2型糖尿病患者血清同型半胱氨酸浓度变化分析

Objective To study the relationship between serum level of homocysteic acid(Hcy)and type 2 diabetic mellitus(T2DM),and to explore the influencing factors serum for Hey level in T2DM patients.Methods Totally T2DM 122 patients(T2DM group),67 patients with chronic kidney diease(CKD group)and 50 healthy controls(CON group)were enrolled in the investigation.The variation of serum Hcy of all groups was observed,and the correlation of serum Hcy level with estimated glomerular filtration rate(eGFR),fasting serum glucose,HbA1C,Urea and creatinine was analyzed.Serum Hcy was measured by enzymatic cycling assay;HbA1C was measured by high-pressure liquid chromatography assay;and eGFR was calculated by using the Levey-modified Modification of Diet in Renal Disease formula.Results There was no significant difference in serum level of Hcy between T2DM group and CON group(P＞0.05).The serum concentration of Hey was significantly higher in CKD group than that of T2DM group and CON group(P＜0.01).There was only 8.20% exceeding the upper limit of 95% of CON group in T2DM group,while 64.18% exceeding the upper limit of 95% of CON group in CKD group.There was no significant difference of Hcy level between patients with eGFR≥90 mL·(min·1.73 m2)-1 in T2DM group and healthy controls(P＞0.05),but the Hey level was significantly higher in patients with eGFR＜90 mL·(min·1.73 m2)-1 than that of healthy controls(P＜0.05).In T2DM group and CKD group,serum Hey level was negatively correlative to eGFR(P＜0.01).positively correlative to Urea and creatinine(P＜0.01);but serum Hcy level did not correlate with fasting serum glucose,HbA1C,total cholesterol and triglyceride(P＞0.05).Conclusion Renal function is an independent risk factor for serum homocysteine level in type 2 diabetes rather than diabetes itself.     

2型糖尿病患者血清同型半胱氨酸浓度变化分析

Objective To study the relationship between serum level of homocysteic acid(Hcy)and type 2 diabetic mellitus(T2DM),and to explore the influencing factors serum for Hey level in T2DM patients.Methods Totally T2DM 122 patients(T2DM group),67 patients with chronic kidney diease(CKD group)and 50 healthy controls(CON group)were enrolled in the investigation.The variation of serum Hcy of all groups was observed,and the correlation of serum Hcy level with estimated glomerular filtration rate(eGFR),fasting serum glucose,HbA1C,Urea and creatinine was analyzed.Serum Hcy was measured by enzymatic cycling assay;HbA1C was measured by high-pressure liquid chromatography assay;and eGFR was calculated by using the Levey-modified Modification of Diet in Renal Disease formula.Results There was no significant difference in serum level of Hcy between T2DM group and CON group(P＞0.05).The serum concentration of Hey was significantly higher in CKD group than that of T2DM group and CON group(P＜0.01).There was only 8.20% exceeding the upper limit of 95% of CON group in T2DM group,while 64.18% exceeding the upper limit of 95% of CON group in CKD group.There was no significant difference of Hcy level between patients with eGFR≥90 mL·(min·1.73 m2)-1 in T2DM group and healthy controls(P＞0.05),but the Hey level was significantly higher in patients with eGFR＜90 mL·(min·1.73 m2)-1 than that of healthy controls(P＜0.05).In T2DM group and CKD group,serum Hey level was negatively correlative to eGFR(P＜0.01).positively correlative to Urea and creatinine(P＜0.01);but serum Hcy level did not correlate with fasting serum glucose,HbA1C,total cholesterol and triglyceride(P＞0.05).Conclusion Renal function is an independent risk factor for serum homocysteine level in type 2 diabetes rather than diabetes itself.     

