CAJ | 학술논문

目的：应用二维应变率成像技术检测健康人及冠状动脉粥样硬化性心脏病患者左心室局部长轴收缩功能变化。方法选取2011年10月至2012年8月在青岛大学医学院附属医院心内科住院治疗的冠状动脉粥样硬化性心脏病患者53例，其中前壁供血受损的左前降支病变患者29例（简称LCA组）、下壁供血受损的右冠状动脉病变患者24例（简称RCA组），同时选取健康志愿者30名（健康对照组）。超声心动图采集心尖四腔心、心尖两腔心切面二维动态灰阶图像，测量左心室前壁、侧壁、下壁及室间隔平均纵向收缩期峰值应变率（PSRs）。3组受检者上述资料的比较采用单因素方差分析，组间两两比较采用LSD-q检验。结果健康对照组受检者室间隔与前壁、侧壁、下壁PSRs分别为（4.61±0.60）s-1、（5.18±0.87）s-1、（5.60±0.70）s-1、（6.05±0.74）s-1，差异有统计学意义（F=20.95， P=0.00），且呈现室间隔→前壁→侧壁→下壁逐渐增大的变化规律；LCA组患者室间隔与前壁、侧壁、下壁PSRs分别为（4.31±0.85）s-1、（1.96±0.93）s-1、（5.54±0.83）s-1、（5.93±0.80）s-1，差异有统计学意义（F=127.25，P=0.00），缺血的前壁PSRs明显低于室间隔、侧壁、下壁，且前壁与侧壁、下壁比较，差异均有统计学意义（q=22.62、25.04，P均＜0.01）；RCA组患者室间隔与前壁、侧壁、下壁PSRs分别为（4.51±0.62）s-1、（4.99±1.13）s-1、（5.31±0.81）s-1、（2.84±0.85）s-1，差异有统计学意义（F=38.12，P=0.00），缺血的下壁PSRs明显低于前壁、侧壁和室间隔，且前壁与下壁比较，差异有统计学意义（q=12.08，P＜0.01），侧壁与下壁比较，差异有统计学意义（q=13.88，P＜0.01）。同部位各组间比较发现，LCA组前壁PSRs与健康对照组比较，差异有统计学意义（q=20.17，P＜0.01）；RCA组下壁PSRs与健康对照组比较，差异有统计学意义（q=19.98，P＜0.01）。结论二维应变率成像技术能准确评价左心室局部长轴收缩功能的变化，且在健康人中存在一定的变化规律，据此可快速早期检测冠状动脉粥样硬化性心脏病局部心肌缺血。目的：應用二維應變率成像技術檢測健康人及冠狀動脈粥樣硬化性心髒病患者左心室跼部長軸收縮功能變化。方法選取2011年10月至2012年8月在青島大學醫學院附屬醫院心內科住院治療的冠狀動脈粥樣硬化性心髒病患者53例，其中前壁供血受損的左前降支病變患者29例（簡稱LCA組）、下壁供血受損的右冠狀動脈病變患者24例（簡稱RCA組），同時選取健康誌願者30名（健康對照組）。超聲心動圖採集心尖四腔心、心尖兩腔心切麵二維動態灰階圖像，測量左心室前壁、側壁、下壁及室間隔平均縱嚮收縮期峰值應變率（PSRs）。3組受檢者上述資料的比較採用單因素方差分析，組間兩兩比較採用LSD-q檢驗。結果健康對照組受檢者室間隔與前壁、側壁、下壁PSRs分彆為（4.61±0.60）s-1、（5.18±0.87）s-1、（5.60±0.70）s-1、（6.05±0.74）s-1，差異有統計學意義（F=20.95， P=0.00），且呈現室間隔→前壁→側壁→下壁逐漸增大的變化規律；LCA組患者室間隔與前壁、側壁、下壁PSRs分彆為（4.31±0.85）s-1、（1.96±0.93）s-1、（5.54±0.83）s-1、（5.93±0.80）s-1，差異有統計學意義（F=127.25，P=0.00），缺血的前壁PSRs明顯低于室間隔、側壁、下壁，且前壁與側壁、下壁比較，差異均有統計學意義（q=22.62、25.04，P均＜0.01）；RCA組患者室間隔與前壁、側壁、下壁PSRs分彆為（4.51±0.62）s-1、（4.99±1.13）s-1、（5.31±0.81）s-1、（2.84±0.85）s-1，差異有統計學意義（F=38.12，P=0.00），缺血的下壁PSRs明顯低于前壁、側壁和室間隔，且前壁與下壁比較，差異有統計學意義（q=12.08，P＜0.01），側壁與下壁比較，差異有統計學意義（q=13.88，P＜0.01）。同部位各組間比較髮現，LCA組前壁PSRs與健康對照組比較，差異有統計學意義（q=20.17，P＜0.01）；RCA組下壁PSRs與健康對照組比較，差異有統計學意義（q=19.98，P＜0.01）。結論二維應變率成像技術能準確評價左心室跼部長軸收縮功能的變化，且在健康人中存在一定的變化規律，據此可快速早期檢測冠狀動脈粥樣硬化性心髒病跼部心肌缺血。
목적：응용이유응변솔성상기술검측건강인급관상동맥죽양경화성심장병환자좌심실국부장축수축공능변화。방법선취2011년10월지2012년8월재청도대학의학원부속의원심내과주원치료적관상동맥죽양경화성심장병환자53례，기중전벽공혈수손적좌전강지병변환자29례（간칭LCA조）、하벽공혈수손적우관상동맥병변환자24례（간칭RCA조），동시선취건강지원자30명（건강대조조）。초성심동도채집심첨사강심、심첨량강심절면이유동태회계도상，측량좌심실전벽、측벽、하벽급실간격평균종향수축기봉치응변솔（PSRs）。3조수검자상술자료적비교채용단인소방차분석，조간량량비교채용LSD-q검험。결과건강대조조수검자실간격여전벽、측벽、하벽PSRs분별위（4.61±0.60）s-1、（5.18±0.87）s-1、（5.60±0.70）s-1、（6.05±0.74）s-1，차이유통계학의의（F=20.95， P=0.00），차정현실간격→전벽→측벽→하벽축점증대적변화규률；LCA조환자실간격여전벽、측벽、하벽PSRs분별위（4.31±0.85）s-1、（1.96±0.93）s-1、（5.54±0.83）s-1、（5.93±0.80）s-1，차이유통계학의의（F=127.25，P=0.00），결혈적전벽PSRs명현저우실간격、측벽、하벽，차전벽여측벽、하벽비교，차이균유통계학의의（q=22.62、25.04，P균＜0.01）；RCA조환자실간격여전벽、측벽、하벽PSRs분별위（4.51±0.62）s-1、（4.99±1.13）s-1、（5.31±0.81）s-1、（2.84±0.85）s-1，차이유통계학의의（F=38.12，P=0.00），결혈적하벽PSRs명현저우전벽、측벽화실간격，차전벽여하벽비교，차이유통계학의의（q=12.08，P＜0.01），측벽여하벽비교，차이유통계학의의（q=13.88，P＜0.01）。동부위각조간비교발현，LCA조전벽PSRs여건강대조조비교，차이유통계학의의（q=20.17，P＜0.01）；RCA조하벽PSRs여건강대조조비교，차이유통계학의의（q=19.98，P＜0.01）。결론이유응변솔성상기술능준학평개좌심실국부장축수축공능적변화，차재건강인중존재일정적변화규률，거차가쾌속조기검측관상동맥죽양경화성심장병국부심기결혈。
