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目的探讨三维超声斑点追踪技术对高血压左室长轴收缩功能的评估价值。方法选择2015年5月—2016年5月在本院进行就诊的原发性高血压患者70例,根据左心室重量指数(left ventricular mass index,LVMI)分为高血压A组和B组,另选择同期在本院体检的健康志愿者30例作为对照组。比较三组患者的常规超声心动图的相关参数情况,计算心肌平均收缩期纵向应变(longitudinal strain,LS)值。计量资料比较采用方差分析,两两比较采用LSD法,P<0.05为差异有统计学意义。结果与对照组比较[(23.91±5.89)mm、(0.84±0.26)m/s、(0.69±0.05)m/s、(1.24±0.56)],高血压A和B组左房舒张末期内径(left atrial end-diastolic dimension,LAEDd)、二尖瓣舒张期E峰流速(E peak,E)、A峰流速(A peak,A)、E/A数值[(29.36±5.42)mm、(0.71±0.12)m/s、(0.78±0.13)m/s、(0.91±0.14),(32.21±5.12)mm、(0.66±0.17)m/s、(0.92±0.15)m/s、(0.75±0.32)]均具有显著差异,差异均有统计学意义(均P<0.05);高血压B组的室间隔厚度(interventricular septal thickness,IVSTd)、左室后壁厚度(left ventricular posterior wall thickness,LVPWT)[(13.78±1.65)、(13.88±1.56)mm]显著高于高血压A组[(9.12±0.87)、(9.24±0.98)mm],差异均有统计学意义(均P<0.05)。高血压A组各个节段及整体应变心内膜层的LS值[(-18.98±1.89)、(-22.98±4.21)、(-22.56±5.06)、(-21.05±7.11)]显著低于对照组[(-23.62±2.56)、(-25.85±3.65)、(-27.56±4.96)、(-24.89±3.67)],差异均有统计学意义(均P<0.05);高血压B组各个节段及整体应变的心内、外膜层的LS值[(-17.85±2.36)、(-18.56±4.98)、(-21.08±5.14)、(-19.23±4.95)与(-16.05±4.25)、(-17.56±4.35)、(-19.88±4.87)、(-18.15±2.36)]均显著低于对照组[(-23.62±2.56)、(-25.85±3.65)、(-27.56±4.96)、(-24.89±3.67)与(-19.20±3.95)、(-21.56±4.05)、(-23.27±4.06)、(-21.63±4.07)],差异均有统计学意义(均P<0.05)。结论三维超声斑点追踪技术可以在准确评价高血压左室长轴整体运动的同时还可以评价各个节段运动,另一方面斑点追踪技术无角度限制、无依赖性,具有很好的可重复性,操作简单,值得在临床推广使用。
Objective To investigate the value of three-dimensional ultrasound speckle tracking in assessment of left ventricular long axis systolic function. Methods Seventy patients with essential hypertension treated in our hospital from May 2015 to May 2016 were divided into two groups according to the left ventricular mass index (LVMI): group A and group B, Select the same period in our hospital physical examination of 30 healthy volunteers as a control group. The relative parameters of routine echocardiography were compared between the three groups of patients to calculate the average myocardial strain systolic longitudinal strain (LS). Measurement data were compared using analysis of variance, pairwise comparison using LSD method, P <0.05 for the difference was statistically significant. Results Compared with the control group, the left atrial diastolic diameter ((23.91 ± 5.89) mm, (0.84 ± 0.26) m / s, (0.69 ± 0.05) m / s, left atrial end-diastolic dimension (LAEDd), E peak (E), A peak (A), E / A value [(29.36 ± 5.42) mm, (0.92 ± 0.15) m / s, (0. ± 0.13) m / s, (0.91 ± 0.14) ) Were significantly different (all P <0.05); interventricular septal thickness (IVSTd), left ventricular posterior wall thickness (LVPWT) [(13.78 ± 1.65) and (13.88 ± 1.56) mm] were significantly higher than those in group A [(9.12 ± 0.87) and (9.24 ± 0.98) mm], respectively, with statistical significance (all P <0.05). The LS values of all segments and global strain of hypertensive group A were significantly lower than those of the control group [(-18.98 ± 1.89), (-22.98 ± 4.21), (-22.56 ± 5.06), (-21.05 ± 7.11) The differences were statistically significant (all P <0.05). The incidence of hypertension in group B was significantly higher than that in group B [(-23.62 ± 2.56), (-25.85 ± 3.65), (-27.56 ± 4.96), (-24.89 ± 3.67) (-17.85 ± 2.36), (-18.56 ± 4.98), (-21.08 ± 5.14), (-19.23 ± 4.95), and (-16.05 ± 4.25), respectively, in the segments and overall strain (-17.56 ± 4.35), (-19.88 ± 4.87), (-18.15 ± 2.36)] were significantly lower than those in the control group [(-23.62 ± 2.56), (-25.85 ± 3.65), (-27.56 ± 4.96), -24.89 ± 3.67, and -19.20 ± 3.95, -21.56 ± 4.05, -23.27 ± 4.06 and -21.63 ± 4.07, respectively) (all P <0.05). Conclusion The three-dimensional speckle tracking technique can evaluate the global motion of left ventricular long axis while evaluating the motion of each segment. On the other hand, the speckle tracking technique is non-angular, independent and has good repeatability. Simple operation, it is worth to promote clinical use.