老年高血压心肌背向散射成像声学密度定量的临床应用

目的　应用声学密度定量 (AD)方法对老年高血压病人心肌超声背向散射成像 (IBS)进行分析 ,探讨其临床诊断应用价值及意义。方法　按 1 999年 WHO高血压治疗标准并应用超声心动图仪检测 64例老年男性住院病人 ,其中正常组 31例 ,高血压组 33例 (高血压病史均 >3年且治疗时间均 >1年 ) ,比较各组室间隔心肌 IBS的 AD诸参数。结果　 Loop和两种触发方式声学密度曲线的峰值密度 (pi)、曲线下面积 (auc)高血压组均高于正常组 (均 P<0 .0 5)。结论　长期高血压和衰老致心肌组织纤维化进一步加重 ,致声学密度参数显著改变 ,其可作为简单、有效且无创的研究心肌病理学方面改变的辅助检测方法     

老年慢性肾功能不全患者血透前后脂代谢变化

目的研究老年慢性肾功能不全患者血透前后脂代谢变化。方法检测３０例老年慢性肾功能不全患者血透前后７项脂质指标,并与正常组和非血透组对照。结果老年慢性肾衰患者广泛存在脂蛋白、载脂蛋白及亚型异常。结论血透不能改善老年慢性肾衰病人的脂代谢紊乱。     

用声学密度定量技术早期评价急性心肌梗死患者直接经皮冠状动脉腔内成形术的疗效

目的　探讨利用声学密度 (AD)定量技术早期评价急性心肌梗死 (AMI)患者行直接经皮冠状动脉腔内成形术 (PTCA)的手术疗效。方法　将 4 0例AMI患者分为两组 :18例病人行直接PTCA治疗 (A组 ) ,2 2例病人用药物治疗 (B组 ) ,比较两组病人在入院第 7天时常规超声心动图检查和用AD技术检测的结果。结果　两组病人常规超声心动图各项检查结果比较差别无显著性 (P >0 0 5 )。AD定量检测结果 :A组的背向散射积分周期变化幅度 (CVIB) (4 2± 1 3)dB明显高于B组 (2 5± 2 4 )dB(P <0 0 1) ;A组校正的周期变化延迟时间 (N Delay) 1 0 9± 0 0 8明显低于B组 1 31± 0 16 (P <0 0 1) ;两组间背向散射积分 (IBS)差异无显著性 (P >0 0 5 )。结论　AD技术能够早期反映AMI再灌注心肌的组织学特征 ,为早期评价介入治疗效果、预测心功能改善情况、判定心肌活性提供了一种新的技术手段。     

肥厚型心肌病与高血压性心脏病心肌超声组织定征的鉴别诊断

目的探讨肥厚型心肌病、高血压病患者与正常人左室后壁、室间隔心肌声学特性是否存在差异,以期将超声组织定征作为鉴别诊断的指标之一. 方法将被检者分成3组肥厚型心肌病组(HCM组)、高血压性心脏病组(EH组)及正常对照组,分别测定各组左室后壁、室间隔部位的心肌背向散射参数.结果左室后壁心肌HCM组与EH组的IBS、CVIB无显著性差异(P>0.05),而与正常对照组均有差异(P<0.05);室间隔部位3组IBS、CVIB均有显著性差异(P<0.05);HCM组室间隔、左室后壁均存在IBS、CVIB的跨壁梯度,而EH组、正常对照组则无上述异常存在.结论 HCM患者左室后壁心肌的声学特性与正常对照组有差异,室间隔与左室后壁均存在IBS、CVIB的跨壁梯度.因此背向散射参数测定可作为鉴别肥厚型心肌病和高血压性心脏病的一项指标.     

组织结构声学定量技术在肝脏弥漫性病变中的应用价值

目的:探讨组织声学定量技术(acoustic structu-re quantification,ASQ)在不同程度均匀性脂肪肝及慢性乙型肝炎的诊断价值.方法:应用ASQ技术对158例正常人、139例均匀性脂肪肝患者(轻度46例,中度64例,重度29例)及66例慢性乙型肝炎患者(肝功正常43例,肝功异常23例)的肝脏进行组织声学结构定量分析,比较ASQ定量参数:众数、均值、标准差及蓝红曲线下面积比.结果:5组人群中红蓝曲线走形及曲线下面积不同;ASQ彩色编码图中,正常人组、脂肪肝组及慢性乙型肝炎组在图像上表现不同;红线Mode值在正常组与轻中重度脂肪肝组比较中有显著性差异(113.71±4.50vs111.18±2.01,104.51±2.55,97.25±2.22,P<0.01),蓝线Average、SD值在正常组、中重度脂肪肝组与慢性乙型肝炎组有显著差异(P<0.01),红线Average值、SD值及RB Ratio值在3组人群中有显著性差异(P<0.01);红线Mode值、Average值及RB Ratio值在慢性乙型肝炎肝功正常组及异常组比较中有显著性差异(P<0.05).结论:ASQ定量参数值可以在一定程度上间接反映均匀性脂肪肝的严重程度.     

