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目的研究对骨质疏松症(OP)患者采用多普勒组织速度成像技术(TDI)检测及评价心室功能的临床价值。方法以住院的OP患者120例为OP组,以同期年龄及性别匹配的健康体检者120例为正常对照(NC)组,应用TDI技术测量2组心肌运动频谱相关指标,心尖四腔心切面选左室侧壁二尖瓣环、间隔侧二尖瓣环及右室游离缘三尖瓣环3个位点,记录速度指标:收缩期S波峰值速度(Sm)、舒张期早期e波(e),舒张晚期a波峰值;S波与e波的速度时间积分(S-VTI及e-VTI),计算e/a值。记录时间指标:S波峰值时间(Ts-m),e波达峰时间(Te-m)。结果 (1)运动速度参数比较:收缩期左室侧壁及间隔侧二尖瓣环两个瓣环位点的Sm、S-VTI值在OP组均低于NC组(P均﹤0.01),在OP组轻、中、重3个亚组间差异有统计学意义(P均﹤0.01)。舒张期左室侧壁二尖瓣环、间隔侧二尖瓣环及右室游离缘三尖瓣环3个瓣环位点的e、e-VTI、e/a值在OP组均低于NC组(P均﹤0.01),在OP组轻、中、重3个亚组间差异亦有统计学意义(P均﹤0.01)。(2)时间参数比较:Te-m与Ts-m在OP组较NC组显著延长(P均﹤0.01);在OP组随轻、中、重骨质疏松程度的依次加重,Te-m与Ts-m呈依次延长(P<0.01)。收缩期的Ts-m在各组同组不同瓣环位点间均无统计学差异(P>0.05);舒张期的Te-m在NC组不同瓣环位点间相近(P>0.05),Te-m在OP组及其轻、中、重亚组不同瓣环位点间均有统计学差异(P均﹤0.05)。结论通过TDI技术测量3个瓣环位点的速度及时间指标,显示OP早期即同时存在左右心室收缩及舒张功能异常,可作为判断OP患者心肌损害严重程度的客观敏感指标。
Objective To study the clinical value of detecting and evaluating ventricular function in patients with osteoporosis (OP) by using Doppler tissue velocity imaging (TDI). Methods A total of 120 hospitalized patients with OP were selected as the OP group. One hundred and twenty healthy subjects with the same age and gender were enrolled as the normal control (NC) group. TDI technique was used to measure the related indexes of myocardial motion, Left ventricular wall mitral annulus, mitral annulus and right ventricular free edge tricuspid annulus 3 sites, recording speed indicators: S wave peak systolic velocity (Sm), early diastole e wave (e ), The a-wave peak of late diastolic phase, the integral of velocity-time integral of S wave and e wave (S-VTI and e-VTI), and calculate the e / a value. Record time indicators: S-wave peak time (Ts-m), e-wave peak time (Te-m). Results (1) Compared with NC group, Sm and S-VTI values of mitral valve annulus in both systolic and diastolic mitral annulus were lower in OP group than in NC group (all P <0.01) There were significant differences among the three subgroups of light, medium and heavy in OP group (all P <0.01). The e, e-VTI, e / a values of the three annulus sites of the left ventricular wall mitral annulus, the spacer-side mitral annulus and the right ventricular free edge tricuspid annulus were all lower than those of the NC group (P <0.01). There were also significant differences among the three subgroups in light, moderate and severe OP (all P <0.01). (2) Comparison of time parameters: Te-m and Ts-m were significantly prolonged in OP group compared with NC group (all P <0.01); in OP group, the severity of osteoporosis increased with the increase of light, Ts-m were followed by prolonged (P <0.01). There was no significant difference in systolic Ts-m between the two groups (P> 0.05). Te-m in diastolic phase was similar in different annulus sites of NC group (P> 0.05) Te-m in the OP group and its light, middle and heavy sub-group of different annulus sites were statistically significant (P all <0.05). Conclusions The velocity and time indexes of three annulus loci measured by TDI technique show that there are both left and right ventricular systolic and diastolic dysfunction in the early stage of OP, which can be used as an objective and sensitive index to judge the severity of myocardial damage in OP patients.