多普勒超声心动图观察年龄与左心室充盈功能的关系

应用脉冲多普勒超声心动图测定９０例正常人的左心室流人道的８个舒张功能参数。ＡＰＦＶ，ＡＰＦＶ／ＥＰＦＶ比值，ＡＴＶＩ，ＡＴＶＩ／ＦＴＶＩ比值，ＩＲＴ随年龄的增长而增加，与年龄呈正相关：ＥＰＦＶ、ＥＴＶＩ、ＤＣ随年龄的增长而减低，与年龄呈负相关。     

超声检测左心室舒张功能的临床意义——85例超声检测结果与冠状动脉造影的对照分析

目的 超声心动图检测左心室舒张功能与冠状动脉造影对照分析,探讨超声诊断的临床意义.方法 85例临床疑诊冠心病超声检查左心室二尖瓣口舒张早、晚期血流充盈速度E、A两峰峰值,计算E/A比值,其结果分为舒张功能正常和降低两组.全部病人均与冠状动脉造影结果对照分析.结果 超声检测左心室舒张功能与冠脉造影均正常24例,均异常53例,共77例,符合率90.59%,不符合8例,占9.41%;本文依据冠脉造影提出超声检测左心室舒张功能正常值;并发现冠心病早期舒张功能降低,且随年龄与病程长短不同.结论 超声检测左心室舒张功能的改变与冠脉造影符合率高,舒张功能于冠心病早期可降低,随病程长短不同,为临床对冠心病诊治和预防提供有价值的信息.     

二维超声心动图和M型超声心动图评价左心室扩大患者左心室收缩功能的对比研究

目的评价二维超声心动图（2DE）法和M型超声心动图（ME）法测量心瓣膜病中重度二尖瓣和（或）主动脉瓣反流（VR）、扩张型心肌病（DCM）和缺血性心肌病（ICM）患者左心室收缩功能相关指标的一致性及其影响因素。方法用2DE和ME同时测量100例左心室扩大患者（VR35例、DCM32例和ICM33例）的左心室舒张末期内径（LVEDD）、左心室舒张末期容积（LVEDV）和左心室射血分数（LVEF）,分别记为LVEDD2DE、LVEDDME、LVEDV2DE、LVEDVME、LVEF2DE和LVEFME。结果①患者的LVEDD2DE与LVEDDME、LVEDV2DE与LVEDVME差异有统计学意义,LVEF2DE与LVEFME差异无统计学意义,且具有良好的相关性,r=0．869;②组内比较：3组的LVEDD2DE与LVEDDME差异均有统计学意义,VR组LVEDV2DE与LVEDVME差异无统计学意义,其他两组差异有统计学意义,3组的LVEF2DE与LVEFME差异无统计学意义;③组间比较：LVEDD2DE在DCM组与ICM组之间差异有统计学意义,在VR组与ICM组之间差异也有统计学意义,LVEDDME、LVEDV2DE。和LVEDVME有相同的结果,LVEF2DE在3组间差异均有统计学意义,LVEFME在3组间差异也均有统计学意义,2DE和ME法均得到LVEDVVR≈LVEDVDCM〉LVEDVICM和LVEFDCM〈LVEFICM〈LVEFVR的一致结论;④按LVEDD2DE分为〈80mm大左心室组和≥80mm巨大左心室组,两组的LVEDV2DE与LVEDVME差异有统计学意义,LVER2DE与LVEFME各组差异无统计学意义。结论二维法和M型超声评价VR、DCM和ICM患者左心室收缩功能的指标中LVEF一致性较好．较少受左心室形状及节段性室壁运动异常的影响。2DE和ME均得出VR组与DCM组左心室增大的程度相近．但LVEF减低的程度却不同．而ICM组左心室增大的程度小于前两组。但LVEF却较VR组减低明显。     

