甲状腺功能亢进性心脏病与单纯甲状腺功能亢进症患者左心房容积及功能的实时三维超声对照研究

Study of left atrial volume and function by real-time three-dimensional echocardiography between hyperthyroidism and hyperthyroid heart disease

目的探讨实时三维超声心动图(RT-3DE)评价甲状腺功能亢进性心脏病(简称甲亢心)与甲状腺功能亢进症(简称甲亢)患者左心房容积及功能变化特点和规律的应用价值。方法选取2020年3-9月于河南省人民医院确诊为甲亢及甲亢心但未经治疗的患者56例,分为单纯甲亢组(30例)和甲亢心组(26例),另选取同期健康志愿者30例作为对照组。应用RT-3DE左心房自动定量技术获得以下参数:左心房最小、最大、收缩前容积指数(LAVImin、LAVImax、LAVIpreA),左心房被动、主动排空及每搏量容积指数(LAVIp、LAVIa、LAVIEV),左心房被动、主动、整体射血分数(LApEF、LAaEF、LAEF);左心室收缩期、舒张早期和晚期左心房纵向应变(LASr、LAScd、LASct)及圆周应变(LASr-c、LAScd-c、LASct-c),比较两组间以上参数的差异。结果与对照组比较,单纯甲亢组LAVImax、LAVIpreA、LAaEF、LAVIEV、LAVIa、LASr、LASct-c增大,LApEF减小(均P<0.05);甲亢心组LAVImin、LAVImax、LAVIpreA、LAVIEV增大,LAaEF、LApEF、LAEF、LASct、LAScd-c、LASr-c减小(均P<0.05)。与单纯甲亢组比较,甲亢心组LAVImin、LAVImax、LAVIpreA进一步增大,LAEF、LAaEF、LASr、LASr-c、LASct、LASct-c、LAScd-c减小(均P<0.05)。LAEF与LASr及LASr-c呈正相关(r=0.617、0.837,均P<0.01),LApEF与LAScd及LAScd-c呈正相关(r=0.620、0.800,均P<0.01),LAaEF与LASct及LASct-c呈正相关(r=0.680、0.727,均P<0.01)。结论单纯甲亢患者左心房储存及收缩功能增强,尚处于代偿阶段,仅管道功能降低;甲亢心患者左心房储存、管道及收缩功能均降低,且管道功能受损可能早于收缩和储存功能减低。

Objective To explore the application value of real-time three-dimensional echocardiography(RT-3DE)in evaluating the characteristics and regularities of left atrial volume and function changes in patients with hyperthyroidism and hyperthyroid heart disease.Methods Fifty-six patients who were diagnosed with hyperthyroidism and hyperthyroid heart disease without treatments in Henan Provincial People′s Hospital from March 2020 to September 2020 were selected.They were divided into hyperthyroidism group(30 patients)and hyperthyroid heart disease group(26 patients).Another 30 healthy volunteers were selected as the control group.The following parameters were obtained by RT-3DE left atrial automatic quantification technology,left atrial minimum,maximum,presystolic volume index(LAVImin,LAVImax,LAVIpreA),left atrial passive,active emptying volume index and stroke volume index(LAVIp,LAVIa,LAVIEV),left atrial passive,active,total ejection fraction(LApEF,LAaEF,LAEF),during left ventricular systole,early diastole,late diastole left atrial longitudinal strain(LASr,LAScd,LASct)and circumferential strain(LASr-c,LAScd-c,LASct-c).The differences of the above parameters between the two groups were compared.Results Compared with the control group,LAVImax,LAVIpreA,LAaEF,LAVIEV,LAVIa,LASr,LASct-c increased and LApEF decreased in the hyperthyroidism group(all P<0.05).While,LAVImin,LAVImax,LAVIpreA and LAVIEV increased,and LAaEF,LApEF,LAEF,LASct,LAScd-c and LASr-c decreased in hyperthyroid heart disease group(all P<0.05).Compared with the hyperthyroidism group,LAVImin,LAVImax and LAVIpreA in hyperthyroid heart disease group were further increased,while LAEF,LAaEF,LASr,LASr-c,LASct,LASct-c and LAScd-c were decreased(all P<0.05).LAEF were positively correlated with LASr and LASr-c(r=0.617,0.837;all P<0.01),LApEF were positively correlated with LAScd and LAScd-c(r=0.620,0.800,all P<0.01),LAaEF were positively correlated with LASct and LASct-c(r=0.680,0.727;all P<0.01).Conclusions In the patients with hyperthyroidism,the left atrial reserve and systolic function are increased,which are still in the compensation stage,and the pipeline function is decreased.The left atrial reserve,pipeline and systolic function in the hyperthyroid heart disease patients are all decreased,and the pipeline function may be impaired earlier than the systolic and reserve function.