中华医学超声杂志（电子版）
中華醫學超聲雜誌（電子版）
중화의학초성잡지（전자판）
CHINESE JOURNAL OF MEDICAL ULTRASOUND(ELECTRONICAL VISION)
2013年
6期
449-454
,共6页
周赵良%朱文军%庄延兵%吕晓东%金惠红%全丽娟
週趙良%硃文軍%莊延兵%呂曉東%金惠紅%全麗娟
주조량%주문군%장연병%려효동%금혜홍%전려연
超声心动描记术%三尖瓣%心室功能,右%肺心病
超聲心動描記術%三尖瓣%心室功能,右%肺心病
초성심동묘기술%삼첨판%심실공능,우%폐심병
Echocardiography%Tricuspid valve%Ventricular function,right%Pulmonary heart disease
目的探讨二维斑点追踪技术测定的三尖瓣环位移（TAD）评价肺源性心脏病（简称肺心病）患者右心室收缩功能的价值。方法选取肺心病心功能代偿期（代偿组）、心功能失代偿期（失代偿组）患者各15例，选取同期健康体检者30名作为健康对照组，测量三尖瓣环中点位移（TADmid）、三尖瓣环游离壁位移（TADfre）、三尖瓣环室间隔处位移（TADsep），同时行实时三维超声心动图检测RVEF，并分析TADmid与RVEF、肺动脉收缩压（PASP）之间的相关性。结果健康对照组、代偿组、失代偿组受检者TADmid 分别为（17．1±3．9）mm、（13．6±2．6） mm、（9．5±3．2） mm；TADfre分别为（21．1±3．0）mm、（17．6±4．2）mm、（11．5±3．8）mm；TADsep分别为（12．0±2．5）mm、（9．7±3．3）mm、（7．4±2．7）mm；RVEF值分别为（56．3±8．2）％、（39．6±6．4）％、（28．1±5．9）％；PASP值分别为（20．6±2．6）mm Hg（1 mm Hg＝0．133 kPa）、（63．3±5．6）mm Hg、（82．5±11．2）mm Hg，3组间比较差异均有统计学意义（F＝8．581、7．816、9．300、6．507、10．235，P均＜0．05）。代偿组与健康对照组相比：TADfre、TADmid、TADsep均减小，其中以TADmid幅度最大，TADfre幅度最小；RVEF亦明显减低，而PASP增高（t＝2．703、2．536、2．379、2．817、3．026，P均＜0．05）。失代偿组与对照组相比：TADfre、TADmid、TADsep进一步减小，RVEF明显减低，PASP明显增高（t＝2．519、2．493、2．236、2．621、2．985，P均＜0．05）。失代偿组与代偿组相比：TADfre、TADmid的减低较明显，TADsep减低幅度较小，RVEF减低，PASP增高（t＝1．947、2．680、2．016、2．653、2．893，P均＜0．05）。 TADmid与实时三维超声心动图测定的RVEF呈显著正相关（r＝0．904，P＜0．01），与PASP呈显著负相关（r＝－0．686， P＜0．01）。 TADmid评价RVEF＜45％及RVEF＜30％的截断点值分别为13．65 mm、9．80 mm，敏感度分别为94．4％、90．0％，特异度分别为78．6％、90．0％。结论TADmid受外部因素影响较小，能较好地反映肺心病患者右心室收缩功能的变化，与实时三维超声心动图测得的RVEF值显著相关，与PASP之间有良好的负相关性，三者结合应用，可以相互验证，准确评价肺心病患者的右心室收缩功能。
目的探討二維斑點追蹤技術測定的三尖瓣環位移（TAD）評價肺源性心髒病（簡稱肺心病）患者右心室收縮功能的價值。方法選取肺心病心功能代償期（代償組）、心功能失代償期（失代償組）患者各15例，選取同期健康體檢者30名作為健康對照組，測量三尖瓣環中點位移（TADmid）、三尖瓣環遊離壁位移（TADfre）、三尖瓣環室間隔處位移（TADsep），同時行實時三維超聲心動圖檢測RVEF，併分析TADmid與RVEF、肺動脈收縮壓（PASP）之間的相關性。結果健康對照組、代償組、失代償組受檢者TADmid 分彆為（17．1±3．9）mm、（13．6±2．6） mm、（9．5±3．2） mm；TADfre分彆為（21．1±3．0）mm、（17．6±4．2）mm、（11．5±3．8）mm；TADsep分彆為（12．0±2．5）mm、（9．7±3．3）mm、（7．4±2．7）mm；RVEF值分彆為（56．3±8．2）％、（39．6±6．4）％、（28．1±5．9）％；PASP值分彆為（20．6±2．6）mm Hg（1 mm Hg＝0．133 kPa）、（63．3±5．6）mm Hg、（82．5±11．2）mm Hg，3組間比較差異均有統計學意義（F＝8．581、7．816、9．300、6．507、10．235，P均＜0．05）。代償組與健康對照組相比：TADfre、TADmid、TADsep均減小，其中以TADmid幅度最大，TADfre幅度最小；RVEF亦明顯減低，而PASP增高（t＝2．703、2．536、2．379、2．817、3．026，P均＜0．05）。失代償組與對照組相比：TADfre、TADmid、TADsep進一步減小，RVEF明顯減低，PASP明顯增高（t＝2．519、2．493、2．236、2．621、2．985，P均＜0．05）。失代償組與代償組相比：TADfre、TADmid的減低較明顯，TADsep減低幅度較小，RVEF減低，PASP增高（t＝1．947、2．680、2．016、2．653、2．893，P均＜0．05）。 TADmid與實時三維超聲心動圖測定的RVEF呈顯著正相關（r＝0．904，P＜0．01），與PASP呈顯著負相關（r＝－0．686， P＜0．01）。 TADmid評價RVEF＜45％及RVEF＜30％的截斷點值分彆為13．65 mm、9．80 mm，敏感度分彆為94．4％、90．0％，特異度分彆為78．6％、90．0％。結論TADmid受外部因素影響較小，能較好地反映肺心病患者右心室收縮功能的變化，與實時三維超聲心動圖測得的RVEF值顯著相關，與PASP之間有良好的負相關性，三者結閤應用，可以相互驗證，準確評價肺心病患者的右心室收縮功能。