左心房构型超声新表达指标评价高血压病左心室舒张功能的价值

目的以左心房构型超声新表达指标评价左心室舒张功能的改变。方法用二维超声于左心室收缩末期测量左心房最大内径(LAD)、面积(LAA)和容积(LAV),用体表面积标化出左心房内径指数(LADi)、面积指数(LAAi)和容积指数(LAVi),观察各危险层高血压患者LADi、LAAi、LAVi3项指标的变化,同时测量二尖瓣血流参数E/A比值。结果高血压患者LADi、LAAi、LAVi均较正常组增大,差异具有显著性(P<0.05)。并随危险度分层的增高,差异愈显著。不同危险层之间比较差异具有显著性(P<0.05)。而E/A比值仅在中危组以上与正常组比较差异具有显著性。结论左心房构型超声新表达指标评价左心室舒张功能优于E/A比值。     

肝硬化患者红细胞免疫功能的变化与血清脂联素水平的相关性分析

探讨了肝硬化患者外周血红细胞免疫功能的变化和血清脂联素水平的相关性,应用放射免疫分析法和免疫法对62例肝硬化患者进行了红细胞免疫功能和血清脂联素水平检测,并与35名正常健康人作比较。肝硬化患者红细胞C3b受体花环率（RBC-C3bRR）水平和血清脂联素水平明显降低（P〈0.01）,而红细胞免疫复合物受体花环率（RBC-ICRRR）水平明显升高（P〈0.01）,RBC-C3bRR水平与脂联素水平呈正相关（r=0.6132P〈0.01）,而RBC-ICRRR水平与血清脂联素水平呈明显负相关（r=-0.5988P〈0.01）。肝硬化患者存在着免疫调节的紊乱,免疫功能低下与血清脂联素水平有一定的相关性。     

原发性高血压肾病患者血清leptin与脂联素水平相关性分析

目的：探讨了原发性高血压肾病患者血清瘦素（leptin）水平与脂联素水平的相关性。方法：分别应用放射免疫分析和ELISA对84例原发性高血压患者（其中34例为伴肾病组,50例为无肾病组）进行了血清leptin和脂联素测定,并与35名正常健康人作比较。结果：原发性高血压无肾病组和肾病组血清leptin水平均非常显著地高于正常人组（P〈0.01）。而血清脂联素水平则明显低于正常人组（P〈0.01）。原发性高血压肾病组与无肾病组亦有显著性差异（P〈0.05）。结论：原发性高血压的发生与血清leptin水平和血清脂联素水平有密切的关系。     

2型糖尿病患者血清脂联素水平与糖尿病肾病的关系

目的:研究2型糖尿病肾病患者血清脂联素水平与糖尿病肾病的关系.方法:用放射免疫分析测定163例2型糖尿病患者及50例正常人的血清脂联素水平.结果:在糖尿病各亚组中,大量蛋白尿组患者的血清脂联素水平高于微量蛋白尿组(P＜0.01)及正常蛋白尿组和对照组(P＜0.001).微量蛋白尿组患者的血清脂联素水平高于正常蛋白尿组(P＜0.05).脂联素水平与血肌酐、HbA1c、TC、SBP、DBP、TG及UAER呈正相关(P＜0.05),而与年龄、HDL-C、BMI无明显相关性(P＞0.05).女性血清脂联素水平(15.82±7.21)mg/L高于男性(13.98±7.86)mg/L,但无统计学意义(P＞0.05).结论:2型糖尿病肾病患者血清脂联素水平随着肾病进展而升高,说明肾脏参与了脂联素的代谢与排泄.脂联素在糖尿病肾病发生发展过程中可能起到重要作用.     

结肠癌患者血清脂联素和胃饥饿素水平的临床分析

目的 检测结肠癌患者血清脂联素和胃饥饿素水平,并探讨二者的关系.方法 收集2010年1月至2013年12月的82例结肠癌患者和30例同期健康体检者血液.分别使用酶联免疫吸附分析(enzyme-linked immunosorbent assay,ELISA)方法和放射免疫法检测结肠癌患者和对照组血清脂联素和胃饥饿素水平.比较结肠癌患者与对照组和未转移组和淋巴结转移组脂联素和胃饥饿素水平,并对结肠癌患者血清脂联素和胃饥饿素水平进行相关性分析.结果 结肠癌患者血清脂联素水平显著低于健康对照组(5.51 ±2.33ng/L vs.13.96±2.95ng/L,P＜0.0001);淋巴结转移组明显低于未转移组患者(3.62 ±2.03ng/L vs.6.91 ±5.12ng/L,P＜0.001).结肠癌患者血清胃饥饿素水平显著高于对照组(156.0±55.1pmol/L vs.58.5土25.9pmol/L,P＜0.001);淋巴结转移组明显高于未转移组患者(164.8±15.1pmol/L vs.93.2±20.9pmoL/L,P＜0.001).结肠癌患者血清脂联素与饥饿素水平无相关性(r=0.083,P=0.729).结论 血清脂联素水平降低和胃饥饿素水平升高与结肠癌发病和转移显著相关,提示血清脂联素和胃饥饿素检测对于结肠癌的早期诊断和病程有一定的临床意义.     

