發(fā)布時間：2018-04-09 12:50

  本文選題：后負(fù)荷　切入點(diǎn)：超聲　出處：《華中科技大學(xué)》2015年博士論文

【摘要】：第一部分 慢性后負(fù)荷升高時左室收縮功能的變化過程的超聲研究 目的應(yīng)用超聲心動圖斑點(diǎn)追蹤技術(shù)評價(jià)左室后負(fù)荷慢性升高時左室收縮功能的變化過程,并利用心肌法向應(yīng)變計(jì)算總應(yīng)變矢量的大小和方向,以更全面地評價(jià)左室收縮功能的改變機(jī)制。 方法8-12周齡Beagle幼犬11只,隨機(jī)分組為升主動脈縮窄組6只,假手術(shù)組5只。升主動脈縮窄組幼犬行開胸手術(shù)縮窄升主動脈制造后負(fù)荷升高模型,假手術(shù)組幼犬僅接受開胸手術(shù),未縮窄升主動脈。兩組動物的超聲心動圖檢查、圖像的采集以及斑點(diǎn)追蹤成像分析分別在術(shù)前、術(shù)后1月、術(shù)后3月和術(shù)后6月進(jìn)行。應(yīng)用二維超聲心動圖測量左室壁厚度、左室內(nèi)徑,計(jì)算心肌橫截面積；雙平面Simpson法計(jì)算左室容積和射血分?jǐn)?shù)；脈沖波多普勒測量二尖瓣口舒張期血流速度；組織多普勒成像測量二尖瓣環(huán)舒張期運(yùn)動速度。應(yīng)用斑點(diǎn)追蹤技術(shù)測量左室壁各節(jié)段的收縮期峰值縱向應(yīng)變、圓周向應(yīng)變及徑向應(yīng)變,并通過以上應(yīng)變值計(jì)算心肌收縮期縱向圓周向總應(yīng)變矢量(ELC)及其角度(θLC)、縱向徑向總應(yīng)變矢量(ELR)及其角度(θLR)、圓周向徑向總應(yīng)變矢量(ECR)及其角度(θCR)。 結(jié)果①升主動脈縮窄組自術(shù)后3月開始,左室壁厚度和心肌橫截面積大于假手術(shù)組,差異有統(tǒng)計(jì)學(xué)意義(p0.05)。②與假手術(shù)組比較,升主動脈縮窄組二尖瓣環(huán)舒張?jiān)缙诜逯颠\(yùn)動速度e’自術(shù)后1月起明顯減低,差異有統(tǒng)計(jì)學(xué)意義(p0.05)。③左室射血分?jǐn)?shù)在兩組之間始終無顯著性差異。④與假手術(shù)組相比,升主動脈縮窄組首先出現(xiàn)縱向應(yīng)變減低,晚期徑向應(yīng)變減低,差異有統(tǒng)計(jì)學(xué)意義(p0.05)；圓周向應(yīng)變始終保持正�；蛏�高。⑤與假手術(shù)組比較,升主動脈縮窄組的ELC在術(shù)后1月和3月未見明顯變化,術(shù)后6月時顯著減低(p0.05)；升主動脈縮窄組ELR于術(shù)后3月起明顯減低,ECR于術(shù)后6月明顯減低(p0.05)。⑥與假手術(shù)組比較,升主動脈縮窄組θLC于術(shù)后1月起減小,θCR于術(shù)后3月起減小,θLR則于術(shù)1月時減小,隨后逐漸增大,至術(shù)后6月時明濕大于假手術(shù)組(p0.05)。 結(jié)論左室后負(fù)荷慢性升高時,左室收縮期應(yīng)變先于射血分?jǐn)?shù)出現(xiàn)異常。收縮期縱向應(yīng)變早期即可出現(xiàn)異常,徑向應(yīng)變減低出現(xiàn)較晚,圓周向應(yīng)變可始終保持正常或升高,以維持足夠的射血分?jǐn)?shù)。為了適應(yīng)左心室壓力負(fù)荷的增加,縱向應(yīng)變首先減低,但此時徑向應(yīng)變和圓周向應(yīng)變不減低,甚至增加,體現(xiàn)為總應(yīng)變矢量大小不變,但總應(yīng)變矢量的指向方向發(fā)生變化,其方向更趨于水平。超聲心動圖斑點(diǎn)追蹤技術(shù)可敏感檢測后負(fù)荷升高引起的早期心肌收縮功能異常。通過斑點(diǎn)追蹤技術(shù)分析結(jié)果計(jì)算出的心肌收縮期總應(yīng)變矢量大小和方向可能有助于對心肌收縮功能變化和機(jī)制做出更全面的評價(jià)。 第二部分 斑點(diǎn)追蹤技術(shù)評價(jià)局部心肌收縮功能與心肌纖維化和心肌細(xì)胞排列紊亂的關(guān)系 目的應(yīng)用超聲心動圖斑點(diǎn)追蹤技術(shù)評價(jià)心肌間質(zhì)纖維化和心肌細(xì)胞排列紊亂與局部心肌收縮期應(yīng)變的關(guān)系。 方法8-12周齡Beagle幼犬11只,隨機(jī)分組為升主動脈縮窄組6只,假手術(shù)組5只。升主動脈縮窄組幼犬行開胸手術(shù)縮窄升主動脈,假手術(shù)組幼犬僅接受開胸手術(shù),未縮窄升主動脈。兩組動物的常規(guī)超聲心動圖檢查及圖像的采集于術(shù)后6月進(jìn)行,并應(yīng)用斑點(diǎn)追蹤技術(shù)測量左室壁各節(jié)段的收縮期峰值縱向應(yīng)變、圓周向應(yīng)變及徑向應(yīng)變。取心臟標(biāo)本進(jìn)行病理分析,計(jì)算心肌間質(zhì)纖維化面積和心肌細(xì)胞排列紊亂面積。分析心肌間質(zhì)纖維化面積和心肌細(xì)胞排列紊亂面積與各收縮期應(yīng)變參數(shù)的相關(guān)性。 結(jié)果①與假手術(shù)組比較,升主動脈縮窄組的左室收縮期縱向應(yīng)變和徑向應(yīng)變明顯減低,差異有統(tǒng)計(jì)學(xué)意義(p0.01);圓周向應(yīng)變在兩組間無明顯差異。