3D-STI评价老年急性NSTEMI合并慢性肾功能不全的临床研究#br#

目的　探讨三维斑点追踪技术（3D-STI）评价老年急性非ST段抬高型心肌梗死（NSTEMI）合并慢性肾功能不全患者冠状动脉病变的严重程度及左室壁运动、左室功能受损程度的价值。方法　收集明确诊断急性NSTEMI的老年患者128例，根据肾功能情况分为肾功能不全组（不全组）和肾功能正常组（对照组），对比患者一般临床特点、心脏超声三维斑点整体纵向应变（GLS）、整体径向应变（GRS）、整体圆周应变（GCS）、整体面积应变（GAS）及左室射血分数（LVEF）与冠状动脉病变SYNTAX评分情况。结果　与对照组比较，肾功能不全组的心脏GLS、GCS、GRS、GAS的绝对值及LVEF均明显降低；冠状动脉病变SYNTAX评分明显升高，以三支病变为主；B型钠尿肽前体（NT-proBNP）、超敏C反应蛋白（hs-CRP）明显升高；以上差异均有统计学意义（P＜0.01）。冠状动脉SYNTAX评分与GLS、GCS、GRS、GAS绝对值及LVEF呈负相关（r分别为-0.472、-0.477、-0.528、-0.580、-0.306，均P＜0.01）；LVEF与GLS、GCS、GRS、GAS绝对值呈正相关（r分别为0.423、0.316、0.413、0.403，均P＜0.01）。结论　3D-STI可作为一种评价老年急性NSTEMI合并慢性肾功能不全的患者冠脉病变程度、左室壁运动及左室功能的新技术，为临床早期治疗及疗效的评估提供参考依据。

Clinical value of 3D-STI in elderly NSTEMI patients with chronic renal insufficiency

Objective　To explore the value of 3D-STI in evaluating the severity of coronary artery disease, left ventricular wall motion and left ventricular function in elderly non-ST-segment elevation myocardial infarction (NSTEMI) patients with chronic renal insufficiency. Methods　A total of 128 elderly NSTEMI patients were collected. According to renal function, patients were divided into renal insufficiency group and normal group. Clinical characteristics, global longitudinal strain (GLS), global radial strain (GRS), global circumferential strain (GCS), global area strain (GAS) and coronary artery disease SYNTAX scores were compared between the two groups. Results　Compared with normal group, the GLS, GRS, GCS, GAS, and LVEF were significantly decreased in the renal insufficiency group (P＜0.05). Compared with the normal group,SYNTAX scores were significantly higher in coronary artery lesion group, and there were more three vessel lesions in this group. There were significantly higher NT-proBNP and hs-CRP in coronary artery lesion group (P＜0.01).SYNTAX score was negatively correlated with GLS, GCS, GRS, GAS and left ventricular ejection fraction (r=-0.472, -0.477, -0.528, -0.306, P＜0.01). The left ventricular ejection fraction was positively correlated with GLS, GCS, GRS and GAS (r= 0.423, 0.316, 0.413, 0.403, P＜0.01). Conclusion　The 3D-STI can be used as a new technique to evaluate the degree of coronary artery lesions, left ventricular wall motion and left ventricular function in elderly NSTEMI patients with chronic renal insufficiency, and provide reference for early clinical evaluation and treatment.