肺癌患者血清脂联素水平变化及其临床研究

目的 探讨血清脂联素在肺癌患者中的临床应用价值.方法 用放射免疫法检测58例肺癌患者和50例健康体检者的血清脂联素水平.结果 肺癌患者脂联素水平显著低于健康对照组（P＜0.01）;肺癌分期之间差异无统计学意义（P＞0.05）;小细胞癌与腺癌和鳞癌比较,血清脂联素水平差异有统计学意义（P＜0.05）;肺癌远处转移癌组与未远处转移癌组比较差异有统计学意义（P＜0.01）.结论 低血清脂联素水平与肺癌的发生及远处转移相关,脂联素水平测定在未来可能成为肺癌患者预防、诊断和治疗的一个新的血清学指标.     

男性冠心病患者血清脂联素水平分析

目的:检测分析男性冠心病(CHD)患者血清脂联素(ADPN)水平变化及其与CHD危险因子的相关性。方法:收集本院心血管内科因胸闷、胸痛症状住院的男性患者149例,根据冠脉造影结果及临床表现分为对照组(CON组,n=42)、稳定性心绞痛组(SA组,n=38)、不稳定性心绞痛组(UA组,n=39)和急性心肌梗死组(AMI组,n=30)。采用ELISA检测各组血清ADPN浓度;采用德国西门子公司ADVIA2400型全自动生化分析仪测定各组血清空腹血糖(FBG)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、超敏C反应蛋白(hsCRP)等CHD危险因子水平。统计学分析各组间血清ADPN水平差异及其与CHD危险因子的相关性。结果:CHD各组血清ADPN水平均低于对照组,且AMI组明显低于SA组和UA组(P均<0.05);男性CHD患者血清ADPN水平与FBG、TC、hs-CRP呈显著负相关(P<0.05),而与患者年龄呈正相关(P<0.05)。结论:ADPN可能是CHD保护性因子之一,或可作为CHD的防治靶标。     

Doppler echocardiographic analysis of diastolic left ventricular function in dialysis patients and its relation to intradialytic hypotension

Summary Doppler echocardiography was used to evaluate left ventricular relaxation and filling in 20 patients on chronic maintenance hemodialysis. In comparison with 11 normal controls hemodialysed patients showed a marked prolongation of isovolumic relaxation period (83±23 ms vs 67±11 ms,P<0.01). Peak velocity of early diastolic filling was similar in both groups, but peak velocity of late ventricular filling due to atrial contraction was substantially increased in dialysis patients (66±23 cm/s vs 37±7 cm/s,P<0.01) and the ratio late to early peak velocity was significantly enlarged (0.97±0.35 vs 0.58±0.19,P<0.01). Although left ventricular mass index, as determined by Echo, was markedly increased in dialysis patients, no significant correlation was found between ventricular mass and indexes of diastolic function. When patients were divided into two groups on the basis of development of hypotension during dialysis clinical and echocardiographic characteristics were similar, although patients with dialysis hypotension (n=9) were significantly older (53±9 years) than normotensiv patients (n=11, 42±14 years,P<0.05). Indexes of diastolic function showed a great overlap between the two groups, but ratio late to early peak velocity was significantly greater in patients with intradialytic hypotension (1.13±0.35 vs 0.83±0.32,P<0.05). It is concluded that dialysis patients exhibit significant alterations of left ventricular relaxation and diastolic filling as assessed by Doppler echocardiography which might be independent of left ventricular hypertrophy. Impaired diastolic function might contribute to intradialytic hypotension.Abbreviations DEF deceleration of early diastolic flow - IVRP isovolumic relaxation period - peakA peak velocity of late left ventricular filling - peakE peak velocity of early left ventricular filling     