2型糖尿病患者血清同型半胱氨酸浓度变化分析

Objective To study the relationship between serum level of homocysteic acid(Hcy)and type 2 diabetic mellitus(T2DM),and to explore the influencing factors serum for Hey level in T2DM patients.Methods Totally T2DM 122 patients(T2DM group),67 patients with chronic kidney diease(CKD group)and 50 healthy controls(CON group)were enrolled in the investigation.The variation of serum Hcy of all groups was observed,and the correlation of serum Hcy level with estimated glomerular filtration rate(eGFR),fasting serum glucose,HbA1C,Urea and creatinine was analyzed.Serum Hcy was measured by enzymatic cycling assay;HbA1C was measured by high-pressure liquid chromatography assay;and eGFR was calculated by using the Levey-modified Modification of Diet in Renal Disease formula.Results There was no significant difference in serum level of Hcy between T2DM group and CON group(P＞0.05).The serum concentration of Hey was significantly higher in CKD group than that of T2DM group and CON group(P＜0.01).There was only 8.20% exceeding the upper limit of 95% of CON group in T2DM group,while 64.18% exceeding the upper limit of 95% of CON group in CKD group.There was no significant difference of Hcy level between patients with eGFR≥90 mL·(min·1.73 m2)-1 in T2DM group and healthy controls(P＞0.05),but the Hey level was significantly higher in patients with eGFR＜90 mL·(min·1.73 m2)-1 than that of healthy controls(P＜0.05).In T2DM group and CKD group,serum Hey level was negatively correlative to eGFR(P＜0.01).positively correlative to Urea and creatinine(P＜0.01);but serum Hcy level did not correlate with fasting serum glucose,HbA1C,total cholesterol and triglyceride(P＞0.05).Conclusion Renal function is an independent risk factor for serum homocysteine level in type 2 diabetes rather than diabetes itself.     

2型糖尿病患者血清同型半胱氨酸浓度变化分析

Objective To study the relationship between serum level of homocysteic acid(Hcy)and type 2 diabetic mellitus(T2DM),and to explore the influencing factors serum for Hey level in T2DM patients.Methods Totally T2DM 122 patients(T2DM group),67 patients with chronic kidney diease(CKD group)and 50 healthy controls(CON group)were enrolled in the investigation.The variation of serum Hcy of all groups was observed,and the correlation of serum Hcy level with estimated glomerular filtration rate(eGFR),fasting serum glucose,HbA1C,Urea and creatinine was analyzed.Serum Hcy was measured by enzymatic cycling assay;HbA1C was measured by high-pressure liquid chromatography assay;and eGFR was calculated by using the Levey-modified Modification of Diet in Renal Disease formula.Results There was no significant difference in serum level of Hcy between T2DM group and CON group(P＞0.05).The serum concentration of Hey was significantly higher in CKD group than that of T2DM group and CON group(P＜0.01).There was only 8.20% exceeding the upper limit of 95% of CON group in T2DM group,while 64.18% exceeding the upper limit of 95% of CON group in CKD group.There was no significant difference of Hcy level between patients with eGFR≥90 mL·(min·1.73 m2)-1 in T2DM group and healthy controls(P＞0.05),but the Hey level was significantly higher in patients with eGFR＜90 mL·(min·1.73 m2)-1 than that of healthy controls(P＜0.05).In T2DM group and CKD group,serum Hey level was negatively correlative to eGFR(P＜0.01).positively correlative to Urea and creatinine(P＜0.01);but serum Hcy level did not correlate with fasting serum glucose,HbA1C,total cholesterol and triglyceride(P＞0.05).Conclusion Renal function is an independent risk factor for serum homocysteine level in type 2 diabetes rather than diabetes itself.     