목적탐토이유반점추종기술측정적삼첨판배위이（TAD）평개폐원성심장병（간칭폐심병）환자우심실수축공능적개치。방법선취폐심병심공능대상기（대상조）、심공능실대상기（실대상조）환자각15례，선취동기건강체검자30명작위건강대조조，측량삼첨판배중점위이（TADmid）、삼첨판배유리벽위이（TADfre）、삼첨판배실간격처위이（TADsep），동시행실시삼유초성심동도검측RVEF，병분석TADmid여RVEF、폐동맥수축압（PASP）지간적상관성。결과건강대조조、대상조、실대상조수검자TADmid 분별위（17．1±3．9）mm、（13．6±2．6） mm、（9．5±3．2） mm；TADfre분별위（21．1±3．0）mm、（17．6±4．2）mm、（11．5±3．8）mm；TADsep분별위（12．0±2．5）mm、（9．7±3．3）mm、（7．4±2．7）mm；RVEF치분별위（56．3±8．2）％、（39．6±6．4）％、（28．1±5．9）％；PASP치분별위（20．6±2．6）mm Hg（1 mm Hg＝0．133 kPa）、（63．3±5．6）mm Hg、（82．5±11．2）mm Hg，3조간비교차이균유통계학의의（F＝8．581、7．816、9．300、6．507、10．235，P균＜0．05）。대상조여건강대조조상비：TADfre、TADmid、TADsep균감소，기중이TADmid폭도최대，TADfre폭도최소；RVEF역명현감저，이PASP증고（t＝2．703、2．536、2．379、2．817、3．026，P균＜0．05）。실대상조여대조조상비：TADfre、TADmid、TADsep진일보감소，RVEF명현감저，PASP명현증고（t＝2．519、2．493、2．236、2．621、2．985，P균＜0．05）。실대상조여대상조상비：TADfre、TADmid적감저교명현，TADsep감저폭도교소，RVEF감저，PASP증고（t＝1．947、2．680、2．016、2．653、2．893，P균＜0．05）。 TADmid여실시삼유초성심동도측정적RVEF정현저정상관（r＝0．904，P＜0．01），여PASP정현저부상관（r＝－0．686， P＜0．01）。 TADmid평개RVEF＜45％급RVEF＜30％적절단점치분별위13．65 mm、9．80 mm，민감도분별위94．4％、90．0％，특이도분별위78．6％、90．0％。결론TADmid수외부인소영향교소，능교호지반영폐심병환자우심실수축공능적변화，여실시삼유초성심동도측득적RVEF치현저상관，여PASP지간유량호적부상관성，삼자결합응용，가이상호험증，준학평개폐심병환자적우심실수축공능。
Objective To explore the diagnostic value of two-dimensional speckle tracking technology in the evaluation of right ventricular systolic function in patients with pulmonary disease .Methods Thirty patients with pulmonary heart disease were divided into two groups:group of compensated pulmonary heart disease(compensated group ) (n =15),group of decompensated pulmonary heart disease (decompensated group)( n =15).30 healthy subjects were enrolled in control group .The displacement of the tricuspid annulus at the midpoint(TADmid),the displacement of the tricuspid annulus at the free wall (TADfre) and the displacement of the tricuspid annulus at the septum (TADsep) were acquired,and simultaneous real-time three-dimensional ultrasound detection of right ventricular ejection fraction (RVEF) were taken.The correlation of TADmid with RVEF and pulmonary artery systolic pressure ( PASP) were analyzed.Results TADmid of the healthy control group,the compensated group and the decompensated group were(17.1 ±3.9)mm, (13.6 ±2.6)mm,and(9.5 ±3.2)mm respectively.TADfre were(21.1 ±3.0)mm,(17.6 ±4.2)mm,and (11.5 ±3.8) mm respectively.TADsep were(12.0 ±2.5) mm,(9.7 ±3.3) mm,and(7.4 ±2.7) mm respectively.RVEF were(56.3 ±8.2)%,(39.6 ±6.4)%,and(28.1 ±5.9)% respectively.PASP were (20.6 ±2.6) mm Hg (1 mm Hg =0.133 kPa), (63.3 ±5.6) mm Hg, and (82.5 ±11.2)mm Hg respectively.There were significant differences of TADmid , RVEF, and PASP among the 3 groups ( F =8.581,7.816,9.300,6.507,10.235, all P <0.05).TADfre, TADmid, TADsep and RVEF were all decreased in the compensated group comparing to the healthy control group ,while PASP was increased.The decrease of TADmid was the most significant ,while that of TADfre was the slightest .There were significant differences of TADfre,TADmid,TADsep,RVEF and PASP between the 2 groups(t=2.703,2.536,2.379, 2.817,3.026,all P<0.05).TADfre,TADmid,TADsep and RVEF of decompensated group reduced more significantly than the compensated group , while PASP was increased significantly .There were significant differences of TADfre,TADmid,TADsep,RVEF and PASP between the 2 groups(t=2.519,2.493,2.236, 2.621,2.985,all P<0.05);TADfre and TADmid were decreased more apparently in decompensated group than that in compensated group ,and so were TADsep and RVEF,while PASP were increased.There were significant differences of TADfre,TADmid,TADsep,RVEF and PASP between the 2 groups (t =1.947, 2.680,2.016,2.653,2.893,all P<0.05).There was significant positive correlation between TADmid and RVEF measured by real-time three-dimensional ultrasound (r =0.904,P <0.01 ).There was significant negative correlation between TADmid and PASP (r=-0.686,P<0.01).The cut-off point value of TADmid measured by speckle tracking technology for evaluation of RVEF <45% and<30% were 13.65 mm and 9.80 mm,respectively.The sensitivity were 94.4%and 90.0%respectively,and the specificity were 78.6%and 90.0%respectively.Conclusions TADmid is hardly affected by the external factors ,and it can better reflect the changes of right ventricular systolic function for patients with pulmonary heart disease .TADmid is positively correlated with RVEF measured by real-time three-dimensional ultrasound and negatively correlated with PASP.Further more,the correlations is significant.The three parameters can authenticate mutually ,and the combination of them can evaluate the right ventricular systolic function in patients with pulmonary heart disease precisely.
