实时三维超声心动图评价肥厚型心肌病

目的探讨应用实时三维超声心动图评价肥厚型心肌病的临床应用价值.方法对8例肥厚型心肌病患者进行二维超声成像,取心尖四腔观及胸骨旁长轴、短轴观显示肥厚型心肌病肥厚室壁部位、程度及二尖瓣收缩期前向运动(SAM)现象;再进行三维超声成像,于胸骨旁3～4肋间及心尖声窗处,转换窄角实时三维显示(Live-3D),取窄角实时三维图像.于心尖声窗,轻换全容量实时三维显示(Full-volume),启动切割键(Crop)对图像上下、左右、前后切割后,观察肥厚型心肌病立体形态及SAM现象.结果实时三维超声心动图能清晰显示肥厚型心肌病肥厚部位、肥厚形态、室壁运动状况以及SAM现象.结论与二维超声心动图相比,实时三维超声心动图能够反映肥厚型心肌病患者心脏的立体空间结构,而且能够确定二尖瓣前叶运动与左心室流出道梗阻的关系.与以往三维超声重建相比,实时三维超声可迅速、实时获得肥厚型心肌病的三维图像.     

心尖肥厚型心肌病心电图临床特征分析

【目的】分析心尖肥厚型心肌病（A HCM ）患者心电图异常的特征。【方法】选择2005年2月至2014年6月本院收治的42例A HCM患者作为观察组;选择同期在本院体检中心进行体检的40例健康者,将其分为对照组,分析比较所有研究对象的12导联心电图资料。【结果】观察组42例患者心电图均有异常改变,左胸导联R波振幅增高较大,以V3～V6导联增幅显著,且有RV4＞ RV5＞ RV3＞ RV6;导联ST 段下移幅度00．3～03．0 mV ,以V3和V4导联为主;胸导联T波倒置的深度为01．2～15．4 mV ,并呈现TV4＞ TV5＞ TV3的规律;除Ⅲ、aVF、V1导联外,观察组其他导联 R波振幅比对照组明显增高（ P ＜00．5）。【结论】A HCM患者心电图具有特征性改变,对该病的早期诊断具有十分重要的意义,但临床确诊仍需要结合超声心动图等检测,有助于确诊A HCM。     

超声心动图诊断肥厚型心肌病合并左心耳口膜性狭窄1例

病例男,42岁,因“阵发性心悸2月”入院。查体:体温36.3 T:,脉搏81次/分,呼吸14次/分,血压96/67 mmHg(1 mmHg≪0.133 kPa)。既往史:曾因肥厚型心肌病行左室流出道疏通术及二尖瓣金属瓣膜置换术。辅助检查:心电图示不纯房扑,心房率约280次/分,心室率90次/分。患者拟行射频消融治术前常规行经食管超声心动图:左心耳开口处可见一膜样回声,左心耳口位于膜性回声中央,直径约5.7mm(图1,2),该处血流速度明显加快,速度约1.4 m/s(图3)。三维经食管超声心动图示:左心耳口面积约0.23 cm2(图4)。超声诊断:左心耳口膜性狭窄。     

