斑點(diǎn)追蹤技術(shù)評價(jià)系統(tǒng)性紅斑狼瘡患者右心室收縮功能

張賀彬 高楓 黃國慶 應(yīng)鳴 吳俊 陳莎莎

●臨床研究

斑點(diǎn)追蹤技術(shù)評價(jià)系統(tǒng)性紅斑狼瘡患者右心室收縮功能

張賀彬 高楓 黃國慶 應(yīng)鳴 吳俊 陳莎莎

目的 采用斑點(diǎn)追蹤成像（STE）技術(shù)評價(jià)系統(tǒng)性紅斑狼瘡（SLE）患者存在和不存在肺動(dòng)脈高壓（PAH）時(shí)右心室收縮功能。方法 將65例SLE患者按照肺動(dòng)脈收縮壓（PASP）分為兩組：SLE無PAH組35例（PASP＜40mmHg），SLE合并PAH組30例（PASP≥40mmHg），并選擇30例健康志愿者作為對照組。分別采集受試者常規(guī)超聲心動(dòng)圖指標(biāo)及三尖瓣環(huán)收縮期位移（TAPSE）、三尖瓣環(huán)收縮期峰值速度（PSv）、右心室心肌做功指數(shù)（MPI）、肺血管阻力（PVR）和右心室射血效率（RVEe）。采用STE技術(shù)獲得右心室游離壁及室間隔各節(jié)段峰值縱向收縮應(yīng)變（LPSS）和右心室整體縱向應(yīng)變（GLS）。分析上述指標(biāo)在各組間的差異性及其之間的相關(guān)性。結(jié)果 3組間TAPSE、PSv、MPI、PVR和RVEe比較，差異均有統(tǒng)計(jì)學(xué)意義（均P＜0.01）。SLE無PAH組與對照組比較，基底段、中間段和游離壁LPSS均減低（均P＜0.05）。SLE合并PAH組與對照組比較，基底段、中間段、心尖段、游離壁、室間隔LPSS和GLS均減低（均P＜0.05）。SLE合并PAH組與SLE無PAH組比較基底段、中間段、心尖段、游離壁、室間隔LPSS和GLS亦均減低（均P＜0.05）。RVEe與PASP、PVR呈曲線關(guān)系，回歸方程：RVEe=exp（1.35+29.44/PASP）（R2=0.81，P＜0.01），RVEe=exp（0.92+2.32/PVR）（R2=0.90，P＜0.01）。GLS與RVEe呈負(fù)相關(guān)（r=-0.708，P＜0.01）。 結(jié)論 STE技術(shù)可以定量評價(jià)SLE患者存在和不存在PAH時(shí)右心室收縮功能的變化，結(jié)合常規(guī)超聲心動(dòng)圖，可簡單、客觀、有效評價(jià)PAH患者的右心室重構(gòu)。

超聲心動(dòng)描記術(shù) 系統(tǒng)性紅斑狼瘡 右心室功能

【 Abstract】 Objective To evaluate the right ventricular(RV)systolic function in systemic lupus erythematousus(SLE) patients with/without pulmonary arterial hypertension (PAH)by two-dimensional speckle tracking echocardiography(STE). Methods Sixty five patients with SLE were divided into two groups according to the pulmonary arterial systolic pressure(PASP) measured by echocardiography:non-PAH group(PASP＜40 mm Hg,n=35)and PAH group(PASP≥40 mm Hg,n=30).Thirty healthy volunteers were enrolled as the controls.Routine echocardiographic parameters and tricuspid annular plane systolic excursion(TAPSE),peak systolic velocity(PSv),myocardial performance index(MPI),pulmonary vascular resistance(PVR)and right ventricular ejection efficiency(RVEe)were measured and documented.Longitudinal peak systolic strain(LPSS)of the basal, middle,apical segments of the free wall of RV and interventricular septum and strains of the whole RV global longitudinal strain (GLS)were measured by STE.The differences were compared and the correlations were analyzed. Results There were significant differences of TAPSE,PSv,MPI,PVR,and RVEe among the three groups(all P＜0.01).LPSS of the basal,middle segments,and the free wall of RV in non-PAH SLE patients were lower than those in control group(all P＜0.05).LPSS of all segments of RVand GLS in PAH SLE patients significantly decreased compared to non-PAH SLE patients(all P＜0.05).LPSS of all segments of RVand GLS in PAH SLE patients were lower than those in control group(all P＜0.05).A power curve trend line fit the relationship between RVEe and PVR[RVEe=exp(0.92+2.32/PVR)(R2=0.90,P＜0.01)]and between RVEe and PASP[RVEe=exp (1.35+29.44/PASP)(R2=0.81,P＜0.01)].There was significant negative correlation between GLS and RVEe(r=-0.708,P＜0.01). Conclusion Speckle tracking echocardiography can quantitatively assess right ventricular systolic function in SLE patients with/without PAH.Combined with routine echocardiography,it can simply,objectively and effectively evaluate the RA remodeling in SLE patients with PAH.

【Key words】 Echocardiography Systemic lupus erythematosus Right ventricular function

系統(tǒng)性紅斑狼瘡（SLE）是自身免疫介導(dǎo)、以免疫性炎癥為突出表現(xiàn)的彌漫性結(jié)締組織病，心血管系統(tǒng)是常見受累系統(tǒng)之一。目前肺動(dòng)脈高壓（PAH）已成為SLE患者繼感染之后的第二大死亡原因[1]，PAH是影響SLE患者預(yù)后的重要因素，最大風(fēng)險(xiǎn)為右心功能不全，早期評價(jià)右心室功能改變并給予相應(yīng)治療具有重要意義。……