發(fā)布時(shí)間：2018-08-22 07:36

【摘要】：目的:利用磁共振組織追蹤(MR tissue tracking,MR-TT)技術(shù)定量評(píng)價(jià)擴(kuò)張型心肌病(Dilated Cardiomyopathy,DCM)患者的左室心肌應(yīng)變。資料與方法:回顧性分析2012年5月~2015年10月在南昌大學(xué)第二附屬醫(yī)院收治的45例擴(kuò)張型心肌病患者作為病變組(B組),其中男29例,平均年齡(47±16)歲。按MRI延遲增強(qiáng)掃描是否出現(xiàn)心肌強(qiáng)化,將45例DCM患者分為有強(qiáng)化的b1組和無(wú)強(qiáng)化的b2組,分別為28例和17例。25名健康志愿者作為對(duì)照組(A組),其中男17例,平均年齡(47±6)歲。所有研究對(duì)象均接受MRI掃描。掃描方位包括左室長(zhǎng)軸四腔,左室長(zhǎng)軸二腔和左室短軸。掃描序列包括相位穩(wěn)態(tài)采集快速成像序列(FIESTA)和反轉(zhuǎn)恢復(fù)快速梯度回波序列(IRFGR)。用Cvi42軟件進(jìn)行定量分析,獲得心功能指標(biāo)如下:左室射血分?jǐn)?shù)(LVEF)、左室舒張末期容積(EDV)、左室收縮末期容積(ESV)及左室排出量(SV);左室心肌應(yīng)變參數(shù)包括:整體徑向應(yīng)變峰值(GPSR)、整體環(huán)向應(yīng)變峰值(GPSC)、整體縱向應(yīng)變峰值(GPSL)、節(jié)段的徑向應(yīng)變峰值(PSR)、環(huán)向應(yīng)變峰值(PSC)及縱向應(yīng)變峰值(PSL)。采用SPSS 22.0軟件對(duì)所有數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:與對(duì)照組比較,病變組患者的左室功能明顯受損,其中LVEF和SV顯著減低(P0.01),ESV和EDV明顯增加(P0.01)。病變組左室GPSR、GPSC、GPSL均較對(duì)照組顯著降低(P0.01)。兩組的GPSR分別為7.99±6.25%和37.88±7.50%,P0.05;GPSC為-3.89±3.1%和14.38±1.86%,P0.01;GPSL為-3.87±3.6%和-11.85±2.2%,P0.05。GPSR、GPSC、GPSL與LVEF之間存在著良好的線性相關(guān),其中GPSR與LVEF呈正相關(guān)(r=0.92,P0.01);GPSC、GPSL與LVEF呈負(fù)相關(guān)(r=-0.94,r=-0.90,P0.01);GPSR、GPSC、GPSL之間具有顯著的相關(guān)性(GPSR vs.GPSC:r=-0.97,P0.01;GPSR vs.GPSL:r=-94 P0.01;GPSC vs.GPSL:r=0.97,P0.01)。對(duì)左室局部心肌應(yīng)變分析,病變組左室心肌各節(jié)段(除AHA分段第17段心尖段外)PSR、PSC及PSL均較對(duì)照組減低,其中病變組第13節(jié)段PSL、第14節(jié)段PSC、第15節(jié)段PSL與對(duì)照組之間的差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.58;P=0.66;P=0.09),其它節(jié)段均存在統(tǒng)計(jì)學(xué)差異)(P0.05)。對(duì)照組室中部PSC大于基底部(-18.35±2.07%vs.-16.15±1.99%,P=0.84);病變組室中部PSC小于基底部(-3.70±1.64%vs.-6.44±1.53%,P0.01)。對(duì)照組的室間隔PSR、PSC、PSL均大于下壁PSR、PSC、PSL,且具有統(tǒng)計(jì)學(xué)差異(P0.05);病變組的室間隔PSR、PSC、PSL在前壁、室間隔、下壁、側(cè)壁中最低,分別為7.00±4.14%、-4.40±0.91%和-3.13±0.65%,與其他各壁之間的差異具有統(tǒng)計(jì)學(xué)差異(P0.01)。結(jié)論:雖然DCM是心肌彌漫性改變的,但是受損程度是不均勻的,室間隔心肌的縱向、環(huán)向及徑向應(yīng)變受損最明顯。MR-TT技術(shù)不僅能夠從整體分析DCM左室心肌應(yīng)變的變化,而且能從局部進(jìn)行分析,可很好地用于評(píng)價(jià)DCM左室心肌受損的程度。
[Abstract]:Objective: to quantitatively evaluate the left ventricular strain in patients with Dilated cardiomyopathy by using Mr tissue tracing (MR tissue tracing MR-TT (MR-TT) technique. Materials and methods: Forty-five patients with dilated cardiomyopathy treated in the second affiliated Hospital of Nanchang University from May 2012 to October 2015 were retrospectively analyzed as group B (29 males with an average age of (47 鹵16) years). According to MRI delayed enhancement scan or not, 45 patients with DCM were divided into two groups: group B 1 with enhanced enhancement and group B 2 with no enhancement. 28 cases and 17 healthy volunteers were used as control group (group A), 17 males with an average age of (47 鹵6) years. All subjects underwent MRI scanning. Scanning azimuth included left ventricular long-axis four-chamber, left ventricular long-axis two-chamber and left ventricular short-axis. Scanning sequence includes phase steady state acquisition fast imaging sequence (FIESTA) and reverse recovery fast gradient echo sequence (IRFGR). Quantitative analysis was carried out with Cvi42 software. Cardiac function parameters were obtained as follows: left ventricular ejection fraction (LVEF),) left ventricular end-diastolic volume (EDV),) left ventricular end-systolic volume (ESV) and left ventricular ejection (SV);) left ventricular strain parameters including: global radial strain peak (GPSR), global circumferential strain peak Radial strain peak (PSR), circumferential strain peak (PSC) and longitudinal strain peak (PSL). Of (GPSC), whole longitudinal strain peak (GPSL), segment All the data were analyzed statistically by SPSS 22. 0 software. Results: compared with the control group, the left ventricular function in the lesion group was significantly impaired, and LVEF and SV were significantly decreased (P0.01) ESV and EDV were significantly increased (P0.01). The GPSL of GPSL in the left ventricular GPSRT GPSL in the lesion group was significantly lower than that in the control group (P 0.01). 涓ょ粍鐨凣PSR鍒嗗埆涓，

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