2型糖尿病患者血清同型半胱氨酸浓度变化分析

Objective To study the relationship between serum level of homocysteic acid(Hcy)and type 2 diabetic mellitus(T2DM),and to explore the influencing factors serum for Hey level in T2DM patients.Methods Totally T2DM 122 patients(T2DM group),67 patients with chronic kidney diease(CKD group)and 50 healthy controls(CON group)were enrolled in the investigation.The variation of serum Hcy of all groups was observed,and the correlation of serum Hcy level with estimated glomerular filtration rate(eGFR),fasting serum glucose,HbA1C,Urea and creatinine was analyzed.Serum Hcy was measured by enzymatic cycling assay;HbA1C was measured by high-pressure liquid chromatography assay;and eGFR was calculated by using the Levey-modified Modification of Diet in Renal Disease formula.Results There was no significant difference in serum level of Hcy between T2DM group and CON group(P＞0.05).The serum concentration of Hey was significantly higher in CKD group than that of T2DM group and CON group(P＜0.01).There was only 8.20% exceeding the upper limit of 95% of CON group in T2DM group,while 64.18% exceeding the upper limit of 95% of CON group in CKD group.There was no significant difference of Hcy level between patients with eGFR≥90 mL·(min·1.73 m2)-1 in T2DM group and healthy controls(P＞0.05),but the Hey level was significantly higher in patients with eGFR＜90 mL·(min·1.73 m2)-1 than that of healthy controls(P＜0.05).In T2DM group and CKD group,serum Hey level was negatively correlative to eGFR(P＜0.01).positively correlative to Urea and creatinine(P＜0.01);but serum Hcy level did not correlate with fasting serum glucose,HbA1C,total cholesterol and triglyceride(P＞0.05).Conclusion Renal function is an independent risk factor for serum homocysteine level in type 2 diabetes rather than diabetes itself.     

2型糖尿病患者血清同型半胱氨酸浓度变化分析

Objective To study the relationship between serum level of homocysteic acid(Hcy)and type 2 diabetic mellitus(T2DM),and to explore the influencing factors serum for Hey level in T2DM patients.Methods Totally T2DM 122 patients(T2DM group),67 patients with chronic kidney diease(CKD group)and 50 healthy controls(CON group)were enrolled in the investigation.The variation of serum Hcy of all groups was observed,and the correlation of serum Hcy level with estimated glomerular filtration rate(eGFR),fasting serum glucose,HbA1C,Urea and creatinine was analyzed.Serum Hcy was measured by enzymatic cycling assay;HbA1C was measured by high-pressure liquid chromatography assay;and eGFR was calculated by using the Levey-modified Modification of Diet in Renal Disease formula.Results There was no significant difference in serum level of Hcy between T2DM group and CON group(P＞0.05).The serum concentration of Hey was significantly higher in CKD group than that of T2DM group and CON group(P＜0.01).There was only 8.20% exceeding the upper limit of 95% of CON group in T2DM group,while 64.18% exceeding the upper limit of 95% of CON group in CKD group.There was no significant difference of Hcy level between patients with eGFR≥90 mL·(min·1.73 m2)-1 in T2DM group and healthy controls(P＞0.05),but the Hey level was significantly higher in patients with eGFR＜90 mL·(min·1.73 m2)-1 than that of healthy controls(P＜0.05).In T2DM group and CKD group,serum Hey level was negatively correlative to eGFR(P＜0.01).positively correlative to Urea and creatinine(P＜0.01);but serum Hcy level did not correlate with fasting serum glucose,HbA1C,total cholesterol and triglyceride(P＞0.05).Conclusion Renal function is an independent risk factor for serum homocysteine level in type 2 diabetes rather than diabetes itself.     

2型糖尿病患者血清同型半胱氨酸浓度变化分析

Objective To study the relationship between serum level of homocysteic acid(Hcy)and type 2 diabetic mellitus(T2DM),and to explore the influencing factors serum for Hey level in T2DM patients.Methods Totally T2DM 122 patients(T2DM group),67 patients with chronic kidney diease(CKD group)and 50 healthy controls(CON group)were enrolled in the investigation.The variation of serum Hcy of all groups was observed,and the correlation of serum Hcy level with estimated glomerular filtration rate(eGFR),fasting serum glucose,HbA1C,Urea and creatinine was analyzed.Serum Hcy was measured by enzymatic cycling assay;HbA1C was measured by high-pressure liquid chromatography assay;and eGFR was calculated by using the Levey-modified Modification of Diet in Renal Disease formula.Results There was no significant difference in serum level of Hcy between T2DM group and CON group(P＞0.05).The serum concentration of Hey was significantly higher in CKD group than that of T2DM group and CON group(P＜0.01).There was only 8.20% exceeding the upper limit of 95% of CON group in T2DM group,while 64.18% exceeding the upper limit of 95% of CON group in CKD group.There was no significant difference of Hcy level between patients with eGFR≥90 mL·(min·1.73 m2)-1 in T2DM group and healthy controls(P＞0.05),but the Hey level was significantly higher in patients with eGFR＜90 mL·(min·1.73 m2)-1 than that of healthy controls(P＜0.05).In T2DM group and CKD group,serum Hey level was negatively correlative to eGFR(P＜0.01).positively correlative to Urea and creatinine(P＜0.01);but serum Hcy level did not correlate with fasting serum glucose,HbA1C,total cholesterol and triglyceride(P＞0.05).Conclusion Renal function is an independent risk factor for serum homocysteine level in type 2 diabetes rather than diabetes itself.     