糖尿病患者左室超声背向散射改变的初步观察

目的　了解 2型糖尿病 (T2 DM)心肌背向散射 (IBS)变化的特点及其临床意义。　方法正常对照组 5 0例 ,T2 DM组 5 0例 ,病程≤ 5年 ,糖化血红蛋白 (Hb A1c) (9.6 9± 1.78) % ,应用HP5 5 0 0型超声诊断仪 ,在胸骨旁左室乳头肌短轴切面分别测量左心室前间壁、前壁、侧壁、后壁、下壁和后间隔心肌组织的 IBS,并将其与心包 IBS的比值作为心肌 IBS的校正值 (IB% ) ;舒张末期与收缩末期的差值即 CVIB,并将其与心包 IBS的比值作为心肌 CVIB的校正值 (CVIB% )。同时测定左室等容舒张期时间 (IVRT) ,二尖瓣血流图 E峰与 A峰的比值 (E/ A )。　结果　 T2 DM组心脏左室各室壁心肌背向散射参数与正常对照组比较 IB%增大 ,CVIB减低 ,差异非常显著 (P <0 .0 0 1) ,两组IVRT、E/ A均在正常范围 (P>0 .0 5 )。　结论　 T2 DM患者左室 IBS有明显的变化且呈弥漫性改变 ,左室 IBS的变化出现在舒张功能异常 (糖尿病心肌病亚临床期 )之前 ,背向散射技术可早期发现糖尿病心肌微结构的病变     

卡维地洛对原发性高血压心肌组织特征及部分血管活性肽水平的改变

目的:应用超声声学密度技术探讨卡维地洛治疗原发性高血压患者左心室心肌组织密度的变化,分析治疗后部分血管活性肽心钠素、脑钠素、内皮素-1(ET-1)、降钙素基因相关肽(CGRP)、胰岛素样生长因子-1(IGF-1)水平的改变及其与心肌组织密度变化的关系。方法:将入选对象101例分为无左心室肥厚组56例及伴左心室肥厚组45例,应用超声声学密度技术测量治疗前后左心室心肌不同切面的平均声学密度(AII％);测量治疗前后部分血管活性肽心钠素、脑钠素、ET-1、CGRP、IGF-1水平,分析治疗前后其变化规律及与心肌声学密度变化的关系。结果:卡维地洛治疗后原发性高血压左心室各室壁AII％之和(SUM)较治疗前有显著性下降(P<0．05)。心钠素、脑钠素、IGF-1在无左心室肥厚组有下降的趋势(P>0．05),ET-1有显著性下降(P<0．05)。在伴左心室肥厚组心钠素、ET-1、IGF-1有显著性下降(P<0．05),脑钠素有下降趋势(P>0．05)。CGRP水平治疗后无左心室肥厚组有升高趋势(P>0．05),伴左心室肥厚组有显著性升高(P<0．05)。伴左心室肥厚组心肌各切面室壁SUM在治疗前后的变化ΔSUM与ΔET-1、Δ心钠素、ΔIGF-1等各因子水平呈正相关,与ΔCGRP水平呈负相关。结论:卡维地洛能降低原发性高血压左心室心肌组织密度;能使原发性高血压左心室肥厚两组心钠素、ET-1、CGRP、IGF-1等部分血管活性肽向有利于维持正常血压水平的方向改变。     

冠心病并发肾功能不全的心脏超声测量分析

目的探讨早期肾功能不全病人心脏重构/功能变化在超声中的表现 .方法 2003年12月-2004年12月住院的冠心病病人共120例,根据2003年美国NKF-K/DOQI工作组的意见进行肾功能分期,其中肾功能正常的冠心病病例(A组)26例,冠心病并发早期肾功能不全病例(B组)77例.另选择同期住院的无心脏病的早期肾功能不全病人22例(C组)及正常人10名作为对照组(D组),观察4组观测者心脏结构/功能在超声中的变化.结果 A组、B组、C组与D组比较,舒张末期左心内径(LVDd)、左心室心肌质量指数(LVMI)、左心室后壁厚度(LVPWT)、室间隔厚度(IVST)具有升高的趋势,有统计学意义.结论冠心病病人一旦出现肾功能不全,心脏功能和结构的各个超声指标则随之加重.     

