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二维超声斑点追踪成像技术评价矽肺患者右心室功能及右心室功能不全的危险因素分析

Evaluation of right ventricular function using two-dimensional speckle tracking echocardiography and analysis of the risk factors for right ventricular dysfunction in patients with silicosis
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摘要 目的应用二维超声斑点追踪成像技术(2-D STE)评价矽肺患者右心室功能,探索矽肺患者合并右心室功能不全的相关危险因素。方法于2022年10月,选取2021年5月至2022年9月在首都医科大学附属北京朝阳医院职业病与中毒医学科住院的104例矽肺患者,收集患者一般资料、血气分析结果、肺功能检查结果等临床信息,分别采用2-D STE测量的右心室游离壁纵向应变(RVFWLS)和常规超声心动图测量的右心室面积变化分数(RVFAC)、三尖瓣环收缩期位移(TAPSE)和组织多普勒模式下三尖瓣环游离壁收缩期运动速度(S')等评价患者右心室功能,根据RVFWLS将患者分为右心室功能不全组和右心室功能正常组,采用二元logistic回归分析矽肺患者合并右心室功能不全的危险因素。结果104例矽肺患者年龄(65.52±11.18)岁,其中矽肺壹/贰期者57例,矽肺叁期者47例。26例(25.00%)患者合并右心室功能不全。患者RVFAC、TAPSE和S'异常率分别为16.35%(17例)、21.15%(22例)和6.73%(7例)。右心室功能不全组患者RVFAC和TAPSE低于右心室功能正常组,肺动脉收缩压≥36 mmHg发生率高于右心室功能正常组(P<0.05)。logistic回归分析显示,动脉血氧分压是矽肺患者合并右心室功能不全的保护因素(OR=0.932,95%CI:0.885~0.981,P=0.007);第1秒用力呼气容积与用力肺活量的比值(FEV1/FVC)<70%(OR=5.484,95%CI:1.049~28.662,P=0.044)和矽肺叁期(OR=6.343,95%CI:1.698~23.697,P=0.007)是矽肺患者合并右心室功能不全的危险因素。结论矽肺叁期患者的右心室功能不全发病率明显高于壹/贰期患者,2-D STE可应用于矽肺患者右心室功能的评价。缺氧、气流受限和矽肺叁期是矽肺患者合并右心室功能不全的危险因素。 Objective To evaluate the right ventricular function using two-dimensional speckle tracking echocardiography(2-D STE)and analyze the associated risk factors of right ventricular dysfunction in patients with silicosis.Methods All 104 patients with silicosis treated in the Department of Occupational Medicine and Toxicology in Beijing Chao-Yang Hospital,Capital Medical University from May 2021 to September 2022 were enrolled in this study in October 2022.The clinical information of patients such as general data,arterial blood gas analysis and pulmonary function test were collected.The right ventricular function of patients was evaluated by 2-D STE-derived right ventricular free wall longitudinal strain(RVFWLS)and conventional echocardiographic-derived parameters,including right ventricular fractional area change(RVFAC),tricuspid annular plane systolic excursion(TAPSE)and doppler tissue imaging-derived tricuspid lateral annular systolic velocity(S'),respectively.Based on their RVFWLS,the patients were divided into right ventricular dysfunction group and normal right ventricular function group.Risk factors for right ventricular dysfunction in patients with silicosis were analyzed using binary logistic regression analysis.Results A total of 104 silicosis patients were enrolled,with aneverage age(65.52±11.18)years old,among whom including 57 cases diagnosed with stageⅠ/Ⅱsilicosis and 47 cases diagnosed with stageⅢsilicosis.26(25.00%)patients concurrent right ventricular dysfunction.The abnormal rates of RVFAC,TAPSE and S'in patients were 16.35%(17 cases),21.15%(22 cases)and 6.73%(7 cases),respectively.The RVFAC and TAPSE in right ventricular dysfunction group were lower than those in normal right ventricular function group,and the incidence of pulmonary arterial systolic pressure≥36 mmHg was higher than that in normal right ventricular function group(P<0.05).Logistic regression analysis showed that arterial partial pressure of oxygen(OR=0.932,95%CI:0.885-0.981,P=0.007)was the protective factor,and the forced expiratory volume in 1 second(FEV1)/forced vital capacity(FVC)ratio<70%(OR=5.484,95%CI:1.049-28.662,P=0.044)and stageⅢsilicosis(OR=6.343,95%CI:1.698-23.697,P=0.007)were the risk factors for silicosis patients concurrent right ventricular dysfunction.Conclusion The incidence of right ventricular dysfunction is higher in patients with stageⅢsilicosis than that in patients with stageⅠ/Ⅱsilicosis.Using 2-D STE can help the early detection of silicosis with right ventricular dysfunction.Hypoxemia,airflow limitation and the stageⅢsilicosis are the risk factors for silicosis patients concurrent right ventricular dysfunction.
作者 姜维 余诗雯 吕秀章 宋玉果 Jiang Wei;Yu Shiwen;Lyu Xiuzhang;Song Yuguo(Department of Ultrasound Medicine,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China;Department of Occupational Medicine and Toxicology,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China)
出处 《中华劳动卫生职业病杂志》 CAS CSCD 北大核心 2023年第7期523-528,共6页 Chinese Journal of Industrial Hygiene and Occupational Diseases
关键词 矽肺 右心室功能不全 二维超声斑点追踪成像技术 右心室游离壁纵向应变 危险因素 Silicosis Right ventricular dysfunction Two-dimensional speckle tracking echocardiography Right ventricular free wall longitudinal strain Risk factors
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