2型糖尿病患者血清同型半胱氨酸浓度变化分析

Objective To study the relationship between serum level of homocysteic acid(Hcy)and type 2 diabetic mellitus(T2DM),and to explore the influencing factors serum for Hey level in T2DM patients.Methods Totally T2DM 122 patients(T2DM group),67 patients with chronic kidney diease(CKD group)and 50 healthy controls(CON group)were enrolled in the investigation.The variation of serum Hcy of all groups was observed,and the correlation of serum Hcy level with estimated glomerular filtration rate(eGFR),fasting serum glucose,HbA1C,Urea and creatinine was analyzed.Serum Hcy was measured by enzymatic cycling assay;HbA1C was measured by high-pressure liquid chromatography assay;and eGFR was calculated by using the Levey-modified Modification of Diet in Renal Disease formula.Results There was no significant difference in serum level of Hcy between T2DM group and CON group(P＞0.05).The serum concentration of Hey was significantly higher in CKD group than that of T2DM group and CON group(P＜0.01).There was only 8.20% exceeding the upper limit of 95% of CON group in T2DM group,while 64.18% exceeding the upper limit of 95% of CON group in CKD group.There was no significant difference of Hcy level between patients with eGFR≥90 mL·(min·1.73 m2)-1 in T2DM group and healthy controls(P＞0.05),but the Hey level was significantly higher in patients with eGFR＜90 mL·(min·1.73 m2)-1 than that of healthy controls(P＜0.05).In T2DM group and CKD group,serum Hey level was negatively correlative to eGFR(P＜0.01).positively correlative to Urea and creatinine(P＜0.01);but serum Hcy level did not correlate with fasting serum glucose,HbA1C,total cholesterol and triglyceride(P＞0.05).Conclusion Renal function is an independent risk factor for serum homocysteine level in type 2 diabetes rather than diabetes itself.     

2型糖尿病患者血清同型半胱氨酸浓度变化分析

Objective To study the relationship between serum level of homocysteic acid(Hcy)and type 2 diabetic mellitus(T2DM),and to explore the influencing factors serum for Hey level in T2DM patients.Methods Totally T2DM 122 patients(T2DM group),67 patients with chronic kidney diease(CKD group)and 50 healthy controls(CON group)were enrolled in the investigation.The variation of serum Hcy of all groups was observed,and the correlation of serum Hcy level with estimated glomerular filtration rate(eGFR),fasting serum glucose,HbA1C,Urea and creatinine was analyzed.Serum Hcy was measured by enzymatic cycling assay;HbA1C was measured by high-pressure liquid chromatography assay;and eGFR was calculated by using the Levey-modified Modification of Diet in Renal Disease formula.Results There was no significant difference in serum level of Hcy between T2DM group and CON group(P＞0.05).The serum concentration of Hey was significantly higher in CKD group than that of T2DM group and CON group(P＜0.01).There was only 8.20% exceeding the upper limit of 95% of CON group in T2DM group,while 64.18% exceeding the upper limit of 95% of CON group in CKD group.There was no significant difference of Hcy level between patients with eGFR≥90 mL·(min·1.73 m2)-1 in T2DM group and healthy controls(P＞0.05),but the Hey level was significantly higher in patients with eGFR＜90 mL·(min·1.73 m2)-1 than that of healthy controls(P＜0.05).In T2DM group and CKD group,serum Hey level was negatively correlative to eGFR(P＜0.01).positively correlative to Urea and creatinine(P＜0.01);but serum Hcy level did not correlate with fasting serum glucose,HbA1C,total cholesterol and triglyceride(P＞0.05).Conclusion Renal function is an independent risk factor for serum homocysteine level in type 2 diabetes rather than diabetes itself.     