三维超声心动图评价肥厚型心肌病患者左心房功能及其影响因素的临床研究

目的应用三维超声心动图（3DE）评价肥厚型心肌病（HCM）患者左心房的功能,并探讨导致左心房功能改变的影响因素。方法46例HCM患者（梗阻性HCM组25例,非梗阻性HCM组21例）与46名健康对照者（健康对照组）入选此研究。应用3DE获得2组受检者的左心房时间－容积曲线,测量左心房最大容积（LAVmax）、左心房最小容积（LAVmin）及左心房收缩前容积（LAVp）,计算左心房容积指数（LAVI）、左心房扩张指数（LAEI）、左心房排空分数（LAEF）、左心房被动排空分数（LAPEF）及左心房主动排空分数（LAAEF）,2组间进行对比分析。并对所有入选者的室间隔厚度（IVSd）、左心室流出道峰值压差（LVOT－PG）、二尖瓣反流（MI）量、左心室舒张功能（LVDF）与LAVI进行Spearman线性相关分析及多元线性回归分析。结果健康对照组LAVmax（45．67±11．96）ml、LAVmin（20．48±6．80）ml、LAVp（24．48±9．31）ml、LAVI 25．63±6．52、LAEI（1．32±0．49）％、LAEF （55．25±8．06）％、LAPEF（35．90±7．00）％、LAAEF（30．20±10．13）％,HCM组LAVmax（81．45±24．24）ml、LAVmin（44．60±18．96）ml、LAVp（61．00±21．64）ml、LAVI 45．39±14．17,与健康对照组比较均明显增高,2组间差异有统计学意义（t＝8．978、8．123、9．227、8．436,P均＜0．01）;HCM组LAEI（0．95±0．43）％、LAEF（46．15±11．12）％、LAPEF（25．64±9．09）％,与健康对照组比较明显减低,2组间差异亦有统计学意义（t＝－3．865、－4．493、－6．504,P均＜0．01）;HCM组LAAEF（28．20±9．26）％,与健康对照组比较仅轻度减低,2组间差异无统计学意义（t＝－0．656,P＞0．01）。 IVSd、LVOT－PG、MI、LVDF均与LAVI在0．01水平上呈显著正相关（r＝0．704、0．517、0．640、0．701,P均＜0．01）,多元回归分析得出IVSd、LVOT－PG、MI、LVDF均为LAVI的影响因素（标准回归系数绝对值分别为0．264、0．515、0．614、0．341,P均＜0．05）。结论3DE能够评估HCM患者左心房的容积及功能,主要表现为各时相左心房容积显著增加,而储蓄功能、管道功能、辅泵功能减低。 HCM患者的二尖瓣反流、左心室流出道梗阻、左心室舒张功能障碍以及室壁的增厚均为左心房功能受损的影响因素,其中二尖瓣反流对其影响最大。     

实时三维超声心动图评价肥厚型心肌病患者左室收缩协调性研究

目的：探讨实时三维超声心动图（RT3DE）评价肥厚型心肌病（HCM）患者左室心肌收缩协调性的临床价值.方法：40例左室射血分数正常的HCM患者和25例正常人,应用RT3DE方法分析其左室特定节段到达最小收缩容积时间（Tmsv）的标准偏差和最大差值被标准化为心动周期的百分比（Tmsv 16-SD％、Tmsv 12-SD％、Tmsv 6-SD％、Tmsv 16-Dif％、Tmsv 12-Dif％、Tmsv 6-Dif％）.结果：HCM患者的Tmsv 16-SD％、Tmsv 12-SD％、Tmsv 6-SD％、Tmsv 16-Dif％、Tmsv 12-Dif％、Tmsv 6-Dif％与对照组比较均显著延长（P＜0.05）,梗阻型与非梗阻型HCM相比无显著统计学差异（P＞0.05）.与对照组比较,HCM患者RT3DE的左室各节段容积-时间曲线交错紊乱,同步性差.结论：HCM患者无论梗阻型或者非梗阻型均存在左室收缩协调性障碍,RT3DE技术能识别HCM患者早期左室收缩协调性异常,对于明确HCM患者心肌损害进程有重要意义.     

超声心动图评价肥厚型心肌病和高血压左心室肥厚患者左心房收缩功能

目的 探讨超声心动图评价肥厚型心肌病(HCM)患者和高血压左室肥厚(HLVH)患者左房收缩功能的临床应用价值.方法 HCM患者、HLVH患者和健康体检者各30例.常规测量左房内径、室间隔厚度、左室后壁厚度及二尖瓣E、A峰,计算左房缩短分数(LAFS).分别采集各受试者的心尖二腔、心尖四腔和心尖左室长轴观动态组织速度图像,获得应变率曲线测量左房峰值应变率(LASRa),计算平均LASRa(mLASRa).结果 与对照组比较,HCM组和HLVH组LAFS和mLASRa增高,差异均有统计学意义(P＜0.05).与HLVH组比较,HCM组LAFS和mLASRa增高,差异均有统计学意义(P＜0.05).HCM组与HLVH组的mLASRa与LAFS均呈显著正相关(r=0.81,0.88;均P＜0.01).结论 超声心动图能够发现HCM患者和HLVH患者左房收缩功能改变,表现为辅泵功能增加.     

