超声背向散射测定结合胶原代谢物评价持续性心房颤动患者心房肌纤维化程度

Ultrasonic backscatter measurement combined with collagen metabolite detection for evaluating myocardial fibrosis in patients with persistent atrial fibrillation

目的探讨应用超声背向散射检测结合胶原代谢物评价老年持续性心房颤动(房颤)患者心房肌纤维化程度的价值。方法持续性房颤患者45例(房颤组)和无房颤病史的窦性心律患者45例(对照组),2组行超声心动图检测左心房直径(left atrial diameter,LAD),行超声背向散射测定技术检测房间隔及左心房后壁背向散射积分值(integrated backscatter,IBS)和背向散射积分周期变化值(cyclic variation of integrated backscatter,CVIB)。采用ELISA法检测患者血清结缔组织生长因子(connective tissue growth factor,CTGF)和Ⅰ型前胶原氨基端肽(procollagen typeⅠN-terminal propeptide,PⅠNP)水平。结果房颤组LAD[(44.65±2.12)mm]、血清CTGF[(130.50±8.40)ng/L]和PⅠNP[(140.32±6.32)ng/L]水平均高于对照组[LAD(28.65±2.31)mm、CTGF(80.26±3.54)ng/L、PⅠNP(89.45±4.25)ng/L)],差异有统计学意义(P<0.05);房颤组房间隔和左心房后壁的IBS%(45.50±3.60、42.20±3.87)明显高于对照组(32.76±2.85、30.24±5.68),CVIB(5.15±2.13、6.54±1.80)明显小于对照组(6.80±1.86、8.25±1.35)(P<0.05);LAD、CTGF和PⅠNP水平与IBS%呈正相关(r=0.358,P=0.041;r=0.525,P=0.021;r=0.632,P=0.018),与CVIB呈负相关(r=-0.152,P=0.035;r=-0.135,P=0.013;r=-0.210,P=0.033);房颤组患者LAD与CTGF(r=0.425,P=0.01)和PⅠNP(r=0.624,P=0.017)水平呈正相关。结论心房纤维化参与了房颤的发生和维持,超声背向散射测定结合胶原代谢物可无创性检查持续性房颤患者心房肌纤维化程度。

Objective To explore the value of ultrasonic backscatter measurement combined with collagen metabolite detection to assessing atrial fibrosis degree in patients with persistent atrial fibrillation（AF）.Methods The left atrial diameter（LAD）was detected by Doppler ultrasonic diagnostic apparatus,integrated backscatter（IBS）and cyclic variation of integrated backscatter（CVIB）in atrial septum and posterior wall of the left atrium were detected by quantitative analysis of ultrasonic backscatter,and the levels of procollagen typeⅠ N-terminal propeptide（PⅠNP）and connective tissue growth factor（CTGF）were detected by ELISA technique in 45 patients with persistent AF（AF group）and 45 sinus rhythm patients with no AF（control group）.Results LAD（（44.65±2.12）mm）,CTGF（（130.50±8.40）ng/L）and PⅠNP（（140.32±6.32）ng/L）in AF group were significantly higher than those in control group（（28.65±2.31）mm,（80.26±3.54）ng/L,（89.45±4.25）ng/L）（p〈0.05）.The IBS values of atrial septum and posterior wall（45.50±3.60,42.20±3.87）were significantly higher and CVIB values（5.15±2.13,6.54±1.80）were significantly lower in AF group than those in control group（32.76±2.85,30.24±5.68;6.80±1.86,8.25±1.35）（p〈0.05）.LAD,CTGF and PⅠ NP were positively correlated with IBS（r=0.358,P=0.041;r=0.525,P=0.021;r=0.632,P=0.018）and negatively correlated with CVIB（r=-0.152,P=0.035;r=-0.135,P=0.013;r=-0.210,P=0.033）in AF group（p〈0.05）.LAD was positively correlated with CTGF（r=0.425,P=0.010）and PⅠNP（r=0.624,P=0.017）in AF group.Conclusion Atrial fibrosis participates the occurrence and maintenance of AF.Ultrasonic backscatter measurement combined with collagen metabolite detection could be a non-invasive method to assess atrial fibrosis in patients with AF.