中华超声影像学杂志
中華超聲影像學雜誌
중화초성영상학잡지
CHINESE JOURNAL OF ULTRASONOGRAPHY
2014年
8期
645-650
,共6页
杜佩%杜国庆%李海茹%陈双%吴言%田家玮
杜珮%杜國慶%李海茹%陳雙%吳言%田傢瑋
두패%두국경%리해여%진쌍%오언%전가위
超声心动描记术%高血压,肺性%心脏缺损,先天性%组织多普勒成像
超聲心動描記術%高血壓,肺性%心髒缺損,先天性%組織多普勒成像
초성심동묘기술%고혈압,폐성%심장결손,선천성%조직다보륵성상
Echocardiography%Hypertension,pulmonary%Heart defcts,congenital%Tissue Doppler imaging
目的 探讨组织多普勒技术评估常见单纯先天性心脏病患者肺动脉压力、判断肺动脉高压(PAH)及分级的应用价值.方法 经手术或介入证实的单纯先天性心脏病(房间隔缺损、室间隔缺损及动脉导管未闭)患者104例,均行组织多普勒检查和右心导管测压.根据右心导管所测肺动脉平均压(mPAP)分为PAH组60例[mPAP≥25 mmHg(1 mmHg=0.133 kPa)且肺毛细血管楔压(PCWP)≤15mmHg]和非肺动脉高压(non-PAH)组44例(mPAP＜25 mmHg).根据严重程度PAH组又分为轻度(25mmHg≤mPAP≤35 mmHg)、中度(36 mmHg≤mPAP≤50 mmHg)及重度(mPAP＞50 mmHg)三个亚组.组织多普勒测量三尖瓣环运动速度,获得三尖瓣环收缩期峰值速度(TS')、舒张早期峰值速度(TE ')、舒张晚期峰值速度(TA')以及TE'/TA',并计算Tei指数,以上各参数均与右心导管所测肺动脉压力(sPAP、mPAP、dPAP)行相关性分析.结果 ①PAH组TS'和TE'较non-PAH组明显降低(P＜0.05),Tei指数较non-PAH组明显升高(P＜0.001),而TA'和TE'/TA'在两组间差异无统计学意义(P＞0.05);②多因素相关分析:Tei指数与肺动脉压力呈正相关(P＜0.001),TS'与肺动脉压力呈负相关(P＜0.05),而TE'、TA'和TE'/TA'与肺动脉压力无相关性(P＞0.05);③ROC曲线分析:Tei指数和TS'判断PAH的曲线下面积分别为0.893和0.699,Tei指数＞0.49和TS'＜16 cm/s提示PAH的敏感性分别为86.67％和80.00％,特异性分别为79.55％和45.45％;④中、重度PAH的Tei指数较轻度PAH明显增高(P＜0.05),重度PAH的TS'和TE'较轻、中度PAH减低(P＜0.05).Tei指数＞0.55提示中-重度PAH的敏感性为95.24％,特异性为72.22％.结论 组织多普勒测得Tei指数和TS '在判断PAH及分级方面具有较高的临床应用价值;Tei指数＞0.49可提示PAH,而Tei指数＞0.55提示中重度PAH;TS'＜16 cm/s提示PAH亦具有一定的参考价值.
目的 探討組織多普勒技術評估常見單純先天性心髒病患者肺動脈壓力、判斷肺動脈高壓(PAH)及分級的應用價值.方法 經手術或介入證實的單純先天性心髒病(房間隔缺損、室間隔缺損及動脈導管未閉)患者104例,均行組織多普勒檢查和右心導管測壓.根據右心導管所測肺動脈平均壓(mPAP)分為PAH組60例[mPAP≥25 mmHg(1 mmHg=0.133 kPa)且肺毛細血管楔壓(PCWP)≤15mmHg]和非肺動脈高壓(non-PAH)組44例(mPAP＜25 mmHg).根據嚴重程度PAH組又分為輕度(25mmHg≤mPAP≤35 mmHg)、中度(36 mmHg≤mPAP≤50 mmHg)及重度(mPAP＞50 mmHg)三箇亞組.組織多普勒測量三尖瓣環運動速度,穫得三尖瓣環收縮期峰值速度(TS')、舒張早期峰值速度(TE ')、舒張晚期峰值速度(TA')以及TE'/TA',併計算Tei指數,以上各參數均與右心導管所測肺動脈壓力(sPAP、mPAP、dPAP)行相關性分析.結果 ①PAH組TS'和TE'較non-PAH組明顯降低(P＜0.05),Tei指數較non-PAH組明顯升高(P＜0.001),而TA'和TE'/TA'在兩組間差異無統計學意義(P＞0.05);②多因素相關分析:Tei指數與肺動脈壓力呈正相關(P＜0.001),TS'與肺動脈壓力呈負相關(P＜0.05),而TE'、TA'和TE'/TA'與肺動脈壓力無相關性(P＞0.05);③ROC麯線分析:Tei指數和TS'判斷PAH的麯線下麵積分彆為0.893和0.699,Tei指數＞0.49和TS'＜16 cm/s提示PAH的敏感性分彆為86.67％和80.00％,特異性分彆為79.55％和45.45％;④中、重度PAH的Tei指數較輕度PAH明顯增高(P＜0.05),重度PAH的TS'和TE'較輕、中度PAH減低(P＜0.05).Tei指數＞0.55提示中-重度PAH的敏感性為95.24％,特異性為72.22％.結論 組織多普勒測得Tei指數和TS '在判斷PAH及分級方麵具有較高的臨床應用價值;Tei指數＞0.49可提示PAH,而Tei指數＞0.55提示中重度PAH;TS'＜16 cm/s提示PAH亦具有一定的參攷價值.
