压力-应变环技术评估格雷夫斯病患者左心室功能

Pressure-strain loops for evaluating left ventricular function in patients with Graves disease

目的 观察左心室压力-应变环(LV-PSL)技术评估格雷夫斯病(GD)患者左心室功能的价值。方法 纳入101例GD患者,根据病程分为长病程组(n=45)及短病程组(n=56);以52名健康人为对照组;获取各组常规超声心动图及LV-PSL相关参数,行心率校正后,比较组间主动脉舒张末期内径(AOEDD)、左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、二尖瓣口血流舒张期峰值速度(E峰、A峰)、二尖瓣环左心室侧壁舒张期组织运动速度(e’、a’)、左心室整体纵向应变(GLS)、左心室峰值离散度(PSD)和整体做功指数、有用功、无用功及做功效率(GWI、GCW、GWW、GWE),结合血清学甲状腺激素指标进行相关性分析。结果 相比对照组,长、短病程组AOEDD、A峰、a’、GWW均增加,GLS、GWI均减小(P均<0.05);长病程组LVEDD增加、GWE减小(P均<0.05);短病程组LVEF、e’均增加、PSD减小(P均<0.05)。相比短病程组,长病程组GWW增加而GLS、GWI、GWE均减小(P均<0.05)。GD患者LV-PSL参数与血清学甲状腺激素指标间均无显著相关性(P均>0.05)。结论 LV-PSL可用于评估GD患者左心室功能、观察病程对心肌功能的影响。

Objective To observe the value of left ventricular pressure-strain loop(LV-PSL) for evaluating left ventricular function in patients with Graves disease(GD). Methods A total of 101 GD patients were enrolled and divided into long course group(n=45) and short course group(n=56) according to the course, while 52 healthy subjects were taken as controls(control group).Parameters of conventional echocardiography and ultrasonic PSL technology were obtained. After heart rate correction, aortic end-diastolic diameter(AOEDD), left ventricular end-diastolic diameter(LVEDD), left ventricular ejection fraction(LVEF), peak diastolic velocity of mitral valve orifice blood flow(peak E, peak A), tissue diastolic velocity of left ventricular lateral wall of mitral annulus(e’, a’), the left ventricular global longitudinal strain(GLS), peak strain dispersion(PSD), as well as global work index, constructive work, waste work and work efficiency(GWI, GCW, GWW, GWE) were compared among groups, and correlation analysis was carried out combining with serological thyroid hormone indexes. Results Compared with control group, AOEDD, peak A, a’ and GWW increased, while GLS and GWI decreased in both short course group and long course group(all P<0.05);LVEDD increased and GWE decreased in long course group(both P<0.05), while LVEF and e’ increased and PSD decreased in short course group(all P<0.05). Compared with short course group, GWW increased, GLS, GWI and GWE decreased in long course group(all P<0.05). No significant correlation was found between LV-PSL parameters and serological thyroid hormone in GD patients(all P>0.05). Conclusion LV-PSL could be used to evaluate left ventricular function of GD patients and explore the influence of course of disease on myocardial function.