二维斑点追踪成像技术检测GLS评价脓毒性休克患者心肌损伤的价值分析

Value of GLS detected by two-dimensional speckle tracking imaging in evaluating myocardial injury in patients with septic shock

目的 探讨二维斑点追踪成像技术(2D STI)检测左心室整体纵向应变(GLS)评价脓毒性休克患者心肌损伤的价值。方法 选取117例脓毒性休克患者为观察组、102例健康志愿者为对照组,均检查GLS、左心室射血分数(LVEF)及血清心肌肌钙蛋白I(cTnI)、N末端B型脑钠肽前体(NT-proBNP)。分析脓毒性休克患者GLS与LVEF、cTnI、NT-proBNP的相关性。绘制受试者工作特征(ROC)曲线分析GLS对心肌损伤的评价价值。结果 观察组GLS绝对值、LVEF低于对照组,差异有统计学意义(P<0.05),cTnI、NT-proBNP水平高于对照组,差异有统计学意义(P<0.05);脓毒性休克患者GLS绝对值与LVEF呈正相关(P<0.05),与血清cTnI、NT-proBNP水平呈负相关(P<0.05);心肌损伤患者GLS绝对值[(16.26±2.69)%]低于非心肌损伤患者[(21.78±1.45)%](P<0.001);GLS值诊断脓毒性休克患者心肌损伤的最佳截断点为-20.259,灵敏度为84.15%,特异度为80.00%,曲线下面积为0.815。结论 2D STI技术中的GLS值对脓毒性休克患者心肌损伤具有较好的诊断价值。

Objective To investigate the value of left ventricular global longitudinal strain(GLS)measured by two-dimensional speckle tracking imaging(2D STI)in the evaluating of myocardial injury in patients with septic shock.Methods 117 patients with septic shock and 102 healthy volunteers were selected as the observation group and control group,respectively.The GLS,left ventricular ejection fraction(LVEF)and serum cardiac troponin I(cTnI)and N-terminal B-type brain natriuretic peptide precursor(NT-proBNP)were examined.The correlations between GLS and LVEF,cTnI,NT-proBNP in patients with septic shock were analyzed.The receiver operating characteristic(ROC)curve was drawn to analyze the evaluation value of GLS for myocardial injury.Results The absolute values of GLS and LVEF in observation group were lower than control group(P<0.05),but cTnI and NT-proBNP levels were higher than control group(P<0.05).The GLS absolute value was positively corre-lated with LVEF in patients with septic shock(P<0.05),but it was negatively correlated with serum cTnI and NT-proBNP levels(P<0.05).The absolute value of GLS[(16.26±2.69)%]of myocardial injury patients was lower than non myocardial injury pa-tients[(21.78±1.45)%](P<0.001).The best cutoff point of GLS value in the diagnosis of myocardial injury in septic shock pa-tients was-20.259,and sensitivity was 84.15%,and specificity was 80.00%,and the area under the curve was 0.815.Conclu-sion The GLS value in 2D STI technology has good diagnostic value for myocardial injury in septic shock patients.