超声二维应变成像评价冠心病患者颈动脉弹性功能

Evaluation of the carotid elasticity in patients with coronary heart disease by two-dimensional strain imaging

目的:应用二维应变成像技术评价冠心病患者的颈动脉血管弹性。方法:选取拟诊冠心病入院行冠状动脉造影检查的住院患者206例,根据冠状动脉造影结果将其分为单支病变组63例、多支病变组113例及非冠心病组30例。分别应用M型超声技术及二维应变成像技术对受试者行颈动脉超声检查,记录测量结果,对数据进行统计分析和处理。结果:①冠状动脉多支病变组收缩期峰值整体圆周应变(Circumferential strain,CS)及收缩早期整体CS小于单支病变组和非冠心病组(P<0.01),收缩晚期整体圆周应变率(Circumferential strain rate,CSr)及僵硬度系数β2大于单支病变组和非冠心病组(P<0.01),单支病变组收缩期峰值整体CS及收缩早期整体CSr小于非冠心病组(P<0.01),收缩晚期整体CSr及β2大于非冠心病组(P<0.01);②收缩期峰值整体CS、收缩早期整体CSr、收缩晚期整体CSr、β2的ROC曲线下面积分别为86.9%、82.7%、80.3%、91.4%,对冠心病均有较高的诊断价值(P<0.001);③经判别分析所得判别函数:Y=0.817β2+0.500IMT-0.185斑块(1或者0),对冠心病的诊断敏感性为78.4%,特异性为93.3%,总判别准确率为80.6%。结论:冠心病患者颈动脉弹性改变早于形态学改变且与冠脉严重程度相关,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） by two-dimensional strain imaging.Methods：Two hundred and six hospitaized patients with suspected CHD who were to undergo coronary angiography were enrolled in the research.According to the coronary angiography,the patients were divided into one diseased branch group inculding sixty-three cases,multiple diseased branch group including one hundred and three cases and nonCHD group including thirty cases.All patients were examined by M mode echocardiogram and two-dimensional strain imaging respectively,the measurement results were recorded.All clinical datas were statistically analyzed and processed.Results：①The systolic peak global CS and early systolic global CSr in multiple diseased branch group were lower than those in one diseased branch group and those in non-CHD group （P＜0.01）,while the late systolic global CSr and β2 in multiple diseased branch group were greater than those in one diseased branch group and those in non-CHD group （P＜0.01）,the systolic peak global CS and early systolic global CSr in one diseased branch group were lower than those in non-CHD group（P＜0.01）,while the late systolic global CSr and β2 in one diseased branch group were greater than those in non-CHD group （P＜0.01）.②）The ROC curve analysis indicated that the under-curve areas of the systolic peak global CS,the early systolic global CSr,the late systolic global CSr and β2 were 86.9％,82.7％,80.3％ and 91.4％ respectively.All of them showed high diagnostic value to CHD（P＜0.001）.③The discriminant function “Y=0.817β2＋0.500IMT-0.185plaque（1 or 0）” was obtained by discriminant ananlysis and its sensitivity and specificity of diagnosis of CHD were 78.4％ and 93.3％ respectively,the accuracy rate was 80.6％.Conclusion：The elasticity of blood vessel wall in CHD patients changed earlier than morphological changes and related with the degree of stenosis of coronary artery.CS and CSr which were carotid elasticity indexes may become two of the noninvasive indexes in evaluating CHD.