Relationship of left ventricular and atrial dimensions with moderate to severe left ventricular diastolic dysfunction (grade II and above)

IntroductionLeft ventricular diastolic dysfunction (DD) is an entity in which the ventricle fails to fill up properly due to impaired ventricular relaxation and/or decreased compliance. The diagnosis of diastolic dysfunction is based on a variety of parameters in doppler echocardiograpy. However, some parameters like interventricular septal thickness in diastole (IVSd), posterior wall thickness in diastole (PWd), left ventricular internal end diastolic and systolic diameters (LVIDD and LVISD) along with left atrial diameters (LAD) have yet to be evaluated for the diagnostic workup of DD.MethodsA case control study was done in the cardiology department from patient records from 2016 to 2018. Patients were diagnosed as diastolic dysfunction grade II and above by doppler echocardiography. IVSd, PWd, LVIDD, LAD, LVISD were obtained through 2-D echocardiography.ResultsPatients with DD had greater LAD, IVSd and PWd and decreased LVIDD and LVISD as compared to control group. Overall, IVSD was the most significant predictor (OR 1.52 95%CI 1.35–1.71) of DD followed by PWd and LAD. Similarly, LAD, IVSd and PWd had higher sensitivity and specificity than LVIDD and LVIDS.ConclusionIVSd, LAD and PWd showed significant performance in the diagnosis of diastolic dysfunction and hence can be used as a screening and diagnostic tool in diastolic dysfunction of grade ll and above.     

Mild carbon monoxide poisoning impairs left ventricular diastolic function

Rationale:

Carbon monoxide (CO) poisoning is associated with direct cardiovascular toxicity. In mild CO poisoning in which cardiovascular life support is not required, the effects of CO on left and right ventricular functions are unknown in patients without cardiac failure.

Objectives:

Echocardiography was used to determine whether or not mild CO poisoning impairs ventricular function. Twenty otherwise healthy patients with CO poisoning and 20 age- and gender-matched controls were studied. Echocardiographic examinations were performed at the time of admission and 1 week after poisoning.

Results:

The impairment observed in the left and right ventricular diastolic function at the time of admission was greater than the impairment 1 week after poisoning. Mild CO poisoning did not have a significant effect on systolic function. Carboxyhemoglobin levels were positively correlated with left ventricular diastolic dysfunction, whereas the levels were not correlated with right ventricular diastolic function.

Conclusions:

In CO intoxication, the development of left and right ventricular diastolic dysfunction precedes systolic abnormality. Patients with mild CO poisoning do not manifest cardiovascular symptoms; however, it should be borne in mind that most of these patients have myocardial involvement.     

Functional changes in left ventricular hypertrophy: diagnosis of impaired diastolic function in patients with hypertension

Summary Left ventricular hypertrophy is usually associated with impaired left ventricular diastolic function which can be characterised by an altered pressure volume relationship. Since diastolic flow velocities are closely related to the difference in pressure between the left atrium and left ventricle, parameters of diastolic function can be determined by Doppler echocardiography. However, the pressure difference is additionally influenced by factors which have no relation to left ventricular diastolic function. These include preload, afterload, inotropy, heart rate and left ventricular systolic function. Despite these limitations, Doppler echocardiography is a valuable tool to diagnose therapeutic effects on diastolic function in patients with left ventricular hypertrophy.     

Effect of maintenance hemodialysis on diastolic left ventricular function in end-stage renal disease

PURPOSE:

To analyze the effect of maintenance hemodialysis on left ventricular diastolic function in patients with end‐stage renal disease.

METHODS:

Study population consisted of 42 patients with end‐stage renal disease. Before an arteriovenous fistula was surgically created, the patients were evaluated by conventional and Doppler echocardiography and Doppler tissue imaging. Then, the patients undergoing hemodialysis treatment when the arteriovenous fistula was compleated. After the first hemodialysis session (mean 76.14 ± 11.37 days) the second echocardiographic evaluations were performed.

