实时三维超声心动图评价高血压前期左心房功能的研究

Real-time three-dimensional echocardiography for reviewing left atrial volume and function in patients with prehypertension

目的探讨实时三维超声心动图（RT3DE）评价高血压病前期人群左心房功能的价值。方法纳入2012年6月~2012年12月北京军区总医院高血压前期患者[收缩压120~139 mmHg和（或）舒张压80~90 mmHg]80例，纳入同期血压＜120/80 mmHg者40例作为对照组，应用二维超声心动图测量左心房、室内径、室间隔厚度（IVST）、左室后壁厚度，及左心室舒张功能指标，如舒张早期峰值速度（E）、收缩期峰值速度（A）、二尖瓣环舒张早期运动速度（E’）、收缩期运动速度（A’），计算E/A。应用RT3DE测量左心房最大容积（LAVmax）、左心房最小容积（LAVmin）及左心房收缩前容积（LAVpre），计算左心房每搏射血量（LASV）、左心房排空分数（LAEF%）、左心房被动排空分数（LAp%）及左心房主动排空分数（LAa%），并对两组结果进行对比分析。结果①二维超声心动图结果：与对照组相比，高血压前期组IVST更厚[（9.71±0.81）mm vs.（9.04±1.08）mm，P＜0.05]，余指标无统计学差异（P均＞0.05）；②RT3DE结果：与对照组比较，高血压前期组LAVmax、LAVpre、LAEF%、LASV及LAa%更高[分别为（35.46±4.27）ml vs.（31.56±3.34）ml，（20.58±3.72）ml vs.（17.84±3.32）ml，（55.60±8.23）%vs.（50.47±7.27）%，（20.34±5.74）ml vs.（16.79±5.12）ml，（39.48±10.48）%vs.（31.57±10.26）%，P均＜0.05]，LAp%更低[（43.69±10.32）%vs.（47.26±10.67）%，P均＜0.05]。结论RT3DE较二维超声心动图更能早期发现高血压前期人群左心房容积和功能改变。

Objective To discuss the values of real-time three-dimensional echocardiography （RT3DE） in the reviewing of left atrial function in the patients with prehypertension. Methods The patients with prehypertension （SBP=120 mmHg-139 mmHg and/or DBP=80 mmHg-90 mmHg） were chosen as prehypertension group （n=80） from Jun. 2012 to Dec. 2012, and the cases with blood pressure below 120/80 mmHg were chosen as control group. The diameters of left atrium and ventricle, interventricular septum thickness （IVST）, left ventricular posterior wall thickness, and left ventricular diastolic indexes, including early diastole peak velocity （E） and systolic peak velocity （A）, mitral ring early motion velocity （E’） and systolic motion velocity （A’）, were detected by using two-dimentional echocardiography, and E/A ratio was calculated. The maximum left atrial volume （LAVmax）, minimum left atrial volume （LAVmin） and left atrial volume before contraction （LAVpre） were detected by using RT3DE. The left atrial stroke volume （LASV）, left atrial emptying fraction （LAEF%）, left atrial passive ejection fraction （LAp%） and left atrial active ejection fraction （LAa%） were calculated. All results were compared and analyzed in two groups. Results ①The results of two-dimentional echocardiography showed that IVST was thicker in prehypertension group than that in control group [（9.71±0.81） mm vs. （9.04±1.08） mm, P〈0.05], and other indexes had no statistical difference between two groups （all P〉0.05）. ②The results of RT3DE showed that LAVmax, LAVpre, LAEF%, LASV and LAa%were higher in prehypertension group than those in control group [（35.46±4.27） mL vs.（31.56±3.34） mL, （20.58±3.72） mL vs. （17.84±3.32） mL, （55.60±8.23）%vs.（50.47±7.27）%, （20.34± 5.74） mL vs. （16.79±5.12） mL, （39.48±10.48）%vs. （31.57±10.26）%, all P〈0.05], and LAp%was lower [（43.69 ±10.32）%vs. （47.26±10.67）%, P〈0.05]. Conclusion RT3DE can find out more early the changes of left atrial volume and function compared with two-dimentional echocardiography in the patients with prehypertension.