②心肌間質(zhì)纖維化面積、心肌細(xì)胞排列紊亂面積在升主動脈縮窄組顯著大于假手術(shù)組,差異有統(tǒng)計(jì)學(xué)意義(p0.05)。③心肌間質(zhì)纖維化面積與左室收縮期縱向應(yīng)變及徑向應(yīng)變具有相關(guān)性,相關(guān)系數(shù)分別為0.662(p0.001)、-0.456(p=0.008)。④心肌細(xì)胞紊亂面積與左室收縮期縱向應(yīng)變及徑向應(yīng)變具有相關(guān)性,相關(guān)系數(shù)分別為0.619(p0.001)、-0.456(p=0.008)。 結(jié)論心肌間質(zhì)纖維化和心肌細(xì)胞排列紊亂可導(dǎo)致心肌收縮期縱向應(yīng)變和徑向應(yīng)變絕對值減低。心肌間質(zhì)纖維化面積與收縮期縱向應(yīng)變、徑向應(yīng)變具有相關(guān)性。心肌細(xì)胞排列紊亂面積與收縮期縱向應(yīng)變、徑向應(yīng)變具有相關(guān)性。利用斑點(diǎn)追蹤技術(shù)測量心肌收縮期應(yīng)變可以反映心肌間質(zhì)纖維化和心肌細(xì)胞紊亂程度,均有潛在的臨床應(yīng)用價(jià)值。
[Abstract]:Part one
Ultrasonic study on the changes of left ventricular systolic function during chronic post load increase
Objective to evaluate left ventricular systolic function in patients with chronic elevation of left ventricular afterload by echocardiography and speckle tracking technique, and to evaluate the mechanism of left ventricular systolic function in a more comprehensive way by using the normal strain of the myocardium to calculate the size and direction of total strain vector.
Methods 8-12 week old puppy Beagle 11, were randomly divided into 6 groups of coarctation of aorta, 5 rats in sham group. Constriction group pups undergoing thoracotomy coarctation of ascending aorta after making a higher load model of ascending aorta, the sham operation group only puppies underwent thoracotomy and without coarctation of ascending aorta ultrasound. Two group of animal echocardiography, image acquisition and speckle tracking imaging analysis was performed preoperatively and postoperatively after January, March and June. After the application of two-dimensional echocardiographic measurements of left ventricular wall thickness, left ventricular diameter, myocardial cross-sectional area; calculation of left ventricular volume and ejection fraction of double plane Simpson method; pulse wave Doppler measuring mitral diastolic velocity of mitral annulus; tissue Doppler imaging. The peak systolic diastolic motion velocity measurement of each segment of left ventricle using speckle tracking of the longitudinal strain, circumferential strain and radial Strain, and the above longitudinal strain values were used to calculate longitudinal systolic longitudinal circumferential total strain vector (ELC) and its angle (theta LC), longitudinal radial total strain vector (ELR) and its angle (theta LR), circumferential radial total strain vector (ECR) and its angle (theta CR).
