087、0.41±0.15及0.53±0.21。Ⅳ组患者的各项心功能指标与其他组的差异均有显著性意义(P<0.05)。Ⅲ组患者的右心Tei指数、Em和Em/Ea的比值较Ⅰ组和Ⅱ组减低(P<0.05),而Ⅲ组患者的RVEF和TrE/A的比值与Ⅱ组和对照组的差异未见显著性意义。结论右心Tei指数和三尖瓣环组织多普勒频谱能评估SLE患者右心功能的损害,较RVEF和TrE/A更为敏感。

AIM To evaluate the feasibility and sensibility of measuring right ventricular function injury in patients with systemic lupus erythematosus （SLE） by echocardiography. METHODS Eighteen healthy individuals （ group Ⅰ ） and 39 SLE patients （ group Ⅱ, Ⅲ,Ⅳ ） were included in the study. Group Ⅱ was SLE patients without left ventricular dysfunction, group m was SLE patients with diastolic dysfunction of left ventricular and group Ⅳ was SLE patients with pulmonary hypertension. Tei index, ejection fraction of right ventricular （RVEF）, spectrum of tricuspid （TrE/A） and the diastolic velocity of tricuspid annulus（ Em, Era/Am）were obtained. RESULTS By the sequence from group I to group IV, Tei index gradually increased （0. 25 ±0. 062, 0. 29 ±0. 087, 0. 41 ±0. 15, 0. 53 ±0. 21 ）. All the parameters of group Ⅳ were significantly different compared with those of the other three groups （P 〈 0. 05 ）. Tei index, Em and Em/Ea of group Ⅲ were significantly different with those of group Ⅰ and group Ⅱ （P 〈 0. 05）, while neither RVEF nor TrE/A in group In was different from that of group Ⅰ and group Ⅱ. CONCLUSION Tei index and the diastolic velocity of tricuspid annulus obtained by tissue Doppler may be more sensitive than RVEF and TrE/A in evaluating right ventrieular function injury in SLE patients.