摘要
目的应用三维斑点追踪成像(3D-STI)联合颈部血管超声评价原发性高血压亚临床动脉粥样硬化病人的左心室功能。方法选取90例原发性高血压病人纳入研究组,行颈部血管超声检查,根据颈动脉内-中膜层厚度(CIMT)及斑块情况分为颈动脉正常组(A组)33例、颈动脉内-中膜增厚且未见斑块组(B组)27例、颈动脉斑块形成组(C组)30例,另选取29例健康体检者为对照组。对所有研究对象均行3D-STI检查,获取左心室整体纵向应变(GLS)、整体径向应变(GRS)、整体圆周应变(GCS)及三维应变(3DS)等,分析各组间参数的差异及心肌应变的相关影响因素。结果与对照组比较,原发性高血压A组、B组、C组GLS均减低,C组GCS、GRS、3DS减低;B组、C组GLS较A组减低;C组GLS较B组减低,差异均有统计学意义(F/H=10.11~85.71,P<0.05);C组GLS<-18%人数较A组明显增多,差异有统计学意义(χ^(2)=24.07,P<0.05)。研究组GLS与CIMT、颈动脉斑块、舒张末室间隔厚度((IVSd)中等程度呈负相关(r=-0.560~-0.400,P<0.05);GCS、GRS、3DS与CIMT及IVSd呈弱负相关(r=-0.380~-0.190,P<0.05);GRS与颈动脉斑块弱相关(r=-0.210,P<0.05)。多元线性回归分析显示,原发性高血压病人SBP、CIMT、左心室心肌质量指数(LVMI)及颈动脉斑块形成对GLS有影响(β=-0.254~0.200,P<0.05,调整后R^(2)=0.49)。结论 3D-STI技术联合颈部血管超声能够敏感评价原发性高血压亚临床动脉粥样硬化病人左心室的收缩功能改变;随着亚临床动脉粥样硬化进展,左心室功能逐渐降低。
Objective To investigate the value of three-dimensional speckle-tracking imaging(3 D-STI)combined with cervical vascular ultrasound in evaluating left ventricular function in patients with essential hypertension and subclinical atherosclerosis. Methods A total of 90 patients with essential hypertension were enrolled as study group and underwent cervical vascular ultrasound,and according to carotid intima-media thickness(CIMT)and plaque conditions,they were divided into in group A with33 patients(normal carotid artery),group B with 27 patients(thickened carotid intima-media without plaque),and group C with30 patients(formation of carotid plaque).In addition,29 healthy individuals who underwent physical examination were enrolled as control group.All subjects underwent 3 D-STI to obtain the data on global longitudinal strain(GLS),global radial strain(GRS),global circumferential strain(GCS),and three-dimensional strain(3 DS)of the left ventricle,and the differences in these parameters were analyzed between groups.The influencing factors for myocardial strain were also analyzed. Results Compared with the control group,groups A,B,and C had a significant reduction in GLS,and group C had significant reductions in GCS,GRS,and3 DS;compared with group A,groups B and C had a significant reduction in GLS,and group C had a significant reduction in GLS compared with group B(F/H =10.11-85.71,P<0.05);compared with group A,group C had a significantly higher number of patients with GLS <-18% (χ2=24.07,P<0.05).GLS was moderately negatively correlated with CIMT,carotid plaque,and thickness of the interventricular septum(IVSd)(r=-0.560 to-0.400,P<0.05);GCS,GRS,and 3 DS were weakly negatively correlated with CIMT and IVSd(r=-0.380 to-0.190,P<0.05);GRS was weakly correlated with carotid plaque(r=-0.210,P<0.05).The multivariate linear regression analysis showed that systolic blood pressure,CIMT,left ventricular mass index,and carotid plaque formation had an influence on GLS in patients with essential hypertension(β=-0.254 to 0.200,P<0.05),with an adjusted R2 of 0.49. Conclusion 3 D-STI combined with cervical vascu-lar ultrasound provides a sensitive evaluation of changes in the systolic function of the left ventricular myocardium in patients with essential hypertension and subclinical atherosclerosis.Left ventricular function gradually decreases with the progression of subclinical atherosclerosis.
作者
单晓英
陈晓菲
孙瑞聪
姜志荣
马建敏
SHAN Xiaoying;CHEN Xiaofei;SUN Ruicong;JIANG Zhirong;Ma Jianmin(Echocardiography Department of the Affiliated Hospital of Qingdao University,Qingdao 266003,China)
出处
《青岛大学学报（医学版）》
2021年第5期750-755,共6页
Journal of Qingdao University(Medical Sciences)
基金
山东省医药卫生科技发展计划项目(2019WS343)。
关键词
原发性高血压
动脉粥样硬化
超声心动描记术
三维
斑点追踪成像
心室功能
左
essential hypertension
atherosclerosis
echocardiography,three-dimensional
speckle tracking imaging
ventricular function,left