RESULTS:

Mean age was 58 ± 13 years and 21 (%50) of the patients were female. After maintenance hemodialysis treatment; peak early (E) and peak late (A) diastolic mitral inflow velocities and E/A ratio were not significantly change however the deceleration time of E wave and left atrial diameter were significantly increased. Also there was no change in the early (Em) and late (Am) diastolic myocardial velocities and Em/Am ratios of lateral and septal walls of left ventricular. E/Em ratio was decreased insignificantly. Pulmonary vein velocities and right ventricular functions are remained almost unchanged after hemodialysis treatment.

DISCUSSION:

The acute and long‐term effect of hemodialysis on left ventricular diastolic function is unclearly. Patients with end‐stage renal disease treatment with hemodialysis via arteriovenous fistula experience a variety of hemodynamic and metabolic abnormalities that predispose to alterations in left and right ventricular functions. The present study showed that left ventricular diastolic function except left atrial diameter and right ventricular functions were not significantly change, however left ventricular systolic functions were impaired after maintenance hemodialysis treatment in patients with end‐stage renal disease.

CONCLUSION:

It has been suggested that echocardiographic parameters are useful markers for evaluation of left ventricular and right ventricular functions in patients with end‐stage renal disease. However, in patients with end‐stage renal disease treated with hemodialysis, repeated assessment of echocardiographic examinations to observe serial changes in left and right ventricular functions are not yet well established. In this study, we showed that acute changes of volume status and electrolytes and autonomic regulation by hemodialysis session did not affect left ventricular diastolic and right ventricular functions in a relatively long term.     

应用二尖瓣环运动速度和时间指标评价冠心病患者左室整体舒张功能

目的：应用脉冲多普勒组织成像（DTI）定量分析并比较心绞痛与心肌梗死（心梗）患者二尖瓣环长轴方向上舒张运动速度和时间变化，探讨其评价左室整体舒张功能异常的价值。方法：冠心病心绞痛组16例、心梗组34例、对照组16例。记录二尖瓣环侧壁、间隔、前壁和下壁的运动频谱。测量舒张早、晚期峰值运动速度及其比值，舒张早期波开始时间、达峰时间和局部等容舒张时间，并计算4个位点的均值，分别以Em、Am、Em/Am、QEm、TEm和IVRTm表示。结果：心绞痛组和心梗组Em和Em/Am显著低于对照组（P<0.01），心梗组Em又低于心绞痛组（P<0.01）；心绞痛组和心梗组QEm、TEm及IVRTm显著长于对照组（P<0.01或P<0.05），心梗组IVRTm又长于心绞痛组（P<0.01）；IVRTm与Em呈显著负相关（r=-0.64, P<0.01）。结论：脉冲DTI所测Em、Em/Am、QEm、TEm及IVRTm均可反映冠心病患者左室整体舒张功能异常，Em和IVRTm尚可反映心肌缺血损害的严重程度。     

实时三维超声心动图和组织多普勒评价扩张型心肌病左心室舒张早期同步性的相关性研究

目的 比较实时三维超声心动图和组织多普勒显像在分析正常人和扩张型心肌病(DCM)患者的左心室舒张早期同步性的临床价值.方法 选取37例DCM患者(DCM组),其中男性25例,女性12例;年龄46～87岁,平均年龄65.4岁(标准差10.0岁).健康志愿者27例(对照组),其中男性19例,女性8例;年龄50～72岁,平均年龄60.3岁(标准差9.7岁).同时进行实时三维超声心动图和组织多普勒检查,测定舒张早期二尖瓣频谱蜂值与二尖瓣环速度峰值之比(E/E')、收缩末期到二尖瓣开放图像时的舒张容积占整个舒张容积的比值(EDV早/EDV)、收缩末期到二尖瓣开放图像时的时间占整个心动周期的比值(T早/T),左心室16节段、12节段心肌舒张早期容积的时间标准差(Tedv 16-SD、Tedv 12-SD)及左心室12节段的组织速率舒张峰值时间的标准差(Te 12-SD),计算舒张早期容积的时间最大差值(Tedv-Dif),评价左心室舒张早期同步性.结果 DCM组舒张功能明显减低,E/E'、EDV早/EDV、T早/T显著大于对照组(P＜0.05).DCM组Te 12-SD、Tedv 16-SD、Tedv 12-SD均明显大于对照组(均P＜0.01).Tedv 16-SD、Tedv 12-SD与Te 12-SD的相关性分别为r=0.879和r=0.773(均P＜0.01);Tedv 16-Dif、Tedv 12-Dif与Te 12-Dif的相关性分别为r=0.850和r=0.718(均P＜0.01).结论 实时三维超声心动图和组织多普勒两种方法均能够评价左心室舒张早期同步性,两种方法的评价结果具有很好的相关性.     

