TDI-Tei指数在高海拔地区肺动脉高压患者右心功能评价中的应用

Application of TDI-Tei Index in Evaluation of Right Ventricular Function in Patients with High Altitude Pulmonary Hypertension

目的:分析脉冲多普勒成像技术与组织多普勒成像技术测定的Tei指数与肺动脉压之间的关系,探讨其在高海拔地区肺动脉高压患者右心功能评价中的价值。方法:选择我院2016年7月至2018年1月收治的60例肺动脉高压患者,根据肺动脉压程度分为轻、中、重度三个亚组,各20例,同时选择长期生活在高海拔地区和平原地区的正常体检者,各30例,作为高原对照组和平原组以及平原地区健康人(平原组30例)进行对照研究,采用脉冲多普勒成像技术与组织多普勒成像技术测定各组患者心尖四腔切面三尖瓣环室间隔的频谱图,测量其射血期、等容收缩期、等容舒张期,并计算每组患者的Tei指数,分析其TDI-Tei指数与患者肺动脉压之间的关系。结果:由平原组至对照组再到PAH组由轻度到重度,患者的ICT、IRT指标逐渐升高,ET指标逐渐下降,而PW-Tei和TDI-Tei指数也逐渐升高(P<0.05);TDI组测量的ET指标明显高于PW组,而ICT、IRT指标明显低于PW组,最终Tei指数明显高于PW组(P<0.05);对患者的右心室TDI-Tei、PW-Tei指数与其肺动脉收缩压进行pearson相关性分析,TDI-Tei、PW-Tei指数与其肺动脉收缩压均呈现为正相关(r=0.968,P<0.01;r=0.732,P<0.01)。结论:PW-Tei和TDI-Tei指数均能够评价高海拔地区肺动脉高压患者的右心功能,TDI-Tei指数准确度、敏感性更高,值得临床推广使用。

Objective： To analyze the relationship between Tei index and pulmonary artery pressure measured by pulsed Doppler imaging and tissue Doppler imaging,and to explore its value in evaluating right ventricular function in patients with pulmonary hypertension at high altitude. Methods： Sixty patients with pulmonary hypertension treated in our hospital from July 2016 to January 2018 were selected as study subjects.According to the degree of pulmonary arterial pressure,the patients were divided into mild,moderate and severe subgroups,20 cases in each group,at the same time,normal subjects（ control group,30 cases） and healthy people（ plain group,30 cases）,pulse wave Doppler imaging and Tissue Doppler imaging were used to measure the tricuspid annulus in each group. The ejection fraction,isovolumic systolic phase,isovolumic diastolic phase,the Tei index of each group of patients was calculated and the relationship between TDI-Tei index and pulmonary pressure was analyzed. Results： From plain to control group to mild to severe PAH group,the indexes of ICT and IRT increased gradually,ET index decreased gradually,but PW-Tei and TDI-Tei index increased gradually（ P〈0.05）. The indexes of ET in TDI group were significantly higher than those of PW group,while the indexes of ICT and IRT were significantly lower than those in PW group. The final Tei index was significantly higher than that in PW group（ P〈0.05）. Pearson correlation analysis of TDI-Tei,PW-Tei index and pulmonary artery systolic pressure showed that there was a positive correlation between TDI-Tei and PW-Tei index and pulmonary artery systolic pressure（ r = 0. 968,P〈0. 01; r = 0. 732,P〈0. 01）.Conclusion： Both PW-Tei and TDI-Tei index can evaluate the right cardiac function of patients with pulmonary hypertension at high altitude,and the accuracy and sensitivity of TDI-Tei index are higher. It is worthy of clinical application.