探讨彩色多普勒超声对扩张型心肌病与缺血性心肌病的诊断价值

To evaluate the diagnostic value of color Doppler ultrasonography in dilated cardiomyopathy and ischemic cardiomyopathy

目的对彩色多普勒超声诊断扩张型心肌病与缺血性心肌病的临床价值。方法选取心肌病患者100例依照其诊断结果分为扩张型心肌病55例(扩张组)和缺血性心肌病45例(缺血组),两组患者均接受彩色多普勒超声诊断,对两组患者的心脏形态结构、血流动力学以及心功能情况进行观察。结果扩张型心肌病55例患者中36例患者出现左心室球形改变、全心扩大,12例单纯左房室大,7例右房室大;缺血性心肌病组45例患者中左室球形改变6例(均为末期患者),左房室大29例,左室大10例,左室形状均不对称。扩张型心肌病组患者室壁普遍降低,表现出弥漫性减弱,缺血性心肌组患者超声表现为段性室壁运动减低,患者多合并不同程度的左室后壁增厚、不同程度的室间隔,其中合并室壁瘤8例,两组结构变化比较差异有统计学意义(P<0.01);扩张型患者左房室内CDFI暗淡率为94.55%显著高于缺血组57.78%;扩张型心肌病组患者TCR 10.91%、AVR 18.18%均显著低于缺血组(P<0.05);扩张型患者AOV为(43.01±15.03)cm/s、LVEF为(39.21±5.02)%、FS为(18.22±2.37)%均显著低于缺血组,扩张型患者E/A为(1.20±0.18)、EPSS(25.01±3.01)mm、EF倾斜为(49.93±11.76)mm显著高于缺血组,差异有统计学意义(P<0.05)。结论彩色多普勒超声能够明确诊断心肌病患者的形态结构、心功能变化,能够作为扩张型心肌病与缺血性心肌病区别诊断的有效工具。

Objective To evaluate the clinical value of color Doppler ultrasonography in the diagnosis of dilated cardiomyopathy and ischemic cardiomyopathy. Methods 100 patients with cardiomyopathy diagnosed and treated in our hospital were divided into dilated cardiomyopathy （55 cases） and ischemic cardiomyopathy （45 cases） according to the diagnosis. In both groups, all patients underwent color Doppler ultrasonography, The two groups of patients with cardiac morphology, hemodynamics and cardiac function were observed. Results Of the 55 patients with dilated cardio- myopathy, 36 patients had left ventricular spherical change and whole heart enlargement, 12 cases with large left atrioventricular and 7 right atrioven- tricular. 45 cases of ischemic caxdiomyopathy were left ventricle spherical change 6 cases （all were end stage patients）, left atrioventricular large 29 cases, left ventriculax large 10 cases, left ventricular shape are asymmetrical. The ventricular wall of the patients with dilated cardiomyopathy was generally lower and showed diffuse attenuation. The patients with ischemic myocardium were characterized by the decrease of the segmental wall movement. The patients combined with different degrees of left posterior wall thickening and different degrees of ventricular septum, including 8 cases with ventriculax aneurysm, and the difference of the two groups was statistically significant （P〈0.01）; The dilation rate of CDFI in the left atrium of the dilated patients was 94.55% significantly higher than that in the ischemic group （57.78%）, and the TCR 10.91% and AVR 18.18% in the dilated cardiomyopathy group were significantly lower than those in the ischemic group （P〈0.05）;T he AOV of dilated patients （43.01± 15.03） cm/s, LVEF （39.21±5.02）% and FS （18.22±2.37）% were significantly lower than those of ischemic group. E/A （1.20±0.18）, EPSS （25.01±3.01） mm and EF tilt （49.93±11.76） mm in dilated patients were significantly higher than those of ischemic group （P〈0.05）. Conclusion Color Doppler ultraso- nography cam clearly diagnose the morphological structure and cardiac function of patients with caxdiomyopathy. It cam be used as an effective tool for differential diagnosis of dilated cardiomyopathy and ischemic cardiomyopathy.