斑点追踪显像技术评价肥厚型心肌病患者心肌应变的研究[摘要]目的??用二维斑点追踪显像（2DSTI）技术评价肥厚型心肌病患者的心肌应变特点。方法选择正常对照组30例，肥厚型心肌病组30例。应用STI技术测定左心室各壁基底段、中间段和心尖段收缩期峰值应变（Ss），并对检测结果进行分析。结果与对照组比较，肥厚型心肌病组室间隔增厚（P<0.05），肥厚型心肌病组心肌纵向应变值在左室基底段和中间段、心尖段均较对照组低（P<0.05）。直线相关分析显示各组间LVEF与收缩期纵向峰值应变之间均存在正相关（r=0.589、0.797）。IVS在对照组与收缩期纵向峰值应变之间无明显相关性，但在肥厚型心肌病组与收缩期纵向峰值应变之间呈负相关（r=-0.538）。结论在肥厚型心肌病患者的整体左室收缩功能减低之前，其左室各节段心肌应变改变已经出现，STI可以发现患者早期局部左室功能的改变。肥厚型心肌病患者的收缩期峰值应变与其LVEF水平呈正相关，与IVS厚度呈负相关。应用二维斑点追踪显像技术测量肥厚型心肌病患者收缩期左室纵向应变值，有助于了解患者心脏收缩时心肌纵向运动和应变值的变化情况，能够判断和评价局部心肌功能。[关键词]二维斑点追踪；肥厚型心肌病；收缩期峰值应变；局部心肌功能[]R542.2[文献标识码]B[]1673-9701（2017）06-0109-04[Abstract]ObjectiveToevaluatethecharacteristicsofmyocardialstraininthepatientswithhypertrophiccardiomyopathybytwo-dimensionalspeckletrackingimaging（2DSTI）.MethodsAtotalof30casesinnormalcontrolgroupand30casesinhypertrophiccardiomyopathygroupwereselected.STItechniquewasusedtodeterminethesystolicpeakstrain（Ss）ofbasalsegment，middlesegmentandapicalsegmentofleftventricularwalls，andtheresultswereanalyzed.ResultsComparedwiththecontrolgroup，theinterventricularseptuminthehypertrophiccardiomyopathygroupwasthickening（P<0.05）.Thelongitudinalstrainofmyocardiuminthehypertrophiccardiomyopathygroupwaslowerthanthatinthecontrolgroupinthebasalsegment，middlesegmentandapicalsegmentofleftventricle（P<0.05）.LinearcorrelationanalysisshowedapositivecorrelationbetweenLVEFandlongitudinalsystolicpeakstrainineachgroup（r=0.589，0.797，respectively）.TherewasnosignificantcorrelationbetweenIVSandlongitudinalsystolicpeakstraininthecontrolgroup；therewasanegativecorrelationbetweenIVSandthelongitudinalsystolicpeakstraininthehypertrophiccardiomyopathygroup（r=-0.538）.ConclusionBeforethereductionofleftventricularsystolicfunctioninthepatientswithhypertrophiccardiomyopathy，thechangesofmyocardialstraininallsegmentsofleftventriclehaveappeared.STIisabletodetectearlychangesofregionalleftventricularfunctioninthepatients.ThesystolicpeakstraininthepatientswithhypertrophiccardiomyopathyispositivelycorrelatedwithLVEFlevelandnegativelycorrelatedwithIVSthickness.Applicationoftwo-dimensionalspeckletrackingimagingtechniquetomeasuretheleftventricularlongitudinalstraininthepatientswithhypertrophiccardiomyopathycanhelptounderstandthechangesofmyocardiallongitudinalmotionandstrainincardiaccontraction，andcanjudgeandevaluateregionalmyocardialfunction.[Keywords]Two-dimensionalspeckletrackingimaging（2DSTI）；Hypertrophiccardiomyopathy；Systolicpeakstrain（Ss）；Regionalmyocardialfunction肥厚型心肌病大多为常染色体显性遗传疾病，由编码心肌肌原纤维的基因突变引起，表现为左室壁非对称性增厚、左心室腔缩小及舒张功能减退[1]。近年我国大范围的资料提示该病的患病率为180/10万，世界范围内其发病率为200/10万[2]。由于肥厚型心肌病的分布和肥厚程度不同，以往检查多关注左心室整体功能的改变，实际上当肥厚型心肌病患者整体收缩功能正常时，往往局部心肌功能已经受损[3]。及时、早期评价肥厚型心肌病患者的心功能改变，...