标题：三维超声心动图检查对急性心肌梗死患者左心室重构和心功能的评估价值

      作者：罗希 1，孙牧 2，李辉 1    宝鸡市中医医院超声科 1、心血管内科 2，陕西 宝鸡 721000

      卷次： 2022年33卷19期

      【摘要】 目的 探究三维超声心动图检查对急性心肌梗死 (AMI)患者左心室重构和心功能的评估价值。方法 选取2018年2月至2019年2月宝鸡市中医医院收治的AMI且择期接受经皮冠状动脉介入术(PCI)治疗的患者206例，根据患者是否发生左心室重构分为重构组(n=69)和非重构组(n=137)。所有患者入院后48 h内及术后均接受单光子发射计算机断层成像术(SPECT)和三维超声心动图检查，比较两组患者左心室功能参数、三维斑点追踪参数和血清左心室重构指标的差异；采用Pearson相关性分析超声心动图检查与SPECT检查左心室功能参数、三维斑点追踪参数与血清左心室重构指标的相关性。结果 重构组和非重构组患者采用三维超声心动图检查的左室收缩末期容积(LVESV) [(53.27±10.68) mL vs (48.76±9.54) mL]、左室心肌质量(LVM) [(181.54±13.47) g vs(177.46±11.63) g]和左心室质量指数(LVMI) [(135.47±7.23) g/m2 vs (131.54±8.41) g/m2]比较，重构组明显高于非重构组，左室射血分数(LVEF) [(49.43±6.37)% vs (52.37±7.84)%]、左室整体纵向峰值应变(GLS) [(9.52±1.23) vs (11.87±1.34)]、整体径向峰值应变(GRS) [(29.26±5.56) vs (33.25±6.14)]和整体面积峰值应变(GAS) [(14.21±2.25) vs (18.64±3.18)]比较，重构组明显低于非重构组，差异均有统计学意义(P<0.05)；重构组和非重构组患者的血清基质金属蛋白酶 9 (MMP9) [(56.78±9.16) ng/mL vs (48.14±7.45) ng/mL]、成纤维细胞生长因子 23 (FGF23) [(886.47±98.63) pg/mLvs (782.16±95.41) pg/mL]和 I型C端胶原前肽(PICP) [(12.15±2.13) ng/mL vs (9.76±2.21) ng/mL]水平比较，重构组明显高于非重构组，差异均有统计学意义(P<0.05)；经Pearson相关性分析结果显示，三维超声心动图检查的LVEDV、LVESV、LVEF指标与SPECT检查结果具有良好的相关性(P<0.01)，患者的三维斑点追踪参数GLS、GRS、GAS与血清MMP9、FGF23、PICP水平呈负相关(P<0.05)。结论 三维超声心动图检查可用于冠心病心肌梗死患者PCI术后左心室重构及心功能的早期评估。
      【关键词】 冠心病；心肌梗死；三维超声心动图；三维斑点追踪参数；左心室重构；心功能
      【中图分类号】 R542.2+2 【文献标识码】 A 【文章编号】 1003—6350（2022）19—2533—04

Evaluation value of three-dimensional echocardiography for left ventricular remodeling and cardiac function inpatients with acute myocardial infarction.
LUO Xi 1, SUN Mu 2, LI Hui 1. Department of Ultrasound 1, Department ofCardiovascular Medicine 2, Baoji Hospital of Traditional Chinese Medicine, Baoji 721000, Shaanxi, CHINA
【Abstract】 Objective To explore the evaluation value of three-dimensional echocardiography for left ventricu-lar remodeling and cardiac function in patients with acute myocardial infarction (AMI). Methods A total of 206 pa-tients with AMI who underwent elective percutaneous coronary intervention (PCI) in Baoji Hospital of Traditional Chi-nese Medicine from February 2018 to February 2019 were selected as the subjects. According to the presence or absenceof left ventricular remodeling, the patients were divided into remodeling group (n=69) and non-remodeling group (n=137). All patients underwent single photon emission computed tomography (SPECT) and three-dimensional echocardiog-raphy within 48 h after admission and after surgery. The left ventricular functionparameters, three-dimensional speckletracking parameters and serum left ventricular remodeling indicators were compared between the two groups. Pearsoncorrelation analysis was performed to analyze the correlation between left ventricular function parameters in three-dimen-sional echocardiography and SPECT, as well as between three-dimensional speckle tracking parameters and serum leftventricular remodeling indicators. Results The left ventricular end systolic volume (LVESV), left ventricular mass(LVM), and left ventricular mass index (LVMI) in the remodeling group were (53.27±10.68) mL, (181.54±13.47) g,(135.47±7.23) g/m2, significantly higher than (48.76±9.54) mL, (177.46±11.63) g, (131.54±8.41) g/m2 in the non-remod-eling group, while left ventricular ejection fraction (LVEF), left ventricular global 1ongitudinal strain (GLS), global radi-al strain (GRS), and global area strain (GAS) in the remodeling group were (49.43±6.37)%, 9.52±1.23, 29.26±5.56,14.21±2.25, significantly lower than (52.37±7.84)%, 11.87±1.34, 33.25±6.14, 18.64±3.18 in the non-remodeling group(P<0.05). The levels of serum matrix metalloproteinase 9 (MMP9), fibroblast growth factor 23 (FGF23), and procollagentype I N-terminal propeptide (PICP) in the remodeling group were significantly higher than those in the non-remodelinggroup: (56.78±9.16) ng/mL vs (48.14±7.45) ng/mL, (886.47±98.63) pg/mL vs (782.16±95.41) pg/mL, (12.15±2.13) ng/mL