职业性哮喘心脏心室收缩和舒张功能变化临床意义

Change of ventricular systolic and diastolic function in patients with occupational asthma and its clinical significance

目的探讨职业性哮喘(OA)患者心脏心室收缩和舒张功能的变化及临床意义。方法以96例OA患者为病例组(轻、中、重度分别为56、30和10例,根据病程和病情程度分为轻度<5年亚组、轻度≥5年亚组、中重度<5年亚组、中重度≥5年亚组),以30名健康成年人为对照组,应用心脏彩色多普勒超声仪检测左右心室收缩和舒张功能指标变化情况并进行分析比较(上述检查在OA缓解期进行)。结果 1左心室:与对照组比较,轻度≥5年亚组、中重度<5年亚组以及中重度≥5年亚组左心室射血分数(LVEF)均下降(P<0.01),而射血前期与左心室射血期比值(PEP/LVET)和二尖瓣A峰血流速度(A peak)均升高(P<0.05);病例组4个亚组二尖瓣E峰血流速度(E peak)/A peak(E/A)均下降(P<0.05)。轻度≥5年亚组与轻度<5年亚组、中重度<5年亚组与轻度<5年亚组以及中重度≥5年亚组与中重度<5年亚组分别比较,LVEF和E/A均下降(P<0.05);PEP/LVET均升高(P<0.05);轻度≥5年亚组和中重度<5年亚组A peak分别高于轻度<5年亚组(P<0.05)。2右心室:与对照组比较,轻度≥5年亚组、中重度<5年亚组以及中重度≥5年亚组右心室射血前期/右心室射血期(RPEP/RVET)均升高(P<0.05),三尖瓣E峰血流速度(E’peak)均下降(P<0.05);病例组4个亚组三尖瓣环位移(TAD)、E’peak与三尖瓣A峰血流速度(A’peak)比值E’/A’均下降(P<0.05);轻度≥5年亚组与轻度<5年亚组、中重度<5年亚组与轻度<5年亚组以及中重度≥5年亚组与中重度<5年亚组分别比较,RPEP/RVET均升高(P<0.05);TAD和E’/A’均下降(P<0.05)。结论 OA患者在缓解期可能存在心室收缩和舒张功能受损,并随病程的延长和病情的加重而加重。

Objective To explore the change of ventricular systolic and diastolic function in patients with occupational asthma（ OA） and its clinical significance. Methods Ninety-six OA patients were selected as case group in the study.These patients included 56 cases of mild,30 cases moderate,and 10 cases severe diseases. Based on the different grades and courses of OA,these patients were divided into 4 subgroups： mild 5 years subgroup,mild ≥5 years subgroup,moderate-severe 5 years subgroup and moderate-severe ≥5 years subgroup. Thirty healthy adults were chosen as the control group. The indexes of systolic and diastolic function in left and right ventricles in all cases were analyzed by doppler echocardiography and compared（ druing OA remission period）. Results In left ventricle,compared to the control group,the left ventricular ejection fraction（ LVEF） were all decreased in the subgroups of mild ≥5 years,moderate-severe 5years and moderate-severe ≥5 years（ P〈0. 01）,while the ratios of pre-ejection period to left ventricular ejection time（ PEP/ LVET） and the mitral peak late diastolic velocity（ A peak） were all increased（ P〈0. 05）. In the 4 subgroups,the mitral peak early diastolic velocity（ E peak） and A peak ratio（ E / A） were all decreased（ P〈0. 05）. In the mild ≥5years subgroup compared to mild〈 5 years subgroup,moderate-severe〈 5 years subgroup compared to mild〈 5 years subgroup,and the moderate-severe ≥5 years subgroup compared to moderate-severe〈 5 years subgroup,the LVEF and E / A all decreased（ P〈0. 05）,while the PEP / LVET all increased（ P〈0. 05）; and the A peak of mild≥5 years and moderate-severe 〈5 years subgroups were higher than that of mild 5 years subgroup（ P〈0. 05）. As for the right ventricle,compared to the control group,the ratios of right pre-ejection period to right ventricular ejection time（ RPEP /RVET） were all increased in the subgroups of mild ≥5 years,moderate-severe 5 years and moderate-severe ≥5 years（ P〈0. 05）,while the tricuspid peak early diastolic velocity（ E＇peak） was decreased（ P〈0. 05）. In 4 subgroups,tricuspid annular displacement（ TAD） and the ratios of E＇peak to tricuspid peak late diastolic velocity（ E＇/ A＇） were all decreased（ P〈0. 05）; in the mild ≥5 years subgroup compared to mild 〈5 years subgroup,moderate-severe〈 5 years subgroup compared to mild 5 years subgroup,and the moderate-severe≥5 years subgroup compared to moderate-severe〈 5years subgroup,the RPEP / RVET were all increased（ P〈0. 05）,the TAD and E＇/ A＇were all decreased（ P〈0. 05）.Conclusion The systolic and diastolic function in ventricles could be damaged in OA patients during remission period.The functional damage would get worse with increasing severity and course of disease.