2型糖尿病患者血清同型半胱氨酸浓度变化分析

Objective To study the relationship between serum level of homocysteic acid(Hcy)and type 2 diabetic mellitus(T2DM),and to explore the influencing factors serum for Hey level in T2DM patients.Methods Totally T2DM 122 patients(T2DM group),67 patients with chronic kidney diease(CKD group)and 50 healthy controls(CON group)were enrolled in the investigation.The variation of serum Hcy of all groups was observed,and the correlation of serum Hcy level with estimated glomerular filtration rate(eGFR),fasting serum glucose,HbA1C,Urea and creatinine was analyzed.Serum Hcy was measured by enzymatic cycling assay;HbA1C was measured by high-pressure liquid chromatography assay;and eGFR was calculated by using the Levey-modified Modification of Diet in Renal Disease formula.Results There was no significant difference in serum level of Hcy between T2DM group and CON group(P＞0.05).The serum concentration of Hey was significantly higher in CKD group than that of T2DM group and CON group(P＜0.01).There was only 8.20% exceeding the upper limit of 95% of CON group in T2DM group,while 64.18% exceeding the upper limit of 95% of CON group in CKD group.There was no significant difference of Hcy level between patients with eGFR≥90 mL·(min·1.73 m2)-1 in T2DM group and healthy controls(P＞0.05),but the Hey level was significantly higher in patients with eGFR＜90 mL·(min·1.73 m2)-1 than that of healthy controls(P＜0.05).In T2DM group and CKD group,serum Hey level was negatively correlative to eGFR(P＜0.01).positively correlative to Urea and creatinine(P＜0.01);but serum Hcy level did not correlate with fasting serum glucose,HbA1C,total cholesterol and triglyceride(P＞0.05).Conclusion Renal function is an independent risk factor for serum homocysteine level in type 2 diabetes rather than diabetes itself.     

三维斑点追踪成像技术对高血压患者左心房功能的评价

目的应用三维斑点追踪成像技术评价不同时相左心房容积、射血分数和应变功能参数在左心室重构和非重构高血压患者中的变化特征。 方法收集2020年1月至2020年8月在四川省人民医院进行心脏超声检查的高血压患者90例（左心室重构组40例,非重构组50例）,另选取健康受试者40例,均进行标准三维和二维经胸超声心动图图像采集及参数分析。测量比较3组受试者的常规心脏参数,左心房储器、管道及泵时相的长轴和圆周应变,不同时相左心房射血分数,左心室整体长轴应变等,并研究不同时相左心房应变与射血分数、左心室整体长轴应变的相关性。 结果与健康受试者相比,高血压非左心室重构组左心房管道及泵时相的长轴应变降低（11.7%±3.0% vs 14.6%±1.4%、12.6%±3.4% vs 15.2%±2.2%）,而储器、管道及泵时相圆周应变增加（34.3%±6.3% vs 29.0%±5.1%、14.6%±3.1% vs 12.4%±2.1%和19.3%±4.4% vs 16.6%±2.3%,均P＜0.05）;左心室重构高血压组的左心房不同时相容积均显著增加（均P＜0.05）,射血分数、长轴及圆周应变均显著降低（均P＜0.05）。左心室重构高血压患者不同时相的左心房长轴及圆周应变与射血分数、左心室整体长轴应变均呈正相关（r=0.35~0.77,均P＜0.05）,左心房管道圆周应变与储器、泵功能射血分数及左心室整体长轴应变相关性最高,相关系数r分别为0.77、0.71、0.66。 结论复杂的左心房功能可以应用三维斑点追踪成像技术来评价,包括快速获取不同时相左心房射血分数、左心房长轴及圆周应变参数,圆周应变是反映左心房功能的重要参数。三维斑点追踪成像可为早期发现高血压患者左心房功能改变及临床早期干预提供有价值的信息。     