应变率成像评价肥厚型心肌病左室局部心肌收缩和舒张功能

应变率成像（SRI）技术是在组织多普勒基础上发展起来的超声心动图新技术。左心室心肌纤维主要有心内膜下的纵行纤维和心外膜下的环行纤维两种,占心肌纤维70%的纵行纤维的舒缩运动在正常心脏功能的维持中起重要作用，本文旨在应用SRI技术对肥厚型心肌病（HCM）左室长轴方向局部心肌舒缩功能进行评价。     

超声心动图诊断胎儿心肌病

目的 探讨胎儿超声心动图诊断胎儿心肌病(FCM)及其并发症的价值.方法 对11 360胎胎儿进行超声心动图检查;对其中诊断为胎儿心肌病或可疑心肌原发病变者进行分析,并与大体病理结果及出生后超声心动图表现进行对照分析.结果 11 360胎中检出FCM 19胎,检出率为0.167%(19/11 360).其中扩张型心肌病10胎(累及双心室4胎、右心室4胎、左心室1胎、右心房1胎)、肥厚型心肌病2胎(累及双心室1胎,室间隔1胎)、心内膜弹力纤维增生症4胎(原发型1胎、继发型3胎)、心肌致密化不全3胎(累及双心室2胎、右心室1胎),FCM累及心室中以双心室为著.结论 胎儿超声心动图可对FCM做出诊断及分型,且可评估胎儿心脏功能及血流动力学的变化,并判断FCM的预后.     

实时三维超声心动图评价高血压肥厚型心肌病患者左心室节段收缩功能

目的采用实时三维超声心动图(RT-3DE)评价高血压肥厚型心肌病(HHC)患者左心室节段收缩功能.方法 选择HHC患者30例,健康人32名.在心尖四腔观,应用全容积显像方式采集RT-3DE图像,显示左心室17节段的容积-时间曲线,获得左心室收缩功能参数:左心室舒张末期容积(EDV)、收缩末期容积(ESV)和左心室射血分数(LVEF),左心室17节段收缩容积变化比值即ESV/EDV,左心室16节段心率校正后达到收缩末期最小容积时间的标准差(Tmsv16-SD)和时间的差值(Tmsv16-Dif).结果 HHC组较正常对照组整体EDV及ESV明显增大,且差异有统计学意义[(88±29)ml vs (72±15) ml,t=-2.680,P=0.008;(28±10)ml vs (22±6)ml,t=-2.613,P=0.01],而LVEF的差异无统计学意义[(67±7)% vs (68±5)%,t=-0.261,P=0.795].HHC组较正常对照组室间隔中段及心尖段收缩容积变化比值明显增大,且差异有统计学意义[前室间隔中段:(40.51±20.28)% vs (26.43±10.10)%,t=-3.378,P=0.002;后室间隔中段:(41.44±23.55)% vs (24.46±8.12)%,t=-3.688,P=0.001;室间隔心尖段:(30.96±21.31)% vs (19.53±7.33)%,t=-2.745,P=0.01].HHC组与正常对照组比较,左心室Tmsv16-SD及Tmsv16-Dif明显增加,且差异有统计学意义[Tmsv16-SD:(2.48±1.38)% vs (1.16±0.26)%,t=-5.117,P＜0.001;Tmsv16-Dif:(7.67±5.07)% vs (3.95±1.48)%,t=-3.865,P＜0.001].HHC组和正常对照组左心室收缩不同步发生率分别为43%及3%.结论 HHC患者左心室整体收缩功能降低之前可能已存在室壁节段收缩功能受损,左心室收缩同步性异常发生率较高,RT-3DE是评价HHC患者左心室心肌收缩功能有价值的方法.     