实验性顿抑心肌的微循环障碍

为了探讨顿抑心肌微循环改变及机制，制备左前降支冠状动脉不同阻断时间(15min和60min)后再灌注犬心肌顿抑模型，在不同观察时间点静脉注射舍全氟丙烷声振白蛋白微泡造影剂，采用二次谐波成像和间歇发射技术行心肌声学造影，计算心肌声学造影图像上心肌视频密度峰值、心肌声学造影曲线上升斜率和曲线早期下降斜率，测定相应时间点冠状静脉窦血乳酸浓度，结果发现，心肌顿抑早期心肌视频密度峰值显著增高，1h后恢复至结扎前水平；再灌注期顿抑区与正常区视频密度峰值比值、心肌声学造影曲线上升斜率比值、心肌声学造影曲线早期下降斜率比值显著高于左前降支冠状动脉结扎前，随着再灌注时间的延长比值逐渐回降；再灌注期冠状静脉窦血乳酸浓度明显增高。以上结果提示，心肌顿抑早期心肌微循环处于“高动力”状态，血流灌注增加与排空加快并存；顿抑心肌缺氧代谢加强；心肌内微循环短路可能是心肌顿抑微循环障碍的机制。     

慢性肾功能不全老年患者心功能的临床探讨

慢性肾功能不全是各种肾脏疾病进行性恶化的结果。为此 ,每年万分之一人口新发病需作肾脏替代治疗。当由肾脏疾病导致心功能受损 ,则严重影响疾病的预后。心血管疾病又是当今老年人的常见病之一。当慢性肾功能不全老年患者并发心肌损害时 ,则更是致死的主要原因之一。为此 ,我们对 5 2例慢性肾功能不全老年患者心功能检测并进行临床探讨。现将结果报道如下。1　资料和方法1.1　研究对象和临床资料　 5 2例慢性肾功能不全老年患者 (测定组 ) ,男 2 8例 ,女 2 4例 ;年龄 6 0～ 85岁 ,平均 6 7 5岁 ;血压 (115～ 188) /(76～ 12 8)ｍｍＨｇ(1ｍ…     

Ultrasound Densitometric Analysis: Comparison Between an Online Digital Acquisition Acoustic Program and an Offline Analog Program

Videodensitometric analysis of myocardial contrast echocardiography is traditionally performed off line. Recently, an online contrast ultrasound analysis system, Acoustic Densitometry (Hewlett-Packard), was introduced. We compared pixel intensities acquired with Acoustic Densitometry to pixel intensities derived from videodensitometry. A tissue phantom was imaged in phase I using three transducer frequencies (2.5, 3.5, and 5.0 MHz). In phase II, an in vitro flowing tube model with various concentrations of Albunex® was imaged at two flow rates, 0.6 and 1.2 m/sec, and at two transducer frequencies, 2.5 and 3.5 MHz. The relationship between pixel intensities yielded by the two systems for identical ultrasound signals was determined with linear regression. Intensities derived with Acoustic Densitometry strongly correlated with those derived from the offline videodensitometry system. The intensities were related by a predictive multiplicative factor based on display characteristics of the two systems. These results suggest that semiquantitative, online perfusion analysis with Acoustic Densitometry is as sensitive as analysis offline with videodensitometry.     

Integrated backscatter during harmonic and fundamental frequency imaging--effect of depth,mechanical index,and tissue anisotropy: implications for myocardial tissue characterization

OBJECTIVE: To explore the potential advantages of tissue harmonic imaging (THI) versus fundamental frequency imaging (FFI) when applied to tissue characterization. METHODS: A Philips Medical Systems Sonos 5500 echocardiograph equipped with a broadband transducer (S4) and an on-line quantitative analysis software package (Acoustic Densitometry) was used for imaging. The effect of mechanical index (MI), imaging depth, and anisotropy on relative backscatter amplitude was evaluated. RESULTS: This study demonstrated that imaging with tissue harmonics generated relatively greater backscatter values at clinically relevant imaging depths and instrument settings referenced to FFI. This effect was dependent on MI setting. A direct relationship between backscatter amplitude and MI was demonstrated. Additionally, tissue anisotropy had similar effects on integrated backscatter amplitude during both THI and FFI. However, relative backscatter values at each fiber orientation are greater during THI at similar instrument settings when referenced to FFI. CONCLUSION: Tissue harmonic imaging may offer advantages over FFI for myocardial tissue characterization.     

Visualization of myocardial cellular architecture using acoustic microscopy.