Results the aortic banding group after the beginning of March, left ventricular wall thickness and myocardial cross-sectional area greater than the sham group, the difference was statistically significant (P0.05). Compared with the sham operation group, coarctation of mitral annular peak early diastolic velocity e after operation in January significantly reduced the ascending aorta the difference was statistically significant (P0.05). The left ventricular ejection fraction between the two groups in the beginning. No significant difference compared with sham operation group, coarctation group first appeared to reduce the longitudinal strain of the ascending aorta, late radial strain decreased, the difference was statistically significant (P0.05); circumferential strain remained normal or increased. Compared with the sham operation group, significant changes in the constriction group ELC in January and March there was no postoperative ascending aorta after June decreased significantly (P0.05); coarctation group ELR decreased significantly after operation in March the ascending aorta, ECR after operation in 6 on the lower (P0.05). The show Compared with the sham operation group, theta LC in the ascending aorta coarctation group decreased from January to January, and theta CR decreased from March to March, while theta LR decreased in January, and then increased gradually.
Conclusion chronic left ventricular afterload increased, left ventricular systolic strain before the ejection fraction is abnormal. The abnormal systolic longitudinal strain occurs in the early stage, reduce the radial strain and circumferential strain appeared relatively late, it can always maintain the normal or elevated, to maintain adequate ejection fraction. In order to adapt to the increase of left ventricular pressure load, longitudinal strain the first is reduced, but at the radial strain and circumferential strain does not reduce, or even increase, reflect the total strain vector size unchanged, but the total strain vector pointing in the direction of change, the direction of more level. Speckle tracking echocardiography can detect early after the sensitive load is increased myocardial systolic function caused by abnormal. Help the changes and mechanisms of myocardial contractile function to make more comprehensive evaluation of possible tracking technology analysis results calculated by spot systolic strain vector magnitude and direction Price.
The second part
Speckle tracking technique to evaluate the relationship between local myocardial contractile function and myocardial fibrosis and cardiac myocyte disorder
Objective to evaluate the relationship between myocardial interstitial fibrosis, myocardial cell arrangement disorder and local myocardial systolic strain by echocardiography speckle tracking technique.
Methods 8-12 week old puppy Beagle 11, were randomly divided into 6 groups of coarctation of aorta, 5 rats in sham group. Constriction group pups undergoing thoracotomy coarctation of ascending aorta in the ascending aorta, the sham operation group only puppies underwent thoracotomy and without coarctation of ascending aorta. Conventional ultrasound heart two groups of animal the inspection and image acquisition after operation in June, the peak systolic and the application of speckle tracking technique for measurement of left ventricular segmental longitudinal strain, circumferential strain and radial strain. Heart samples were collected for pathological analysis, calculating the area of myocardial interstitial fibrosis and myocardial cells arranged disorder area. Correlation analysis of myocardial interstitial the area of fibrosis and myocardial cells arranged in disorder area with various systolic strain parameters.
Results compared with sham operation group, coarctation group left ventricular systolic longitudinal strain and radial strain decreased the ascending aorta, the difference was statistically significant (P0.01); circumferential strain was no significant difference between the two groups. The myocardial interstitial fibrosis area, myocyte disarray area constriction group in ascending aorta significantly higher than the sham group, the difference was statistically significant (P0.05). The myocardial interstitial fibrosis area and left ventricular systolic longitudinal strain and radial strain with correlation, the correlation coefficients were 0.662 (p0.001), -0.456 (p=0.008). The correlation between myocardial cell disorder area and left ventricular systolic longitudinal strain and radial strain, correlation coefficient were 0.619 (p0.001), -0.456 (p=0.008).
Conclusion myocardial interstitial fibrosis and myocardial cell disorder can lead to myocardial systolic longitudinal strain and radial strain decreased. The absolute value of myocardial interstitial fibrosis area and systolic longitudinal strain associated with radial strain. The disordered arrangement of myocardial cells area and systolic longitudinal strain, radial strain correlation. Using speckle tracking technique to measure myocardial systolic strain can reflect myocardial interstitial fibrosis and myocardial cell disorder, has potential clinical application value.

【學(xué)位授予單位】：華中科技大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R540.45;R542.2

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