超声心动图评价肺动脉高压患者的左心功能

目的 应用超声心动图评价肺动脉高压(PH)患者的左心功能.方法 对39例PH患者(PH组)和27名健康志愿者(对照组)行全面超声心动图检查,测量右心功能、左心收缩及舒张功能.留取胸骨旁左心室短轴切面(乳头肌水平)和心尖四腔心切面动态图像,采用斑点追踪分析软件测量左心室心肌整体收缩期环形应变(GCSS)、径向应变(GRSS)及纵向应变(GLSS).对两组测量结果进行对比分析.结果 PH患者右心功能减低,左心室舒张功能减低,左心室射血分数(LVEF)无明显变化(66.48％±6.38％ vs 65.26％±4.01％,P＞0.05).左心室心肌GCSS(-15.66％±3.67％ vs一18.56％±2.16％,P＜0.01),GRSS(15.54％±5.35％ vs 30.03％±9.64％,P＜0.01)和GLSS(- 16.18％±4.35％ vs-20.91％±2.96％,P＜0.01)绝对值均较对照组明显减低.结论 中重度PH患者左心室舒张功能明显减低;尽管LVEF无明显变化,其左心室心肌收缩功能存在不同程度减低.     

三维斑点追踪显像分析左心室收缩功能及同步性的初步研究

目的 应用三维斑点追踪显像(3D STI)分析扩张型心肌病(DCM)合并完全性左束支传导阻滞(CLBBB)患者左心室功能及左心室同步性.方法 分别对37例DCM合并CLBBB患者及25例正常对照者进行3D STI分析,计算左心室射血分数(LVEF),16节段3D应变及经心动周期标化的达峰时间标准差(3D-SDI),左心室整体3D、长轴、短轴及圆周应变.结果 对照组心尖水平、二尖瓣水平及乳头肌水平3D应变值差异无统计学意义(P＞0.05).左心室整体3D、长轴及短轴应变与LVEF间有良好的负相关(r分别为-0.92,-0.84及-0.78,P均＜0.01),圆周应变与LVEF间有良好的正相关(r =0.81,P＜0.01).与对照组比较,病例组3D、长轴、短轴及圆周应变均明显下降(P均＜0.01),16节段3D-SDI明显增大(P ＜0.01).左心室收缩功能轻度下降、中度下降及显著下降组之间3D-SDI差异具有统计学意义(P ＜0.05),而QRS时限无显著差异.结论 3D STI测得的左心室3D、长轴、短轴及圆周应变以及3D-SDI可以准确有效地评估左心室整体、局部收缩功能及左心室同步性.     

三维斑点追踪成像对早发性卵巢功能不全患者左心室心肌收缩功能的评价

目的应用实时三维斑点追踪成像（RT3D-STI）技术定量评价左心室射血分数（LVEF）正常的早发性卵巢功能不全（POI）女性亚临床左心室心肌收缩功能改变。 方法选取2018年10月至2019年9月于四川省人民医院就诊的LVEF正常的POI患者54例（POI组）和同期来院体检的年龄、身高、体质量相匹配的健康女性志愿者42例（对照组）。2组均进行常规经胸超声心动图检查获得常规左心室构型及功能参数,同时进行RT3D-STI检查获得三维左心室收缩功能参数：整体纵向应变（GLS）、整体圆周应变（GCS）、整体面积应变（GAS）及整体径向应变（GRS）、三维左心室射血分数（3D-LVEF）。比较2组参数的差异。 结果POI组舒张末期室间隔厚度（IVST）较对照组增大（P＜0.05）。POI组E、E/A、e_侧壁均较对照组降低（P＜0.01或P＜0.05）,POI组MPI较对照组增高（P＜0.01）,2组间比较二维左心室射血分数（2D-LVEF）差异无统计学意义（P＞0.05）。POI组GLS、GCS、GAS、GRS均较对照组减低（P均＜0.01）,2组间比较3D-LVEF差异无统计学意义（P＞0.05）。 结论LVEF正常的POI女性可能已存在亚临床左心室心肌收缩功能受损。与常规参数LVEF相比,RT3D-STI三维应变参数可更敏感地检测POI女性亚临床左心室心肌收缩功能受损,其可作为评价POI女性早期左心室心肌收缩功能受损的无创检查方法。     

