左室压力-应变环定量评估甲状腺功能亢进患者左室心肌做功改变的应用价值

Application Value of Left Ventricular Pressure Strain Loop Quantitative Evaluation of Left Ventricular Myocardial Work Changes in Patients with Hyperthyroidism

目的 探讨左室压力-应变环(left ventricular pressure-strain loop,LV-PSL)定量评估甲状腺功能亢进患者左室心肌做功改变的应用价值。方法 选取2021年8月—2023年8月在南宁市第二人民医院45例确诊为甲状腺功能亢进的患者为研究对象,根据甲亢程度分为A组(临床甲亢,n=33)与B组(亚临床甲亢,n=12),同期选取健康人群45名作为对照(C组)。收集患者一般资料,应用LVPSL技术获取整体纵向应变(global longitudinal strain,GLS)、整体做功指数(global myocardial work index,GWI)、整体有用功(globalmyocardialconstructivework,GCW)、整体无用功(globalmyocardial wasted work,GWW)及整体做功效率(global myocardial work efficiency,GWE),比较三组间上述参数的差异、血清甲状腺功能指标[促甲状腺激素(thyroid stimulating hormone,TSH)、游离甲状腺素(free thyroxine,FT4)、游离三碘甲腺原氨酸(free triiodothyronine,FT3)]、常规超声心动图指标[左心房内径(left atrial dimension,LAD)、左室后壁厚度(left ventricular posterior wall,LVPW)、舒张末期室间隔厚度(interventricular septal thickness at diastole,IVSD)、左心室舒张末期容积(left ventricular end diastolic volume,LVEDV)、左室收缩末期容积(left ventricular end systolic volume,LVESV)、左室射血分数(left ventricular ejection fractions,LVEF)]。结果 A组TSH[(0.19±0.06)mIU/L]和B组TSH[(0.23±0.02)mIU/L]均低于C组[(2.08±0.36)mIU/L];A组FT4[(25.15±2.18)pmol/L]、FT3[(9.19±1.24)pmol/L]和B组FT4[(20.48±1.98)pmol/L]、FT3[(6.14±0.93)pmol/L]均高于C组FT4[(14.25±1.57)pmol/L]、FT3[(3.14±1.01)pmol/L],差异有统计学意义(F=612.913、304.926、290.891,P均<0.05)。A组和B组甲亢患者与C组的各项常规超声心动图指标比较,差异无统计学意义(P均>0.05)。A组和B组的GLS、GWI、GCW、GWE均低于C组,GWW高于C组,差异有统计学意义(P均<0.05)。结论 LV-PSL可以定量评估甲状腺功能亢进患者的心肌功能改变,不同类型的甲状腺功能亢进患者的甲状腺激素水平存在一定的差异,有利于临床对于甲状腺功能亢进类型的辨别。

Objective To explore the application value of left ventricular pressure strain loop(LV-PSL) in quantitatively evaluating left ventricular myocardial work changes in patients with hyperthyroidism.Methods A total of 45 patients diagnosed with hyperthyroidism at Nanning Second People's Hospital from August 2021 to August 2023 were selected as the study objects.And they were divided into group A(clinical hyperthyroidism,n=33) and group B(subclinical hyperthyroidism,n=12) according to the degree of hyperthyroidism.Select 45healthy individuals as controls(group C) during the same period.Collect general patient information,use LVPSL technology to obtain global longitudinal strain(GLS),global work index(GWI),global constructive work(GCW),global wasted work(GWW),and global work efficiency(GWE).The differences of the above parameters,serum thyroid function indexes [ thyroid stimulating hormone(TSH),free thyroxine(FT4),free triiodothyronine(FT3) ],conventional echocardiography indexes [ left atrial diameter(LAD),left ventricular posterior wall thickness(LVPW),end-diastolic interventricular septal thickness(IVSD),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular ejection fraction(LVEF) ] were compared among the three groups.Results The TSH in group A [(0.19±0.06) mIU/L] and groupB [(0.23±0.02) mIU/L] were lower than that in group C [(2.08±0.36) mIU/L],the FT4 and the FT3 in group A [(25.15±2.18) pmol/L,(9.19±1.24) pmol/L] and group B [(20.48±1.98) pmol/L,(6.14±0.93) pmol/L] were higher than that in group C [(14.25±1.57) pmol/L,(3.141.01) pmol/L],and the differences were statistically significant(F=612.913,304.926,290.891,all P<0.05).There was no significant difference in the conventional echocardiographic indexes between group A and group B and group C(all P>0.05).The GLS,GWI,GCW,and GWE of the group A and group B were all lower than those of the groups C,and the GWW was higher than that in the groups C,and the differences were statistically significant(all P<0.05).Conclusion LV-PSL can quantitatively evaluate the changes in myocardial function in patients with hyperthyroidism.There are certain differences in thyroid hormone levels among different types of hyperthyroidism,which is beneficial for clinical identification of hyperthyroidism types.