基于药物基因导向的冠心病患者个体化治疗决策临床路径的超声影像学评估

Drug gene-oriented clinical pathway for individualized treatment decision-making in patients with coronary heart disease:Ultrasound imaging assessment

目的运用二维斑点追踪(2D-STI)及实时三维超声心动图(RT-3DE)探讨对不同基因型的冠心病患者进行个体化治疗后左室的结构及功能变化的应用价值,为构建个体化精准治疗、临床路径的评估提供参考依据。方法选取2018年10月-2019年5月入本院治疗且具有心脑血管介入治疗指征的冠心病患者,其中个体化治疗组40例(其中快代谢型及非快代谢型各20例);另选常规治疗组20例。分别在入院及治疗6个月后行2D-STI及RT-3DE技术测量左室容积及功能参数。结果三组LVEF、LVGLS、LVGCS及MSR治疗后均较入院增高;ESV、EDV及Tmsv-16-SD治疗后均较入院减低;治疗后个体化治疗组LVEF、LVGLS、LVGCS及MSR显著大于常规治疗组;ESV、EDV及Tmsv-16-SD显著小于常规治疗组,差异均有统计学意义(P<0.05)。结论对不同基因分型的冠心病患者进行个体化治疗,较常规治疗后左心室结构及功能均明显改善,疗效更佳。

Objective To explore the application value of real-time three-dimensional echocardiography(RT-3 DE)and two-dimensional speckle tracking technology(2 D-STI)in the evaluation of left ventricular structure and function changes before and after individualized treatment of different genotyping patients with coronary heart disease.Provide a reference for the evaluation of treatment and clinical pathway.Methods Methods Patients with coronary heart disease who were treated in our hospital during October 2018 and May 2019 and had indications for cardiovascular and cerebrovascular intervention were enrolled,including 40 patients in the individualized treatment group(including 20 cases of fast metabolizing type and non-fast metabolizing type),another 20 patients in the conventional treatment group.Left ventricular volume and functional parameters were measured by 2 D-STI and RT-3 DE techniques at admission and 6 months after treatment.Results The levels of LVEF,LVGLS,LVGCS and MSR in the three groups were significantly higher than those before treatment.ESV,EDV and Tmsv 16-SD were significantly lower than those before treatment;After treatment,LVEF,LVGLS,LVGCS and MSR in the individualized treatment group were higher than those in the conventional treatment group.ESV,EDV and Tmsv 16-SD in the individualized treatment group were lower than those in the conventional treatment group(P<0.05).Conclusions For patients with coronary heart disease of different genotyping,individualized treatment could significantly improve the left ventricular structure and function compare with conventional treatment group,and the curative effect is better.