二维斑点追踪显像技术评价尿毒症高血压患者左室功能的临床应用

Evaluation of Left Ventricular Function in Uremia Hypertension Patients by Two Dimensional-Speckle Tracking Imaging

目的:通过二维斑点追踪显像技术(2D-STI)定量评价尿毒症高血压和原发性高血压患者左室收缩及舒张功能,并进行对比研究。方法:对30例正常人(A组),35例原发性高血压(B组)和60例尿毒症高血压患者(包括射血分数正常的C1组32例和射血分数减低的C2组28例)采集左室短轴基底水平和心尖水平图像进行二维斑点追踪分析,可得出左室基底部旋转角度峰值(Prot-B)、心尖部旋转角度峰值(Prot-A)、整体扭转角度峰值(PtwAll)及达峰时间(T-Ptw)、收缩末期扭转角度(AVCtw)、解旋率(UntwR)和解旋减半时间(HTU)。并分析扭转和解旋参数与常规超声指标之间的相关性。结果:1扭转参数的比较,原发性高血压组扭转增强(Prot-B、Prot-A、Ptw-All、AVCtw增加,T-Ptw缩短,P<0.05);尿毒症高血压C1组扭转减弱(Prot-B、Prot-A、Ptw-All、AVCtw降低,T-Ptw延长,P<0.05);C2组减弱更显著,差异均有统计学意义(P<0.05)。2解旋参数的比较,UntwR和HTU在正常对照组、原发性高血压组、尿毒症高血压C1组、尿毒症高血压C2组依次降低,差异有统计学意义(P<0.05)。3整体扭转角度峰值Prot-All与LVEF呈正相关,与LVEDD呈负相关;解旋率UntwR与LAD相关性较强,r=-0.663,P<0.05。结论:原发性高血压患者左室扭转运动增强,解旋能力降低,尿毒症高血压左室扭转运动减低,解旋功能更低。2D-STI技术可早期识别尿毒症高血压和原发性高血压心肌力学改变,为临床提供重要信息。

Objective：To assess the left ventricular function in uremia hypertension patients by two dimensional-speckle tracking imaging（2D-STI）.Methods：Thirty healthy controls,thirty-five primary hypertension patients and sixty uremia hypertension（which were divided into C1 group with normal ejected fraction,n=32;and C2 group with decreased ejected fraction,n=28）patients were studied.The imaging of base and apex level of left ventricular were analyzed by 2D-STI.Prot-B,Prot-A,Ptw-All,T-Ptw,AVCtw,UntwR and HTU were acquired.The correlation were analyzed between torsion and untwisting parameters with conventional indexes.Results：1By comparison of torsion parameters,in primary hypertension group,the Prot-B,Prot-A,Ptw-All,AVCtw were increased,T-Ptw was shortened（P〈0.05）.In uremia hypertension C1 group,the Prot-B,Prot-A,Ptw-All,AVCtw were decreased,T-Ptw was prolonged（P〈0.05）;in uremia hypertension C2 group,the torsion parameters were decreased more significantly（P〈0.05）.2The comparsion of UntwR and HTU were gradually decreasing from control group to uremia hypertension C2 group,all untwisting parameters had significant difference between them（P〈0.05）.3The Ptw-All had a positive correlation with LVEF,but had a negative correlation with LVEDD.The UntwR had a significantly negative correlation with LAD（r=-0.663,P〈0.05）.Conclusion：The torsion of left ventricular in primary hypertension patients are increased,but the untwisting are decreased;the torsion and untwisting function in uremia hypertension are both decreased.2D-STI could play important roles in the evaluation of left ventricular function between primary hypertension and uremia hypertension patients.