二维应变成像技术评价冠心病患者颈动脉弹性的研究

Study on evaluation of the carotid elasticity in patients with coronary heart disease with two-dimensional strain imaging

目的应用超声二维应变成像技术评价冠心病患者的颈动脉弹性。方法选取冠心病患者66例,根据冠状动脉造影结果分为单支病变组32例和多支病变组34例,非冠心病患者30例,所有入选患者均行颈动脉超声检查,采用二维应变成像技术测量颈动脉短轴方向收缩期峰值整体圆周应变(CS)及收缩晚期整体圆周应变率(CSr),对数据进行统计分析和处理。结果 (1)单支病变组收缩期峰值整体CS(5.24%±0.84%)小于非冠心病组(5.69%±0.80%,P<0.05),收缩晚期整体CSr[(-0.33±0.07)s-1]大于非冠心病组[(-0.38±0.09)s-1,P<0.05],多支病变组收缩期峰值整体CS(3.65%±0.58%)小于非冠心病组及单支病变组(P<0.01),收缩晚期整体CSr[(-0.25±0.06)s-1]大于非冠心病组及单支病变组(P<0.01);(2)Pearson相关分析示:收缩晚期整体CSr与Gensini积分呈正相关(r=0.409,P<0.05),收缩期峰值整体CS与Gensini积分呈负相关(r=-0.485,P<0.01);(3)收缩期峰值整体CS与收缩晚期整体CSr的ROC曲线下面积分别为0.840及0.777,对冠心病有较高的诊断价值(P<0.001)。结论冠心病患者颈动脉弹性改变早于形态学改变且与冠状动脉严重程度相关,颈动脉弹性指标CS及CSr有可能成为评价冠心病的参考指标。

Objective To evaluate the carotid elasticity in patients with coronary heart disease（CHD）with two-dimensional strain imaging.Methods Sixty-six patients with CHD and thirty patients with non-CHD were enrolled in our study.According to the coronary angiography,the CHD group was divided into one diseased branch group including thirty-two cases and multiple diseased branches group including thirty-four cases.All patients were examined by carotid artery ultrasound technology,the systolic peak global circumferential strain（CS）and late systolic global circumferential strain rate（CSr）were obtained in short axis views using 2D strain imaging.All clinical data were statistically analyzed and processed.Results（1）The systolic peak global CS（5.24%±0.84%）in one diseased branch group was lower than those in non-CHD group（5.69%±0.80%,P0.05）;the late systolic global CSr[（-0.33±0.07）s-1]in one diseased branch group was greater than those in non-CHD group[（-0.38±0.09）s-1,P0.05];the systolic peak global CS（3.65%±0.58%）in multiple diseased branches group was lower than those in one diseased branch group and those in non-CHD group（P0.01）,while the late systolic global CSr[（-0.25±0.06）s-1]was greater than those in one diseased branch group and those in non-CHD group（P0.01）.（2）Pearson correlation analysis indicated that late systolic global CSr positively（r=0.409,P0.05）and systolic peak global CS negatively（r=-0.485,P0.01）related with Gensini score.（3）The under-curve area of systolic peak global CS and late systolic global CSr were 84.0% and 77.7% respectively.Both of them all showed high diagnostic value to CHD（P0.001）.Conclusions The elasticity of blood vessel wall in CHD patients change earlier than morphological changes and relate with the degree of stenosis of coronary artery.CS and CSr which are carotid elasticity indexes may become two of the noninvasive indexes in evaluating CHD.