超声左心室压力-应变环评价肥厚型心肌病

目的 观察超声左心室压力-应变环（PSL）评价肥厚型心肌病（HCM）患者左心室收缩功能的价值,评价心肌做功（MW）参数与常规舒张收缩功能、左心室应变参数间的相关性。方法 纳入43例HCM患者（HCM组）与49名健康志愿者（对照组）,比较组间常规超声参数、应变参数和MW参数。绘制受试者工作特征（ROC）曲线,计算曲线下面积（AUC）,评价各参数诊断HCM的效能。采用Pearson或Spearman相关分析评估常规超声参数、应变参数与MW参数间的相关性,以多元线性回归分析与MW独立相关的参数。结果 HCM组室间隔舒张末期厚度（IVSD）、左心室后壁舒张末期厚度（LVPWD）、左心房前后径（LAD）、容积指数（LAVI）、A峰流速、E/A、E/e''、左心室心内膜下心肌圆周应变（CS-Endo）、左心室整体扭转应变（Twist）、峰值应变离散度（PSD）及整体无效功（GWW）均明显高于对照组（P均<0.05）,舒张早期二尖瓣环侧壁（Lateral e''）、室间隔运动速度（Septal e''）、e''、左心室舒张末期容积（LVEDV）、收缩末期容积（LVESV）、左心室中层心肌（CS-Mid）、心外膜下心肌圆周应变（CS-Epi）、左心室整体纵向及分层应变、整体做功指数（GWI）、整体做功效率（GWE）均明显低于对照组（P均<0.05）。MW指标、左心室整体纵向应变（LVGLS）及PSD诊断HCM的效能均较高（AUC均>0.80）。对照组MW参数与传统收缩舒张功能参数、LVGLS及PSD多呈中度相关,且具有独立相关性（P均<0.05）;HCM组不同方向整体和分层应变、PSD及A峰流速均多与MW参数呈低度及以上相关,且具有独立相关性（P均<0.05）。结论 超声PSL技术可无创评估HCM患者左心室收缩功能;MW参数与常规舒张收缩功能、左心室应变参数具有一定相关性。     

Standardization, specificity, and diagnostic sensitivity of four immunoassays for carcinoembryonic antigen

Four "sandwich"-type immunoassays for carcinoembryonic antigen (CEA) based on monoclonal antibodies (Abbott CEA-RIA Monoclonal, Pharmacia/Wallac Delfia CEA kit, Roche CEA EIA Duomab 60, and our in-house immunoradiometric assay) were compared for 357 samples from colorectal cancer patients and samples from 48 patients with chronic liver disease or with acute, irrelevant diseases. Relative to a common 5 micrograms/L reference limit, all four assays agreed regarding classification in 92% to 94% of the samples in the colorectal cancer samples, with the Abbott and Roche assays giving slightly more "normal" values. Cross-testing of CEA standards and the 1st International Reference Preparation 73/601 showed that calibration differences could not be eliminated by the use of a common standard. It has been earlier demonstrated that the monoclonal antibodies in the Roche assay have an epitope group specificity slightly different from those of the other three assays. This can explain why the correlations involving the Roche assay were weaker (r = 0.84-0.87) than those obtained with the other assays (r = 0.94-0.97). I conclude that agreement between the assays studied is as good as can be expected when different antibodies are used; nevertheless, consistent discrepancies between assays in several patients still necessitate the use of the same assay during follow-up.     

The sensitivity, specificity and predictive value of diagnostic information: a guide for clinicians

Nurse practitioners and other clinicians use laboratory studies and ancillary tests to confirm or rule out suspected conditions. Deciding which tests to use and interpreting results are essential to the practice of high-quality, cost-effective primary care. A working knowledge of test characteristics and performance facilitates these decisions. This article illustrates how a conceptual understanding of sensitivity, specificity and predictive value applies to daily practice. In addition, the article explains how to evaluate the quality and relevance of literature that reports test performance. While discussion focuses on laboratory tests, the same principles may be applied to the history and physical examination, and to other types of diagnostic data.     