高血压患者心肌缺血性改变与左室后壁厚度的相关性研究

目的探讨高血压患者Holter上心肌缺血性改变与左心室后壁（LVPW）厚度之间的相关性。方法收集2005年5月至2008年9月在本院经查冠脉CTA及超声心动图排除冠心病的高血压患者共138例,首先根据Holter上有无发作性ST段压低将资料分为有缺血性改变与无缺血性改变两组,分析缺血性改变与LVPW厚度之间的相关性,并比较两组间LVPW厚度的大小;然后以单因素及多因素分析筛选Holter上缺血性改变的影响因素;最后建立ROC曲线评估LVPW厚度预测发生缺血性改变的价值。结果高血压患者Holter上有或无缺血性改变与LVPW厚度及收缩压（SBP）均呈正相关（r=0.429,P=0.000;r=0.274,P=0.034）,高血压伴有缺血性改变的患者其LVPW厚度与无缺血性改变的患者相比差异有统计学意义（z=-5.025,P=0.000）;伴有LVPW增厚的高血压患者出现Holter上缺血性改变的机率高于无LVPW增厚的患者（χ2=23.670,P=0.000）;多因素分析中只有LVPW厚度被筛选出来（OR=26.024,P=0.001）;以LVPW厚度预测心肌缺血的AUC为（0.760±0.044）,P=0.000。最佳分界值为9.5mm,以LVPW≥9.5mm来预测高血压患者Holter上出现缺血性改变,敏感性为63.6%,特异性为80.9%。结论高血压患者Holter上出现缺血性改变与LVPW厚度呈正相关;以LVPW预测高血压患者Holter上出现缺血性改变的特异性较高,但敏感性较差。     

高血压左心功能声学定量技术与Tei指数之间的比较研究

目的研究高血压患者心功能Tei指数与声学定量（AQ）技术指标关系,找出Tei指数在高血压患者左心功能判断中的变化规律。方法将试验对象分为正常组30例和高血压组45例,其中又将高血压组依左心室情况分成非肥厚组21例和肥厚组24例;对各组进行了AQ技术指标检测及Tei指数测量。结果与正常组左心室AQ舒张功能指标相比,高血压肥厚组峰值左心房充盈率（PAFR）、左心室快速充盈分数（RFF）降低（P〈0.05）,高血压非肥厚组及肥厚组的左心房收缩充盈分数（AFF）增高,左心室快速充盈容积与左心房收缩充盈容积比值（RF/AF）降低（P〈0.05）;左心室AQ收缩功能指标显示,与对照组相比,高血压非肥厚组及肥厚组的左心室射血分数（LVEF）、峰值排空率（PER）差异无统计学意义（P〉0.05）;与正常组左心室AQ容量指标结果相比,左心室肥厚组的左心室舒张末期容积（LVEDV）、左心房收缩充盈前容积（LAOAFV）增加,左心室非肥厚组与肥厚组的左心室收缩末期容积（LVESV）增加（P〈0.05）。与正常组相比,高血压非肥厚组与高血压肥厚组左心室Tei指数、等容舒张时间（IRT）、等容收缩时间（ICT）均增高（P〈0.05）,并且高血压肥厚组Tei指数和IRT高于高血压非肥厚组（P〈0.05）;Tei指数与左心室AQ指标中的PAFR（r=0.239,P〈0.05）、LVEF（r=0.376,P〈0.05）具有相关趋势。多元逐步回归分析显示左心室质量（LVM）与Tei指数独立相关（P〈0.01）。结论同AQ技术指标相比,Tei指数有效评价高血压患者整体心功能,不仅能够反映高血压患者心功能受损,而且能够反映靶器官心脏受累的严重程度。Tei指数可用于临床预测心功能,评价预后,是值得临床广泛推广的心功能测量方法。