二维应变成像对冠心病患者的初步研究

目的 探讨冠心病患者心肌应变特点.方法 43例冠心病患者及35例正常人,分别获取左室短轴观二尖瓣环水平、乳头肌水平、心尖水平及心尖四腔观、二腔观,左室长轴观的高帧频图像,应用二维应变软件测量各个节段的二维应变值.结果 狭窄＜75%冠状动脉(冠脉)供血节段共96个,狭窄≥75%冠脉供血节段共147个.①狭窄≥75%冠脉供血节段与正常对照组比较,基底段、中间段及心尖段纵向收缩期峰值应变均明显减低,差异有统计学意义(P＜0.05);左室短轴(二尖瓣环、乳头肌及心尖水平)的绝大部分径向收缩期峰值应变及圆周收缩期峰值应变与正常对照组相比,差异无统计学意义(P＞0.05);②以纵向收缩期峰值应变≥-16.1%为截点值,预测冠脉狭窄≥75%的敏感性及特异性分别为78.7%和76.4%.③狭窄＜75%冠脉供血节段与正常对照组比较,纵向收缩期峰值应变、径向收缩期峰值应变及圆周收缩期峰值应变差异无统计学意义(P＞0.05).结论 当冠脉出现严重狭窄时,虽然二维超声心动图上无明显室壁运动异常,但反映心内膜下心肌功能的纵向应变已明显降低.     

三维超声斑点追踪成像技术评价高血压患者左心室整体收缩功能的临床研究

目的 探讨三维超声斑点追踪成像技术评价原发性高血压患者左心室整体收缩功能的临床应用价值.方法 左室几何构型正常的原发性高血压患者50例,年龄、性别匹配的对照组29例.采取心尖全容积图像,应用三维超声斑点追踪成像技术测量并比较各组左室整体纵向收缩峰值应变(GLS)、左室整体径向收缩峰值应变(GRS)、左室整体圆周收缩峰值应变(GCS)及左室整体三维径向收缩峰值应变(3DGRS),三维斑点追踪分析软件计算左室射血分数(LVEF).结果 高血压患者左室GLS、GRS、GCS及3DGRS均较对照组减低,差异有统计学意义(P均＜0.05);Pearson相关分析表明高血压组左室GCS、GLS、GRS与LVEF相关(r1=0.930,P1＜0.001;r2=0.705,P2＜0.001; r3=0.474,P3=0.001),对照组左室GCS、GLS与LVEF相关(r1=0.838,P1＜0.001;r2=0.697,P2＜0.001).结论 高血压患者早期左室整体三维形变能力降低,三维超声斑点追踪成像技术可发现高血压患者早期心功能的变化.左室圆周运动在左室三维运动中占重要作用,对左室射血产生重要影响.     

超声斑点追踪显像评价心肌梗死患者左心室整体收缩功能的研究

目的 应用超声斑点追踪显像(STI)技术评价心肌梗死患者的左室整体收缩功能,探讨二尖瓣环位移(MAD)评价左室整体收缩功能指标的可行性和准确性。方法 对20例心肌梗死患者及30例健康对照者,应用STI技术计算左室收缩期整体峰值纵向应变(GLs)、圆周应变(GCs)、MAD,应用实时三维超声心动图计算左室射血分数(LVEF)。比较对照组和心肌梗死组应变参数、MAD与LVEF之间的关系。结果 与对照组比较,心肌梗死组各参数明显减低(P＜0.05)。对照组与心肌梗死组GLs为LVEF的独立预测因子,对照组及心肌梗死组MAD与LVEF均呈显著相关(分别r=0.84,P＜0.01 ;r=0.87,P ＜0.01)。结论MAD和LVEF之间存在较好的相关性,有望成为临床常规评价心肌梗死患者左室整体收缩功能的一种快捷、准确的方法。     