McNemar chi2 test revisited: comparing sensitivity and specificity of diagnostic examinations

When evaluating a novel diagnostic examination for clinical use, it should be compared with a reference standard, defined as the best available examination, which may include clinical and laboratory criteria. The novel examination and reference standard's results are usually presented in the form of a 2 x 2 table, which allows calculation of sensitivity, specificity and accuracy. It has been recommended that the measures of statistical uncertainty should be reported, such as the 95% confidence interval, when evaluating the accuracy of diagnostic examinations. Comparing the difference in sensitivity or specificity of a novel examination with the reference standard is important when evaluating its usefulness. The McNemar chi(2) test, used to compare discordance of two dichotomous responses, can be applied for this purpose. However, applying the McNemar test to a 2 x 2 table for comparing the accuracy of examinations is not recommended, since this test is sensitive to the proportion of positive versus negative subjects. Moreover, if the novel examination has higher sensitivity than the one considered as the reference standard, constructing a classic 2 x 2 table would result in low specificity of the novel examination. Thus, in order to compare sensitivities and specificities between examinations, this table is inappropriate and an independent reference standard is necessary. In this article, we propose the use of the McNemar chi(2) test to compare sensitivities between examinations using a 2 x 2 table exclusively among diseased patients, defined by a set of criteria and follow-up of patients. Likewise, specificities can be compared applying the McNemar test among healthy individuals.     

The sensitivity and specificity of transcricothyroid ultrasonography to confirm endotracheal tube placement in a cadaver model

Confirmation of endotracheal (ET) tube placement is critical when performing emergency airway management. No single confirmation strategy has emerged as ideal in all circumstances. Our objective in this study was to assess the sensitivity and specificity of a novel approach to verify endotracheal intubation using transcricothyroid ultrasonography (US). We performed a prospective, randomized double-blinded trial in a human cadaver model. A 7.5-MHz curvilinear probe was placed longitudinally over the cricothyroid membrane as cadavers were randomly intubated in either the trachea or esophagus in two phases: 1) as the intubation was being performed (dynamic) and, 2) after intubation had been completed (static). Volunteer emergency medicine (EM) residents, blinded to tube placement, assessed for esophageal vs. tracheal ET placement using dynamic and static US views. Sensitivity, specificity, positive predictive value, and negative predictive value for detecting esophageal ET placement with 95% confidence intervals were calculated. Seven EM residents made a total of 70 dynamic and 70 static assessments of ET position using transcricothyroid US. Dynamic assessment resulted in 97% sensitivity and 100% specificity for detecting esophageal ET placement. Static assessment resulted in only 51% sensitivity and 91% specificity. This pilot study suggests that dynamic transcricothyroid US is a potentially accurate method of confirming ET placement during the intubation process. Further investigation in live humans is warranted to validate these data.     

附睾炎的超声诊断

目的总结附睾炎高频彩色多普勒超声图像特征及超声对附睾炎的诊断价值。方法对55例经高频彩色多普勒超声检查并经手术、病理确诊的附睾炎患者的声像图资料进行回顾性分析。结果55例附睾炎中,慢性附睾炎36例、附睾精子肉芽肿性炎9例、急性附睾炎7例及附睾结核3例。其中2例附睾精子肉芽肿性炎和1例急性附睾炎误诊为附睾肿瘤。结论高频彩色多普勒超声结合临床资料综合分析,能准确诊断附睾炎。     

肝创伤局部注射治疗后超声与病理对照的实验研究

目的观察肝创伤灶局部注射治疗后不同时期常规超声与超声造影表现,并与病理对照,明确局部注射止血法创伤灶的组织修复形式和相对应的超声声像图特点.方法选用NIH小鼠18只,随机分为3组,每组各6只.18只小鼠建立创伤级别相同的肝脏创伤灶,采用局部注射蛇毒凝血酶和α-氰基丙烯酸酯的方法行创伤灶局部注射止血,分别于治疗后1周、1个月、3个月行常规超声检查、超声造影检查,同时处死动物进行病理检查.结果治疗后随着时间延长,治疗区常规超声示回声强度逐渐增高,治疗后1周局部表现为不均匀低回声;治疗后1个月局部表现为不均匀中高回声,内见点状强回声;治疗后3个月可见斑片状强回声,后方伴声影.超声造影显示治疗区为低/无增强,随着时间延长,低/无增强区范围逐渐缩小.创伤区病理表现:治疗后1周表现为肝汇管区血管扩张、淤血,血管及胆管周围可见较多白细胞及淋巴细胞浸润,随时间延长,可见汇管区纤维组织增生,胆管增生并纤维化,治疗后3个月局部可见慢性淋巴细胞、浆细胞及嗜酸粒细胞,并见明显钙化形成.结论局部注射蛇毒凝血酶和α-氰基丙烯酸酯治疗肝创伤,局部表现为炎性瘢痕修复,超声回声强度与局部纤维化和钙化程度呈正相关,超声检查可作为病理改变的初步评价方法.     