목적 탐토조직다보륵기술평고상견단순선천성심장병환자폐동맥압력、판단폐동맥고압(PAH)급분급적응용개치.방법 경수술혹개입증실적단순선천성심장병(방간격결손、실간격결손급동맥도관미폐)환자104례,균행조직다보륵검사화우심도관측압.근거우심도관소측폐동맥평균압(mPAP)분위PAH조60례[mPAP≥25 mmHg(1 mmHg=0.133 kPa)차폐모세혈관설압(PCWP)≤15mmHg]화비폐동맥고압(non-PAH)조44례(mPAP＜25 mmHg).근거엄중정도PAH조우분위경도(25mmHg≤mPAP≤35 mmHg)、중도(36 mmHg≤mPAP≤50 mmHg)급중도(mPAP＞50 mmHg)삼개아조.조직다보륵측량삼첨판배운동속도,획득삼첨판배수축기봉치속도(TS')、서장조기봉치속도(TE ')、서장만기봉치속도(TA')이급TE'/TA',병계산Tei지수,이상각삼수균여우심도관소측폐동맥압력(sPAP、mPAP、dPAP)행상관성분석.결과 ①PAH조TS'화TE'교non-PAH조명현강저(P＜0.05),Tei지수교non-PAH조명현승고(P＜0.001),이TA'화TE'/TA'재량조간차이무통계학의의(P＞0.05);②다인소상관분석:Tei지수여폐동맥압력정정상관(P＜0.001),TS'여폐동맥압력정부상관(P＜0.05),이TE'、TA'화TE'/TA'여폐동맥압력무상관성(P＞0.05);③ROC곡선분석:Tei지수화TS'판단PAH적곡선하면적분별위0.893화0.699,Tei지수＞0.49화TS'＜16 cm/s제시PAH적민감성분별위86.67％화80.00％,특이성분별위79.55％화45.45％;④중、중도PAH적Tei지수교경도PAH명현증고(P＜0.05),중도PAH적TS'화TE'교경、중도PAH감저(P＜0.05).Tei지수＞0.55제시중-중도PAH적민감성위95.24％,특이성위72.22％.결론 조직다보륵측득Tei지수화TS '재판단PAH급분급방면구유교고적림상응용개치;Tei지수＞0.49가제시PAH,이Tei지수＞0.55제시중중도PAH;TS'＜16 cm/s제시PAH역구유일정적삼고개치.
Objective To evaluate the value of tissue Doppler imaging (TDI) in diagnosing pulmonary arterial hypertension(PAH) with common simple congenital heart disease(CHD).Methods 104 patients of CHD approved by operation or intervention were retrospectively analyzed.Both TDI and right cardiac catheterization were performed in all patients,whose were divided into PAH and non-PAH groups according to mean pulmonary arterial pressure (mPAP) on diagnostic right cardiac catheterization:60 PAH patients[mPAP ≥25 mmHg(1 mmHg =0.133 kPa) and pulmonary arterial capillary wedge pressure ≤15 mmHg],44 non-PAH patients (mPAP ＜25 mmHg).The PAH group was divided into mild (25 mmHg≤ mPAP≤35 mmHg),moderate (36 mmHg≤mPAP≤50 mmHg) and severe (mPAP＞50 mmHg) subgroups.The tricuspid annular systolic peak velocity (TS'),early diastolic peak velocity (TE'),late diastolic peak velocity (TA') were measured by TDI and TE'/TA' and Tei index were calculated.The correlation between TDI parameters and the cardiac catheterization findings (sPAP,mPAP and dPAP) were assessed.Results ①TS' and TE' in PAH group were significantly lower than those in non-PAH(P ＜ 0.05),but Tei in PAH group were significantly higher than that in non-PAH (P ＜0.001),however,there were no significant difference in TA' and TE'/TA' between two groups (P ＞ 0.05).②Tei correlated positively with pulmonary arterial pressure (P ＜0.001),TS' was found to be negatively correlated with pulmonary arterial pressure(P ＜0.05),but no correlation between TE',TA',TE'/TA' and pulmonary arterial pressure(P ＞0.05).③ROC analysis showed the area under curves for Tei index and TS' diagnosis for PAH was 0.893 and 0.699,respectively.At the cutoff of Tei＞0.49 and TS'＜16 cm/s for indicating PAH,the sensitivity were 86.67 ％ and 80.00％,respectively and the specificity were 79.55 ％ and 45.45 ％,respectively.④Tei in the moderate and severe PAH were significantly higher than that in mild PAH (P ＜ 0.05),TS' and TE' in severe PAH were significantly lower than those in mild and moderate PAH (P ＜ 0.05),At the cutoff of Tei＞0.55 for indicating moderate or severe PAH,the sensitivity and specificity were 95.24％ and 72.22％.Conclusions Tei index and TS' have high application value in assessing PAH and classification of PAH.Tei＞0.49 indicates PAH,while Tei＞0.55 suggests moderate or severe PAH.
