三维斑点追踪技术及血浆脑钠肽检测对PAH患者右心室功能改变的评价

Evaluation of 3D speckle tracking technique and plasma brain natriuretic peptide for the change of right ventricular function

目的:通过三维斑点追踪技术和检测血浆脑钠肽(BNP)对肺动脉高压(PAH)患者右心室(RV)功能进行评价。方法:回顾性选取50例PAH患者,根据右心室(RV)功能状态将其分为RV正常组和RV减退组,每组25例;同期选择25名健康体检者作为健康对照组。采用三维斑点追踪技术检测右室舒张末期容积(RVEDV)、右室收缩期末期容积(RVESV)、右室射血分数(RVEF)、右室整体纵向收缩期峰值应变(GLS)和右室整体圆周向收缩期峰值应变(GCS)。采用吖啶酯化学发光法检测血浆脑钠肽(BNP)水平。血浆BNP与三维斑点追踪成像指标的相关性检验采用Pearson分析。结果:三组GCS的比较差异无统计学意义,随左室功能减退,三组RVEDV和RVESV逐渐增加,而三维RVEF和GLS逐渐降低,其差异均有统计学意义(F=12.324,F=10.324,F=20.140,F=13.548;P<0.05)。健康对照组血浆BNP为(13.56±3.01)ng/L,RV正常组为(230.64±23.84)ng/L,RV减退组为(840.24±65.14)ng/L,组间比较差异有统计学意义(F=45.214,P<0.001)。BNP与RVEDV、RVESV、三维RVEF和GLS有较好的相关性(r=0.448,r=0.426,r=-0.354,r=-0.605;P<0.05)。结论:血浆BNP和三维超声心动图指标具有明显的相关性,二者联合检测有利于评价RV功能的改变。

Objective: To evaluate the function of right ventricle (RV) of patients with pulmonary arterial hypertension (PAH) through brain natriuretic peptide (BNP) combined with three dimensional (3D) speckle tracking technique. Methods: Fifty patients with PAH in our hospital were included in this retrospective study. According to the functional status of RV, they were divided into normal group of RV function (25 cases) and RV hypofunction group (25 cases). In addition, 25 healthy persons were selected as healthy control group. The right ventricular end diastolic volume (RVEDV), right ventricular end systolic volume (RVESV), right ventricular ejection fraction (RVEF), right ventricular overall longitudinal systolic strain (GLS) and right ventricular global circumference peak strain (GCS) were measured by 3D speckle tracking technique. The plasma brain natriuretic peptide (BNP) level was measured by electrochemiluminescence method with acridinium ester. The correlation between plasma BNP and 3D speckle tracking imaging was analyzed by Pearson analysis. Results: The differences of GCS between the three groups were no significant. With the decrease of the left ventricular function, RVEDV and RVESV of three groups gradually increased, while the 3D RVEF and GLS gradually decreased, and the differences of them were statistically significant (F=12.324, F=10.324, F=20.140, F=13.548, P<0.05). The plasma BNP of healthy control group was (13.56±3.01) ng/L, and it was (230.64±23.84) ng/L in RV normal group, and it was (840.24 ±65.14) ng/L in the RV decreasing group, and the difference of BNP among three groups was significant (F=45.214, P<0.001). BNP has good correlation with RVEDV, RVESV, 3D RVEF and GLS (r=0.448, r=0.426, r=-0.354, r=-0.605, P<0.05). Conclusion: There is a significant correlation between the BNP and the indicators of 3D echocardiography. The combined detection of the two methods is beneficial to evaluate the changes of RV function.