超声斑点追踪成像技术评价系统性红斑狼疮患者右心室收缩功能的研究

Evaluation of the right ventricular systolic function in patients with systemic lupus erythematosus by speckle tracking imaging

目的 应用超声斑点追踪成像（STI）技术评价SLE活动期患者右心室收缩功能.方法 入选SLEDAI评分≥5分的SLE患者40例[包括单纯SLE组24例,合并肺动脉高压（PAH）组16例],健康对照组35名.应用STI技术测定右心室游离壁及室间隔基底段、中间段、心尖段和右心室整体心内膜下心肌纵向收缩峰值应变（PSS）,对各研究对象的参数进行比较,并分析影响右心室整体应变的主要因素.采用独立样本t检验、单因素方差分析、SNK-q法、Spearman和Pearson相关性分析进行统计学分析.结果 ①SLE组右心室壁各节段PSS及右室整体应变（GLS RV）均低于对照组,差异均有统计学意义（P＜0.05）.其中SLE组右心室壁节段PSS游离壁基底段（bas FW）及GLS RV分别为（-27±8）％和（-22±4）％均低于对照组分别为（-33±6）％和（-26±4）％（t=-3.619,P=0.001;t=-4.815,P=0.000）;SLE组与对照组常规超声参数三尖瓣口舒张期流速比值及右心室射血分数差异有统计学意义（P＜0.05）.②合并PAH组与单纯SLE组相比,常规超声测值及右心室各节段PSS和GLS RV差异均有统计学意义,其中bas FW分别为（-22±6）％和（-30±7）％及GLS RV分别为（-18.4±2.3）％,（-23.7 ±3.5）％（t=-3.581,P=0.001;t=-5.769,P=0.000）.③中至重度SLE组右心室前壁厚度高于轻度组[分别为（5.0±0.8） mm和（4.3±0.8）mm; t=-2.49,P=0.017],bas FW[分别为（-22±9）％和（-35±6）％,t=-3.125,P=0.03]及室间隔基底段[分别为（-19±6）％和（-24±6）％;t=-2.272,P=0.029）和GLS RV[分别为（-19±4）％,（-24±7）％;t=-3.016,P=0.015]低于轻度组.结论 SLE患者右心功能减低,STI技术可客观地评价右心室纵向收缩功能.

Objective To evaluate the right ventricular （RV） systolic function in patients with systemic lupus erythematosus （SLE） by speckle tracking imaging （STI）.Methods A total of 40 cases with SLE were divided into two groups,SLE （24 cases） and SLE complicated with pulmonary arterial hypertension （PAH） （16 cases）.Meanwhile,35 healthy subjects were used as control group.Longitudinal peak systolic strain （PSS） of the basal,mid,apical segments of the free wall of right ventricular and interventricular septum and suben-docardial myocardium of the whole right ventricular were measured by STI respectively.Every parameter was compared.And the main factors affecting the strain of the whole right ventricule were analyzed.T test,one-way ANVOA,SNK-q,Spearman＇s correlation and Pearson＇s correlation analysis were used for statistical analysis.Results ① In SLE group,strains of the whole RV（GLS RV） [（-22±4）％] and all segments of RV wall[the basal segments of free wall （bas FW） （-27±8）％ were lower than that of the control group （-26±4）％,（-33±6）％,respectively （t=-4.815,P=0.000; t=-3.619,P=0.001）].Tricuspid valve orifice peak velocity E/A and right ventricular ejection fraction were significantly different between SLE group and control group （P＜0.05）.② In terms of conventional parameters and the strain of all segments of RV wall,bas FW and GLS RV were different between the SLE group [（-30±7）％,（-23.7±3.5）％,respectively] and SLE with PAH group [（-22±6）％,（-18.4±2.3）％,respectively] （t=-3.581,P=0.001; t=-5.769,P=0.000）.③ The RV anterior wall thickness of the moderate-severe subgroup was significantly higher than that of the mild group [（5.0±0.8） mm,（4.3±0.8） mm; t=-2.49,P=0.017].GLS RV[（-19±4）％,（-24±7）％;t=-3.016,P=0.015],bas FW [（-22±9）％,（-35±6）％; t=-3.125,P=0.03] and bas IVS [（-19±6）％,（-24±6）％; t=-2.272,P=0.029] were significantly lower than that of the mild group.Conclusion Right ventricular function is decreased in patients with SLE.STI can be used objectively to assess the right ventricular longitudinal systolic function.