背向散射积分技术在评价伴靶器官损害高血压患者心肌纤维化中的应用

Investigation of myocardial fibrosis in hypertensive patients with target organ damage by ultrasonic integrated backscatter

目的研究背向散射积分(IBS)作为高血压患者心肌纤维化早期指标的可行性。方法根据2007年欧洲高血压学会(ESH)/欧洲心脏学会(ESC)指南中亚临床靶器官损害标准将原发性高血压患者分成两组:非靶器官损害组(1组,42例),靶器官损害组(2组,51例),健康对照组36例。用IBS技术测量对照组、1组和2组室间隔心肌、左心室后壁心肌、左心房后壁心肌及心腔的IBS指标,计算并比较各组标化背向散射积分(IBS%)值是否存在差异。结果各部位的IBS值在对照组、1组、2组呈逐渐增高趋势,2组最高。其中左心房后壁IBS%值2组[(181±48)dB]与1组[(164±27)dB]、对照组[(164±27)dB]比较差异有统计学意义(P<0.05),左心室后壁IBS%值2组[(190±43)dB]与1组[(169±36)dB]、对照组[(166±28)dB]间差异有统计学意义(分别为P<0.05,P<0.01),室间隔左心室侧1/2处心肌IBS%值在2组和对照组间差异有统计学意义(P<0.05)。结论超声IBS技术可以评价伴有靶器官损害的高血压患者左心室心肌纤维化程度,但尚不能作为高血压患者心肌纤维化的早期指标。

Objective To investigate the feasibility of ultrasonic integrated backscatter （IBS） as an early index in myocardial fibrosis of hypertensive patients. Methods Ninety-three essential hypertensive patients （ 33 males and 60 females） and 36 normotensive subjects （11 males and 25 females） were studied. According to the standards of preclinical target organ damage in the ESH/ESC hypertension guideline 2007, the essential hypertensive patients were divided into two groups ： 42 patients without target organ damage （ group 1 ）, 51 patients with target organ damage （ group 2）. All patients and normal subjects underwent 2-dimensional echocardiography and IBS evaluation. Average IBS were measured at left atrial posterior wall, left ventricular posterior wall, left and right septum. IBS score was calculated and IBS score （ % ） was compared among each group. Results The IBS% value at left atrial posterior wall level was （164 ± 27 ）dB （controls） , （164 ± 27 ）dB （group 1 ）, and （181 ± 48 ）dB （group 2） （P 〈 0. 05 ） ; the IBS% value at left ventricular wall level was （166 ±28）dB （controls）, （169 ±34）dB （group 1 ）, and （190 ±43）dB （group 2） （P 〈0. 05） ; the IBS% value at left side of septum was （ 171 ± 43） dB （controls）, （ 170 ± 53） dB （ group 1 ） and （203 ±78） dB （ group 2） （ all P 〈 0. 05 ）. Conclusions The ultrasonic integrated backscatter can evaluate the left myocardial fibrosis of hypertensive patients with target organ damage.