摘要
目的探讨纵向应变(GLS)及峰值离散度(PSD)联合左室-压力应变环技术(PSL)对系统性红斑狼疮(SLE)患者早期心肌损伤诊断的应用价值。方法选取2022年8月~2024年7月在云南省第一人民医院住院的SLE患者共74例,均行心脏彩超检查,排除5例患者因图像质量差不能完成分析,另69例患者按照SLEDAI-2K评分进行疾病活动度分级,分为A组(基本无活动和轻度活动组,评分<9分,n=22)、B组(中度活动组,评分10~14分,n=21)、C组(重度活动组,评分≥15分,n=26),选取同期36例门诊健康体检者作为正常对照组(D组),分析各组临床基础资料及相关超声心动图测量参数。结果4组GLS呈下降趋势,PSD呈上升趋势,差异有统计学意义(P<0.05),以B组及C组明显;4组GWE下降,GWW、GNW、GSWW增加(P<0.05),以B组及C组明显;相关性分析显示,GLS与LVEF呈负相关(r=-0.274,P<0.05);GWE、GWI、GCW、GPW、GSCW与GLS呈负相关(r=-0.584、-0.451、-0.431、-0.404、-0.428,P<0.05),GWW、GNW、GSWW与GLS呈正相关(r=0.390、0.221、0.362,P<0.05);GWE与PSD呈负相关(r=-0.621,P<0.05),GWW、GNW、GSWW与PSD呈正相关(r=0.567、0.264、0.442,P<0.05);SLE组(A组+B组+C组)与D组心肌收缩功能参数比较,LVEF、GLS、PSD、GWE、GWI、GWW、GNW、GSWW的差异有统计学意义(P<0.05);GLS、PSD与GWE、GWW、GNW、GSWW曲线下面积分别为0.841、0.714、0.841、0.763、0.725、0.740;GLS、PSD与左室PSL参数GWE、GWW、GNW、GSWW联合预测的AUC最大(0.913),敏感度为85%,特异度为96%。结论超声心动图测量指标GLS及PSD联合PSL参数可评估SLE患者的早期心肌损伤,尤其在疾病中重度活动度患者中更敏感,可为临床诊疗狼疮心肌病变提供新的敏感指标。
Objective To explore the application value of global longitudinal strain(GLS)and peak strain dispersion(PSD)combined with left ventricular pressure strain loop(PSL)technology in the early diagnosis of myocardial injury in systemic lupus erythematosus(SLE)patients.Methods We selected 74 SLE patients hospitalized at Yunnan 1st People Hospital from August 2022 to July 2024,all undergoing cardiac ultrasound examinations.Exclude 5 patients who were unable to complete the analysis due to poor image quality.Additionally,69 patients were graded and grouped based on the SLEDAI-2K score.Divided into group A with 22 cases(basically inactive and mildly inactive,score<9),group B with 21 cases(moderate activity,score 10-14),and group C with 26 cases(severe activity,score≥15),36 outpatient health examiners were selected as the normal control group D,for statistical analysis of clinical baseline data and related echocardiographic measurement parameters.Results It showed a declining trend in GLS and an increasing trend in PSD among the four groups,with statistically significant differences(P<0.05)observed in groups B and C.GWE decreased among the four groups,while GWW,GNW and GSWW increased,with statistically significant differences(P<0.05)observed in groups B and C;Correlation analysis showed that GLS was negatively correlated with LVEF(r=-0.274,P<0.05);GWE,GWI,GCW,GPW,GSCW were negatively correlated with GLS(r=-0.584,-0.451,-0.431,-0.404,-0.428,P<0.05),while GWW,GNW,GSWW was positively correlated with GLS(r=0.390,0.221,0.362,P<0.05).GWE was negatively correlated with PSD(r=-0.621,P<0.05),while GWW,GNW,GSWW were positively correlated with PSD(r=0.567,0.264,0.442,P<0.05).Comparison of myocardial contraction function parameters between the SLE group(group A+B+C)and D group,showed that there was a statistically significant difference(P<0.05)between the two groups in terms of LVEF,GLS,PSD,GWE,GWI,GWW,GNW and GSWW.The AUC of GLS,PSD,GWE,GWW,GNW,and GSWW were 0.841,0.714,0.841,0.763,0.725 and 0.740,respectively.The AUC predicted by GLS,PSD and left ventricular PSL parameters GWE,GWW,GNW and GSWW was the highest(0.913),with a sensitivity of 85%and specificity of 96%.Conclusion Echocardiographic measurements using GLS and PSD combined with PSL parameters could be used to assess early myocardial injury in SLE patients,particularly in those with moderate to severe activity,which providing new sensitive indicators for clinical diagnosis of lupus myocardial lesions.
作者
刘岁娟
吴海燕
周靓
蒋小丽
李文
LIU Suijuan;WU Haiyan;ZHOU Liang;JIANG Xiaoli;LI Wen(Department of Cardiology,The First People's Hospital of Yunnan Province,The Affiliated Hospital of Kunming University of Science and Technology,Kunming 650032,China;Department of Cardiology,Qujing No.1 Hospital,Qujing 655000,China)
出处
《分子影像学杂志》
2025年第6期719-725,共7页
Journal of Molecular Imaging
基金
云南省科技厅-昆医联合应用基础研究(202401AY070001-310)
云南省心脏疾病临床研究中心开放课题(2022LCZXKF-X203)。
关键词
系统性红斑狼疮
心肌损伤
纵向应变
峰值离散度
左室压力-应变环
systemic lupus erythematosus
myocardial injury
global longitudinal strain
peak strain dispersion
left ventricular pressure-strain loop
