二维斑点追踪技术评价阻塞性睡眠呼吸暂停综合征患者右室功能

Evaluation of right ventricular function in patients with obstructive sleep apnea syndrome by two-dimensional speckle tracking

目的通过二维斑点追踪技术(2D-STE)早期评价阻塞性睡眠呼吸暂停综合征(OSAS)患者右心室的亚临床功能。方法将30名健康人群与61名经多导睡眠检测诊断为OSAS的患者分为对照组与OSAS组,其中OSAS组根据呼吸暂停-低通气指数(AHI)分为轻、中、重三组。常规检测右室收缩功能的超声参数,运用二维斑点追踪技术评价右心室收缩功能,并结合血生化指标观察其是否与右心功能相关。结果随着OSAS疾病的严重程度,三尖瓣环收缩期位移(TAPSE)逐渐降低,右心室整体纵向应变(RVGLS)和右心室游离壁纵向应变(RVLLS)亦随之减低,且与对照组比较差异有统计学意义(P <0. 01),而右心室间隔纵向应变(RVSLS)无明显差异。甘油三酯(TG)越高,三尖瓣环平面收缩期位移(TAPSE)则越低,而高密度脂蛋白(HDL)越低,TAPSE也越低,且甘油三酯对OSAS患者右心功能的影响更大。结论 RVGLS和RVLLS随疾病严重程度逐渐降低,且比TAPSE更为敏感,因此,二维斑点追踪技术可评价OSAS患者亚临床期右心室功能障碍。

Objective To early evaluate the subclinical function of the right ventricle in patients with obstructive sleep apnea syndrome( OSAS) by two-dimensional speckle tracking( 2 D-STE). Methods Thirty healthy subjects and 61 patients with OSAS by polysomnography were chosen as control group and OSAS group,respectively. The patients in OSAS group were divided into three subgroups according to apnea-hypopnea index( AHI). The right ventricular systolic function parameters were detected,and the right ventricular systolic function was evaluated by a two-dimensional speckle tracking. Correlation between blood biochemical parameters and right heart function was analyzed. Results As the severity of OSAS disease increased,the tricuspid annulus systolic displacement( TAPSE) was gradually reduced,the right ventricular global longitudinal strain( RVGLS) and the right ventricular free wall longitudinal strain( RVLLS) were also reduced,and they were statistically different between two groups( P < 0. 01),but right ventricular septal longitudinal strain( RVSLS) showed no significant difference. When triglyceride( TG) increased,TAPSE reduced. When high-density lipoprotein( HDL) was decreased,TAPSE decreased. Moreover,triglycerides had a greater effect on right heart function in patients with OSAS.Conclusion RVGLS and RVLLS are gradually reduced as disease severity increases,and they are more sensitive than TAPSE.Therefore,two-dimensional speckle tracking technology can evaluate subclinical right ventricular dysfunction in OSAS patients.