二维斑点追踪分层应变参数联合白细胞衍生炎症指标诊断冠心病的临床价值

Clinical value of two-dimensional speckle tracking layer-specific strain parameters combined with leukocyte-derived inflammation indicators in the diagnosis of coronary artery disease

目的分析冠状动脉粥样硬化性心脏病(CAD)患者二维斑点追踪分层应变参数与白细胞衍生炎症指标的相关性,探讨二者联合在CAD诊断中的应用价值。方法选取我院因胸痛行冠状动脉造影诊断为CAD的患者141例,根据冠状动脉狭窄程度分为轻度狭窄组(46例)、中度狭窄组(54例)及重度狭窄组(41例),另选同期健康体检者30例为对照组。收集各组实验室检查结果,计算淋巴细胞与单核细胞比值(LMR)、单核细胞与高密度脂蛋白胆固醇比值(MHR);应用二维斑点追踪分层应变技术获得左室心内膜下、中层、心外膜下心肌整体纵向应变(GLSendo、GLSmid、GLSepi),比较各组上述参数的差异。分析LMR、MHR与分层应变参数的相关性,绘制受试者工作特征(ROC)曲线分析LMR、MHR、分层应变参数单独及联合应用诊断CAD的效能,采用组内相关系数(ICC)评价分层应变参数在观察者内及观察者间的一致性。结果与对照组比较,轻、中、重度狭窄组LMR均减低、MHR均升高,轻度狭窄组GLSendo、GLSmid均减低,中、重度狭窄组GLSendo、GLSmid、GLSepi均减低,差异均有统计学意义(均P<0.05)。相关性分析显示,MHR与GLSendo、GLSmid及GLSepi均呈正相关(r=0.382、0.384、0.366,均P<0.05),LMR与GLSendo、GLSmid及GLSepi均呈负相关(r=-0.198、-0.231、-0.249,均P<0.05)。ROC曲线分析显示,GLSendo分别联合LMR、MHR诊断CAD的曲线下面积分别为0.791、0.858(均P<0.01)。一致性检验显示,各分层应变参数在观察者间及观察者内的一致性均良好(ICC均>0.8)。结论二维斑点追踪分层应变参数与白细胞衍生炎症指标具有相关性,LMR、MHR分别联合GLSendo对CAD有一定的诊断价值。

Objective To analyze the correlation between two-dimensional speckle tracking layer-specific strain parameters and leukocyte-derived inflammation indicators in patients with coronary artery disease(CAD),and to explore the application value of the two combined in the diagnosis of CAD.Methods A total of 141 patients diagnosed as CAD by coronary angiography due to chest pain in our hospital were selected,and according to the degree of coronary artery stenosis,they were divided into mild stenosis group(46 cases),moderate stenosis group(54 cases)and severe stenosis group(41 cases),and 30 healthy subjects were selected as the control group.The laboratory test results of each group were collected to calculate lymphocytes to monocytes ratio(LMR)and monocytes to high density lipoprotein ratio(MHR).The global longitudinal strain of left ventricular endocardial,middle myocardial and epicardial layers(GLSendo,GLSmid,GLSepi)were detected by twodimensional speckle tracking layered strain technique.The differences of the above parameters in each group were compared.The correlation between LMR,MHR and each layered strain parameter were analyzed,and the receiver operating characteristic(ROC)curve was drawn to analyze the efficacy of LMR,MHR,layered strain parameter alone and in combination in the diagnosis of CAD.Intraclass correlation coefficient(ICC)was used to evaluate the intra-and inter-observer consistency for each layered strain parameter.Results Compared with the control group,LMR was reduced,MHR was increased in the mild,moderate and severe stenosis groups,GLSendo and GLSmid were reduced in the mild stenosis group,and GLSendo,GLSmid and GLSepi were reduced in the moderate and severe stenosis groups,and the differences were statistically significant(all P<0.05).Correlation analysis showed that MHR was positively correlated with GLSendo,GLSmid and GLSepi(r=0.382,0.384,0.366,all P<0.05),and LMR was negatively correlated with GLSendo,GLSmid and GLSepi(r=-0.198,-0.231,-0.249,all P<0.05).ROC curve analysis showed that the area under the curve of GLSendo combined with LMR and MHR in the diagnosis of CAD were 0.791 and 0.858(both P<0.001).The consistency test showed that the consistency of each layered strain parameter was good in intraand inter-observer(all ICC>0.8).Conclusion Two-dimensional speckle tracking layer-specific strain parameters are correlated with leukocyte-derived inflammation indicators,and LMR,MHR combined with GLSendo have certain diagnostic value in the diagnosis of CAD.