CAJ | 학술논문

目的应用三维斑点追踪成像（3D-STI）技术评价亚临床甲状腺功能减退（SHT）女性患者行左旋甲状腺激素治疗前后左心室整体收缩功能的改变。资料与方法收集研究组32例 SHT 女性患者及对照组40例健康女性志愿者，研究组给予左旋甲状腺激素治疗，待甲状腺功能达到正常状态后随访1年；两组均行血生化检查、常规超声心动图检查和3D-STI 检查，比较两组左心室舒张末期内径（LVEDd）、左心室收缩末期内径（LVEDs）、室间隔舒张末期厚度（IVSd）、左心室后壁舒张末期厚度（LVPWd）、左心房内径（LAD）、二尖瓣口舒张期血流频谱 A 峰值、左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）、左心室射血分数（LVEF），分析三维左心室整体纵向应变（GLS）、整体圆周应变（GCS）、整体径向应变（GRS）及整体面积应变（GAS）参数以及促甲状腺激素（TSH）水平与各参数的相关性。结果治疗前研究组 IVSd、LVPWd 较对照组增加（t=3.30、3.64，P<0.05），研究组治疗前二尖瓣口舒张期血流频谱 E 峰速度及 E/A 均小于对照组及研究组治疗后（t=13.55、13.85、3.19、2.93，P<0.05）。研究组治疗前左心室 GLS、GCS、GRS 及GAS 显著低于对照组（t=8.60、11.95、9.78、5.92，P<0.05）。研究组治疗后左心室 GLS、GCS、GRS 及 GAS 均高于治疗前（t=6.91、9.41、6.46、4.31，P<0.05）。TSH 水平与 E/A 比值、E 呈负相关（r=－0.39、－0.42，P<0.05）；TSH 水平与 GLS、GCS、GRS 及 GAS 呈负相关（r=－0.38、－0.56、－0.33、－0.41，P<0.05）。结论利用3D-STI 可以较好地评价 SHT 女性患者左旋甲状腺激素治疗前后左心室整体收缩功能变化。
목적응용삼유반점추종성상（3D-STI）기술평개아림상갑상선공능감퇴（SHT）녀성환자행좌선갑상선격소치료전후좌심실정체수축공능적개변。자료여방법수집연구조32례 SHT 녀성환자급대조조40례건강녀성지원자，연구조급여좌선갑상선격소치료，대갑상선공능체도정상상태후수방1년；량조균행혈생화검사、상규초성심동도검사화3D-STI 검사，비교량조좌심실서장말기내경（LVEDd）、좌심실수축말기내경（LVEDs）、실간격서장말기후도（IVSd）、좌심실후벽서장말기후도（LVPWd）、좌심방내경（LAD）、이첨판구서장기혈류빈보 A 봉치、좌심실서장말기용적（LVEDV）、좌심실수축말기용적（LVESV）、좌심실사혈분수（LVEF），분석삼유좌심실정체종향응변（GLS）、정체원주응변（GCS）、정체경향응변（GRS）급정체면적응변（GAS）삼수이급촉갑상선격소（TSH）수평여각삼수적상관성。결과치료전연구조 IVSd、LVPWd 교대조조증가（t=3.30、3.64，P<0.05），연구조치료전이첨판구서장기혈류빈보 E 봉속도급 E/A 균소우대조조급연구조치료후（t=13.55、13.85、3.19、2.93，P<0.05）。연구조치료전좌심실 GLS、GCS、GRS 급GAS 현저저우대조조（t=8.60、11.95、9.78、5.92，P<0.05）。연구조치료후좌심실 GLS、GCS、GRS 급 GAS 균고우치료전（t=6.91、9.41、6.46、4.31，P<0.05）。TSH 수평여 E/A 비치、E 정부상관（r=－0.39、－0.42，P<0.05）；TSH 수평여 GLS、GCS、GRS 급 GAS 정부상관（r=－0.38、－0.56、－0.33、－0.41，P<0.05）。결론이용3D-STI 가이교호지평개 SHT 녀성환자좌선갑상선격소치료전후좌심실정체수축공능변화。
Purpose To assess the left ventricular global systolic function changes using three-dimensional speckle tracking imaging (3D-STI) in female patients with subclinical hypothyroidism (SHT) undergoing L-thyroxine treatment. Materials and Methods Thirty-eight female patients with SHT and 40 healthy female volunteers of the same age (control group) were selected, all the SHT patients received L-thyroxine therapy and were followed for 1 year after euthyroid status was achieved; all the participants underwent blood biochemical examinations, complete conventional echocardiographic and 3D-STI examinations, left ventricular end-diastolic diameter (LVEDd), left ventricular end-systolic diameter (LVEDs), interventricular septal depth (IVSd), left ventricular posterior wall depth (LVPWd), left atrial diameter (LAD), diastolic mitral flow spectrum of A peak, left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and left ventricular ejection fraction (LVEF) of the two groups were compared, and the correlation of parameters of three dimensional left ventricular global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), global area strain (GAS), and thyroid stimulating hormone (TSH) with each parameter was analyzed. Results IVSd and LVPWd in the study group were higher than those of the control group (t=3.30 and 3.64, P<0.05). Compared with the control group, GLS, GCS, GRS and GAS of left ventricular of SHT patients in the study group were significantly lower (t=8.60, 11.95, 9.78 and 5.92, P<0.05) before treatment. GLS, GCS, GRS and GAS of SHT patients improved after L-thyroxine therapy, and the difference was statistically significant (t=6.91, 9.41, 6.46 and 4.31, P<0.05).TSH level was negatively correlated with E/A ratio and E (r= - 0.39 and - 0.42, P<0.05), and also negatively correlated with GLS, GCS, GRS and GAS (r= - 0.38, - 0.56, - 0.33 and - 0.41, P<0.05). Conclusion Left ventricular global systolic function changes of SHT patients before and after L-thyroxine treatment can be evaluated properly using 3D-STI.