速度向量成像应变指标评价冠心病患者左心室局部和整体收缩功能

目的 应用速度向量成像(VVI)技术应变指标定量分析静息状态下冠心病患者左心室局部及整体收缩功能.方法 冠心病患者和健康志愿者各30例.采集心尖四腔、两腔及左室长轴观和二尖瓣环、乳头肌及心尖水平左室短轴观二维灰阶图像.按18节段法划分左室壁,分析各节段纵向(L)、周向(C)和径向(R)收缩期峰值应变(S).将LS、CS心内、外膜测值之差分别定为纵向应变跨壁阶差(LSG)、周向应变跨壁阶差(CSG);将左室壁所有节段各向应变平均值定为左室壁各向整体收缩期峰值应变并分别与左室射血分数(LVEF)作相关性分析.结果 A组为冠脉狭窄≤70%供血心肌,共176个节段,其LS及LSG明显低于对照组(P＜0.05),CS、RS及CSG与对照组差异无统计学意义(P＞0.05);B组为冠脉狭窄＞70%供血心肌,共132个节段,其LS、CS及RS均显著低于对照组(P＜0.05),LSG及CSG与对照组差异无统计学意义(P＞0.05).B组LS、RS、CS显著低于A组,LSG显著高于A组(P＜0.05),CSG与A组差异无统计学意义(P＞0.05).冠心病组各向整体收缩期峰值应变指标均与LVEF指标显著相关(P＜0.0001),其中GLS与LVEF指标相关系数最高.结论 VVI技术应变指标可以准确评价冠心病患者左心室收缩功能异常.局部心肌LS、RS、CS、LSG及CSG的变化可以反映冠脉狭窄的严重程度;左室壁GLS可以作为评价冠心病患者左心室整体收缩功能的新指标.     

右心室不同部位起搏时左心室总体及节段心肌收缩功能的超声评估

目的 应用斑点追踪显像技术评价右心室不同部位起搏对左心室总体及节段心肌收缩功能的影响.方法 获取右室间隔起搏组(9例)、右室心尖起搏组(15例)、正常对照组(13例)心尖左室长轴观、胸骨旁左室短轴观图像,测量各节段峰值纵向应变(S_L)、峰值径向应变(S_R),计算左室总体峰值纵向应变(GS_L)、总体峰值径向应变(GS_R).结果 右室心尖起搏组GS_L[-(18.29±2.67)%]低于正常对照组[-(21.07±2.08)%]及右室间隔起搏组[-(20.54±2.29)%],差异均具有统计学意义(P＜0.05),右室间隔起搏组与正常对照组GS_L比较差异无统计学意义(P＞0.05).而右室心尖起搏组GS_R[-(26.85±7.73)%]与右室间隔起搏组GS_R[(28.59±6.06)%]均低于正常对照组[(36.26±9.37)%],差异有统计学意义(P＜0.05),两起搏组间GS_R差异无统计学意义(P＞0.05),但右室心尖起搏组GS_R有进一步降低趋势.两起搏组邻近起搏位点的左室节段心肌S_L及S_R较正常对照组相应节段明显降低,但右室间隔起搏组保持了与正常对照组相似的左室内应变分布,右室心尖起搏组左室内应变分布异常.结论 斑点追踪显像技术可定量评价右室不同部位起搏时左室总体及节段心肌收缩功能变化.     

Myocardial Strain and Strain Rate in Monitoring Subclinical Heart Failure in Asymptomatic Long-Term Survivors of Childhood Cancer

We studied the role of global myocardial strain and strain rate in monitoring subclinical heart failure in a large group of asymptomatic long-term survivors of childhood cancer. Global strain (rate) parameters of survivors were compared with those in healthy controls and were related to conventional echocardiographic parameters, N-terminal-pro-natriuretic peptide (NT-pro-BNP) levels and clinical parameters. Two-dimensional (2-D) echocardiography was performed in 111 survivors and 107 healthy controls. Blood samples were taken from survivors to determine NT-pro-BNP levels. We showed that global myocardial strain, strain rate and time to peak systolic strain in asymptomatic survivors of childhood cancer were significantly lower compared with healthy controls (p values <0.0001) and were significantly related to several systolic and diastolic left ventricular parameters. Whether myocardial strain and strain rate are superior to conventional echocardiography in the early detection of subclinical heart failure needs to be explored in further longitudinal prospective studies. (E-mail: A.Mavinkurve@cukz.umcn.nl)