Objective To evaluate the regional long-axis systolic function of left ventricular in patients with coronary artery disease and healthy subjects by two-dimensional strain rate imaging (2D-SRI). Methods During October 2011 to August 2012 , 53 inpatients with coronary artery disease in the department cardiology from the Afifliated Hospital of Medical College, Qingdao University were enrolled. Twenty-nine patients with anterior wall infarction induced by left front-descending coronary artery disease (group LCA) and twenty-four with interior wall infarction induced by right coronary artery disease (group RCA) proved by coronary angiography and echocardiography were enrolled into the study and thirty healthy volunteers in the control group. High frame rate two-dimensional dynamic images were recorded in apical four-chamber view and two-chamber view of the left ventricle. Using two-dimensional strain software, peak systolic longitudinal strain rate (PSRs) of interventricular septum, anterior wall, lateral wall and interior wall of left ventricle were measured. All data of 3 groups were analyzed using One-Way analysis of variance, and LSD-q test used to compare the 2 groups. Results The PSRs were (4.61±0.60) s-1, (5.18±0.87) s-1, (5.60±0.70) s-1, (6.05±0.74) s-1 from interventricular septum, anterior wall, lateral wall to interior wall in the control group. There were signiifcant differences among the groups (F=20.95, P=0.00), and there were signiifcant gradient changes from intervetrivular septum, anterior wall, lateral wall to interior wall in the control group. The PSRs were (4.31±0.85) s-1, (1.96±0.93) s-1, (5.54±0.83) s-1, (5.93±0.80) s-1 from interventricular septum, anterior wall, lateral wall to interior wall in the LCA group respectively. There were signiifcant differences among the different walls (F=127.25, P=0.00), which was signiifcant lower in ischemic anterior wall than interventricular septum, lateral wall and interior wall, and the significant differences were identified in anterior wall with lateral wall and interior wall (q=22.62, 25.04, both P<0.01). The PSRs were (4.51±0.62) s-1, (4.99±1.13) s-1, (5.31±0.81) s-1, (2.84±0.85) s-1 from interventricular septum, anterior wall, lateral wall to interior wall in RCA group respectively. There were signiifcant differences among the different walls (F=38.12, P=0.00), which were signiifcant lower in ischemic interior wall than interventricular septum, anterior wall, and lateral wall, and the signiifcant differences were identiifed in interior wall with lateral wall and interior wall (q=13.88, 12.08, both P<0.01). Comparing the same part among 3 groups, signiifcant differences were identiifed as following:the PSRs of anterior wall in group LCA vs control group (q=20.17, P<0.01), the PSRs of interior wall in group RCA vs control group (q=19.98, P<0.01). Conclusions Longitudinal systolic function changes of left ventricular regional myocardium in patients with coronary artery disease and healthy subjects could be accurately analyzed by 2D-SRI. The early changes in ischemic myocardium would be assessed quickly in patients with coronary artery disease using 2D-SRI.