The resolution of an ultrasound transducer depends on its frequency. The resolution improves when higher frequency transducers are used. A 1000 MHz transducer has a resolution of approximately 1 micron. Acoustic microscopy utilizes very high-frequency ultrasound (600 to 1000 MHz) to visualize structures on a microscopic level. Unstained, deparaffinized, 5 microns sections of myocardial biopsy specimens from 10 patients were placed on a slide and imaged using an Olympus UH3 scanning acoustic microscope. To compare with light microscopy, the section used for acoustic microscopy was subsequently stained with hematoxylin and eosin and a serial section from the paraffin block was stained with PTAH stain. Myocytes, myofibrils, and interstitial tissue were accurately imaged. Pathologic phenomena such as cell fallout, interstitial fibrosis, and lymphocytic infiltration were identified by acoustic microscopy. Intramural vessels, nuclei of endothelial cells, and the media were clearly identified by this technique. There was close correlation between findings by acoustic microscopy and light microscopy. Acoustic microscopy permitted the visualization of cardiac cellular detail with a resolution similar to that of light microscopy. Unlike light microscopy, acoustic microscopy requires no staining of the specimen.     

Coronary atherosclerosis within a myocardial bridge, not a benign condition

In patients with myocardial bridging, the area within the bridge usually remains free from atherosclerotic disease. The case of a 47 year old man is described who had the rare combination of myocardial bridging with an atherosclerotic plaque within the area of bridging, which was detected with intravascular ultrasound but not with coronary angiography. The clinical history of the patient demonstrates that this is not a benign condition. In symptomatic patients the bridged segment should be screened for the presence of plaque with intracoronary ultrasound.

Keywords: myocardial bridging;  intravascular ultrasound;  atherosclerotic plaque     

Waardenburg Syndrome With Familial Unilateral Renal Agenesis: A New Syndrome Variant?

A 64‐year‐old man with Waardenburg syndrome presented with anuria and was subsequently discovered by renal ultrasound to have unilateral renal agenesis. The patient is one of three generations with incidental finding of renal agenesis also marked by the presence of Waardenburg syndrome. To our knowledge, there has been no mention elsewhere in the scientific literature of a variant of Waardenburg syndrome with associated renal agenesis.     

Duale sekundäre Hypertonie bei einer 49-jährigen Patientin

We report the case of a 49-year old woman with hypertension due to renal artery stenosis resulting from compression of the renal artery. Compression was caused by a norepinephrine-secreting extra-adrenal phaeochromocytoma/paraganglioma. The pitfalls of diagnostic imaging are described based on colour-coded ultrasound, CT scan, angiography and MIBG scintigraphy performed in the patient.     

主动脉内球囊反博术在急性左心功能不全中的临床应用

目的:探讨主动脉内球囊反博术(IABP)在急性左心功能不全中的临床应用,方法:取自我院2010年1月至2015年12月在我院就诊符合入组条件的病人40例,均为急性左心功能不全患者,应用常规药物治疗效果欠佳,分为两组,20例治疗组中在常规药物治疗基础上加上应用IABP治疗, 20例对照组继续常规药物治疗,不予IABP治疗,结果:20例治疗组中患者经治疗后,住院期间3例死亡,5例自动出院,其他12例均有症状不同程度改善,对照组中5例死亡,10例自动出院,5例症状改善,其中左心功能不全加重、恶性心律失常、甚至死亡等并发症,治疗组均低于对照组,肾功能不全发生率治疗组也低于对照组,下肢动脉缺血发生率无明显差异,且治疗组疗程短于对照组,结论:主动脉内球囊反博术在急性左心功能不全的治疗疗效确切,特别是在急性心肌梗死合并左心功能不全,疗效更明显。     

老年急性心肌梗死患者直接冠状动脉介入治疗术后随访分析

目的分析老年急性心肌梗死患者直接PCI术后的危险因素。方法将619例直接行PCI的急性心肌梗死患者,按年龄分为老年组(≥65岁)236例和对照组(<65岁)383例,全部入选患者行PCI术后记录主要不良心脏事件,进行回顾性分析,采用Log-Rank检验进行两组的生存分析,Cox回归分析用于预后多因素分析。结果老年组患者女性比例、左心功能不全、肾功能不全比例高于对照组,差异有统计学意义(P<0.01)。高血压、糖尿病、血肌酐水平、LVEF值、无复流、支架的数目是老年组预后的独立危险因素。结论老年AMI患者直接PCI是有效可行的治疗手段。     

陈旧性心肌梗死患者颈动脉粥样硬化与危险因素的关系

为探讨陈旧性心肌梗死患者颈动脉粥样硬化情况，对38例陈旧性心肌梗死患者的颈动脉内中膜厚度及斑块进行超声检测，与32例健康者作对照。结果发现，陈旧性心肌梗死患者的颈动脉内中膜厚度、斑块指数及斑块发生率明显高于对照组。多因素回归分析显示，年龄、总胆固醇、收缩压与颈动脉内中膜厚度密切相关。