二维斑点追踪技术评价慢性阻塞性肺疾病继发肺动脉高压病人右心室收缩功能的价值研究

Evaluation of Right Ventricular Systolic Function in Patients with Pulmonary Hypertension Secondary to Chronic Obstructive Pulmonary Disease by Two-dimensional Speckle Tracking

目的探讨二维斑点追踪技术(2D-STI)评价慢性阻塞性肺疾病(COPD)继发肺动脉高压病人右心室收缩功能的临床价值。方法选择2019年9月—2021年11月于陕西中医药大学附属医院住院并确诊的COPD病人60例作为研究对象,依据超声心动图估测的肺动脉收缩压将病人分为无肺动脉高压组(NPAH)25例和肺动脉高压组(PAH)35例,同时纳入19名健康成人作为对照组。采用超声心动图测量各组病人右室游离壁厚度(RVFT)、右室基底段内径(RVD)、右室面积变化分数(RVFAC)、三尖瓣环收缩期位移(TAPSE)、三尖瓣环收缩期的运动速度(PSV)及右心做功指数(RIMP);采用2D-STI分析各组病人右室游离壁基底段、中间段和心尖段长轴方向收缩期峰值基底段、中间段和心尖段应变(Sb、Sm、Sa)及整体长轴应变(GLS)。结果与对照组比较,PAH组RVFT明显增厚、RVD明显增大,RVFAC、TAPSE、PSV明显减低,RIMP明显增大,差异均有统计学意义(P<0.05);与对照组比较,NPAH组RVFAC、TAPSE明显减低,差异均有统计学意义(P<0.05);与NPAH组比较,PAH组RVD、RIMP明显增大,PSV明显减低,差异均有统计学意义(P<0.05)。与对照组比较,PAH组、NPAH组右室游离壁纵向应变Sb、Sm、Sa和GLS均低于对照组,差异均有统计学意义(P<0.05);与NPAH组比较,PAH组右室游离壁纵向应变Sb、Sm、Sa和GLS均较低,差异均有统计学意义(P<0.05)。结论2D-STI可对COPD病人右心室结构及功能进行准确、客观评价,具有重要的临床指导价值。

Objective To analyze the clinical value of two-dimensional speckle tracking technology(2D-STI)for evaluating right ventricular systolic function in patients with pulmonary hypertension secondary to chronic obstructive pulmonary disease(COPD).Methods A total of 60 COPD patients were selected as subjects.According to the pulmonary artery systolic blood pressure estimated by echocardiography,the patients were divided into NPAH group(n=25)and PAH group(n=35).Nineteen healthy adults were selected as control group.Right ventricular free wall thickness(RVFT),right ventricular basal segment diameter(RVD),right ventricular area change fraction(RVFAC),tricuspid annulus systolic displacement(TAPSE),tricuspid annulus systolic velocity(PSV),and right heart work index(RIMP)were measured by echocardiography.2D-STI was used to analyze the peak systolic strain in basal,middle,apical segments(Sb,Sm,Sa)and overall long axis strain(GLS)of the free wall of the right ventricle.Results Compared with the control group,RVFT and RVD in PAH group were significantly thickened and enlarged,RVFAC,TAPSE,and PSV were significantly decreased,and RIMP was significantly increased(P<0.05).Compared with the control group,RVFAC and TAPSE in NPAH group were significantly decreased(P<0.05).Compared with NPAH group,RVD and RIMP in PAH group were significantly increased,while PSV was significantly decreased(P<0.05).Compared with the control group,the longitudinal strains of Sb,Sm,Sa and GLS of right ventricular free wall in PAH group and NPAH group were lower than those in the control group,and the differences were statistically significant(P<0.05).Compared with NPAH group,the longitudinal strains of Sb,Sm,Sa and GLS of right ventricular free wall in PAH group were lower than those in control group,and the differences were statistically significant(P<0.05).Conclusion 2D-STI can accurately and objectively evaluate the structure and function of right ventricle in COPD patients,and it could supply important clinical guiding value.