斑点跟踪超声心动图对一氧化碳中毒引起心脏毒性的预测价值分析

Predictive Value of Speckle Tracking Echocardiography for Cardiotoxicity Induced by Carbon Monoxide Poisoning

目的探究斑点跟踪(STI)超声心动图在一氧化碳(CO)中毒者心脏毒性中的临床价值。方法选取新乡医学院第三附属医院收治的126例CO中毒病人作为病例组,其中轻度47例,中度42例,重度37例,另选取62名正常者作为对照组,Elisa法检测血清中肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、天门冬氨酸氨基转移酶(AST)、乳酸脱氢酶(LDH)、羟丁酸脱氢酶(HBD)水平,STI超声心动图检测病人超声心动图指标以及心肌峰值应变参数。绘制受试者工作特征曲线(ROC),对比不同峰值应变参数曲线下面积(AUC)。结果病例组病人血清中CK、CK-MB、LDH、AST水平均明显高于对照组(P<0.05),随着中毒程度加重,CK、CK-MB、LDH、AST水平逐渐升高(P<0.05)。病例组左室射血分数(LVEF)及二尖瓣舒张早期、晚期血流峰值比值(E/A)明显低于对照组(P<0.05),随着中毒程度加重,LVEF、E/A水平逐渐降低(P<0.05)。病例组心肌整体纵向峰值应变(GLS)、心内膜下纵向峰值应变(LS-endo)、心外膜下纵向峰值应变(LS-epi)、跨壁纵向应变梯度(TMSG-LS)明显低于对照组,随着中毒程度加重GLS、LS-endo、LS-epi、TMSG-LS逐渐降低(P<0.05)。43例病人发生心脏毒性,心脏毒性发生组GLS、LS-endo、LS-epi、TMSG-LS均明显低于心脏毒性未发生组(P<0.05)。TMSG-LS AUC值最高为0.859,LS-epi、GLS、LS-endo AUC值分别为0.773、0.803、0.807。结论 CO中毒后,病人心肌酶指标升高、心室功能发生改变,STI超声心动图GLS、LS-endo、LS-epi、TMSG-LS在病人心脏毒性评测中具有较高的临床诊断价值,其中TMSG-LS诊断价值最高。

Objective To explore the clinical value of speckle tracking(STI)echocardiography in cardiotoxicity induced by carbon monoxide(CO)poisoning.Methods One hundred twenty-six patients with CO poisoning in the Third Affiliated Hospital of Xinxiang Medical College were selected as the patients group,of which 47 cases were mild,42 cases were moderate,37 cases were severe.Sixty-two normal subjects were selected as the control group.The levels of serum creatine kinase(CK),creatine kinase isoenzyme(CK-MB),aspartate aminotransferase(AST),lactate dehydrogenase(LDH),and hydroxybutyrate dehydrogenase(HBD)were measured by enzyme linked immunosorbent assay(ELISA).STI echocardiography was used to detect the echocardiographic parameters and the myocardial peak strain parameters of the patients.The receiver operating characteristic curve(ROC)was drawn and the area under curve(AUC)of different peak strain parameters was compared.Results The levels of serum CK,CK-MB,LDH,and AST in patients with CO poisoning were significantly higher than those in the control group(P<0.05),which were increased as the degree of poisoning severity,(P<0.05).The left ventricular ejection fraction(LVEF)and E/A in the poisoning group were significantly lower than those in the control group(P<0.05),which were decreased gradually as the degree of poisoning severity(P<0.05).The myocardial global longitudinal peak strain(GLS),endocardium longitudinal peak strain(LS-endo),epicardial longitudinal peak strain(LS-epi),and transmural gradient longitudinal strain gradient(TMSG-LS)in the patients group were significantly lower than those in the control group,which were decreased with the severity of poisoning(P<0.05).Cardiac toxicity occurred in 43 patients,and GLS,LS-endo,LS-epi,and TMSG-LS in the cardiotoxicity group were significantly lower than those in the non-cardiac toxicity group(P<0.05).The maximum value of TMSG-LS AUC was 0.859,and the values of LS-epi,GLS and LS-endo AUCs were 0.773,0.803 and 0.807,respectively.Conclusion After CO poisoning,the patient′s myocardial enzyme index increased and ventricular function changed.STI echocardiography GLS,LS-endo,LS-epi,and TMSG-LS have high clinical diagnostic value in cardiotoxicity evaluation.TMSG-LS has the highest diagnostic value.