A diagnostic approach for the evaluation of spina bifida by three-dimensional ultrasonography.

OBJECTIVE: To describe a prenatal diagnostic method for evaluating spina bifida by three-dimensional ultrasonography. METHODS: Two- and three-dimensional ultrasonography were used to determine the extent of vertebral defects among fetuses with spina bifida. Spinal levels were independently counted from the most caudal thoracic vertebra with a rib (e.g., 12th thoracic rib). A virtual cutting plane was manipulated through a volume-rendered spine to generate optimal multiplanar views for this blinded analysis. Prenatal diagnosis was compared with a postnatal analysis of bony spine defects derived from radiographic films or magnetic resonance imaging. RESULTS: Nine fetuses were examined by two-dimensional ultrasonography (21.8 +/- 3.4 menstrual weeks) and three-dimensional ultrasonography (22.8 +/- 4.4 menstrual weeks). For two-dimensional ultrasonography, the spinal level agreed to within 1 vertebral segment in 6 of 9 infants. In contrast, three-dimensional ultrasonography agreed to within 1 vertebral segment in 8 of 9 infants. Three fetuses had vertebral defect levels on two-dimensional ultrasonography that were 1.5 to 2 segments away from postnatal findings. The same fetuses had results that were within 1 vertebral segment on three-dimensional ultrasonography. Volume rendering showed splayed vertebral pedicles and disrupted vertebrae. An intact meningeal sac was easily rendered in 5 of 9 subjects. CONCLUSIONS: Multiplanar views are generally more informative than rendered views for localizing bony defects of the fetal spine. The level of the defect on three-dimensional ultrasonography correlates well with those on two-dimensional ultrasonography and postnatal imaging studies. This approach may improve characterization of spina bifida by adding diagnostic information that is complementary to the initial assessment by two-dimensional ultrasonography.     

A combined biomarker panel shows improved sensitivity and specificity for detection of ovarian cancer

BackgroundCombined biomarkers can improve the sensitivity and specificity of ovarian cancer (OC) diagnosis and effectively predict patient prognosis. This study explored the diagnostic and prognostic values of serum CCL18 and CXCL1 antigens combined with C1D, FXR1, ZNF573, and TM4SF1 autoantibodies in OC.MethodsCCL18 and CXCL1 monoclonal antibodies and C1D, FXR1, ZNF573, and TM4SF1 antigens were coated with microspheres. Logistic regression was used to construct a serum antigen‐antibody combined detection model; receiver‐operating characteristic curve (ROC) was used to evaluate the diagnostic efficacy of the model; and the Kaplan‐Meier method and Cox regression models were used for survival analysis to evaluate the prognosis of OC. Data from The Cancer Genome Atlas (TCGA) and Genotype‐Tissue Expression (GTEx) projects and online survival analysis tools were used to evaluate prognostic genes for OC. The CIBERSORT immune score was used to explore the factors influencing prognosis and their relationship with tumor‐infiltrating immune cells.ResultsThe levels of each index in the blood samples of patients with OC were higher than those of the other groups. The combined detection model has higher specificity and sensitivity in the diagnosis of OC, and its diagnostic efficiency is better than that of CA125 alone and diagnosing other malignant tumors. CCL18 and TM4SF1 may be factors affecting the prognosis of OC, and CCL18 may be related to immune‐infiltrating cells.ConclusionsThe serum antigen‐antibody combined detection model established in this study has high sensitivity and specificity for the diagnosis of OC.