【作者】 吴丹；

【导师】 刘霞；

【作者基本信息】 宁夏医科大学 ， 影像医学与核医学， 2009， 硕士

【摘要】 Tei指数,又称心肌作功指数,是1995年由日本学者Tei C提出的一种综合评价心脏收缩和舒张功能的新指标。该指数不依赖心率、心室的几何形态及瓣膜返流、心室收缩压和舒张压的影响,测量简便、重复性强。目前,传统脉冲多普勒法测量Tei指数已被证实在评价左室整体舒缩功能方面具有很高的准确性,但无法判定局部心肌的病变情况。而组织多普勒成像(Tissue Doppler imaging,TDI)是针对心肌组织的超声成像新技术,近年来,应用组织多普勒技术测定Tei指数受到广泛关注,该方法不仅可以在同一周期内获取Tei指数测量所需所有参数,而且通过对左室壁二尖瓣环处各位点逐点取样测量Tei指数,可达到对局部心肌功能的定量评价。目的本研究拟应用组织多普勒技术检测冠心病心肌梗死(myocardial infarction,MI)患者和正常成年人的组织多普勒Tei指数(Tei index measured by Tissue Doppler imaging,t-Tei),旨在:①探讨局部t-Tei指数在评价冠心病心肌梗死患者局部左心功能的可行性及临床应用价值;②证实整体t-Tei指数评价冠心病MI患者整体左心功能的准确性;③了解t-Tei指数与脉冲多普勒Tei指数(Tei index measured by plused-wave Doppler method,p-Tei)、二维超声心动图Simpson法所测左室射血分数(Left ventricular ejective fraction, LVEF)及与年龄、心率、血压等的相关性,进一步证实TDI法测量Tei指数准确性;④探讨正常成年人t-Tei正常值的范围。资料与方法正常对照组(NP组):31例,男性20例,女性11例,年龄25~66岁,平均(45±9)岁,全部经病史、体检、心电图、超声心动图检查排除心肺血管疾患。心肌梗死组(MI组):收集2008年4月~2008年12月在宁夏医科大学附属医院心脏中心就诊或住院治疗的符合1979年国际心脏病学会和协会及世界卫生组织临床命名标准化联合专题组的报告《缺血性心脏病的命名和诊断标准》的急性或陈旧性心肌梗死患者。共50例,男性44例,女性6例,年龄29~79岁,平均(56±12)岁。其中,前壁及前间壁MI患者35例,下壁及后壁MI患者15例。超声检查采用数字彩色多普勒超声诊断仪(美国GE-Vivid7),M3S探头(频率2.0-4.0MHz)。超声心动图测量指标包括:①左室舒张末期内径(LVDd)及收缩末期内径(LVDs)、左房内径(LAD);②二尖瓣舒张早期血流峰速(E峰)、二尖瓣舒张晚期峰速(A峰)及E/A比值;③Simpson法所测左室射血分数(LVEF) ;④脉冲多普勒Tei指数(p-Tei);⑤组织多普勒Tei指数(t-Tei)。结果(1)MI患者的t-Tei测值均较正常对照组明显延长(P<0.001);MI组中前壁及前间壁MI患者共35例,其前壁及前间壁二尖瓣环处位点的t-Tei值明显较侧壁、下壁、后壁、后间隔二尖瓣环处位点的t-Tei值延长(P<0.01);下壁及后壁MI患者共15例,其中下壁及后壁二尖瓣环处位点的t-Tei值较前壁、前间壁、侧壁、后间隔二尖瓣患处位点的t-Tei值显著延长(P<0.05);(2)MI组左室整体t-Tei测值较正常对照组明显延长(P<0.001),且MI组中EF值减低组较EF正常组t-Tei值延长明显[(0.71±0.10)vs(0.52±0.05),P<0.01];(3)二尖瓣血流(E/A)假性正常组与正常对照组的E/A测值无明显差别[(1.70±0.3)vs(1.5±0.5), P>0.05],而t-Tei指数却明显较正常对照组延长[(0.75±0.10)vs(0.39±0.04),P<0.001];(4)正常成年人的左心室整体t-Tei测值为0.39±0.04,p-Tei测值为0.38±0.05,t-Tei指数与p-Tei指数测值间无明显差异(P>0.05);各年龄组间t-Tei指数测值无明显差别(P>0.05);不同室壁间心肌的t-Tei指数测值无差别(P>0.05);(5)MI组和正常对照组t-Tei测值与p-Tei测值均呈很好的相关关系(正常对照组: r=0.836,P<0.001;MI组: r=0.933,P<0.01);MI组t-Tei与二维超声心动图Simpson法所测的LVEF呈负相关关系(r=-0.859,P<0.001);t-Tei值与年龄、身高、体重、心率、血压等因素无相关关系(P>0.05)。结论(1)t-Tei指数与p-Tei指数相关性良好,且t-Tei指数测值稳定,与年龄、心率、血压等因素不相关。说明利用组织多普勒成像技术测量Tei指数是准确的,且较传统脉冲多普勒测量方法更为简便。(2)各室壁的Tei值在一定程度上能够反映该侧室壁的局部心肌功能。(3)应用TDI方法获得的左室整体t-Tei评价左室整体功能是准确可行的。(4)应用E/A比值结合Tei指数可以将左室充盈压升高引起的二尖瓣血流假性正常的患者与正常人区别开来,且Tei指数不受年龄等因素影响,对于舒张功能减低程度的准确评价有较高临床价值。更多还原

【Abstract】 Background and Objective Tei index is a new Doppler index applied to the evaluation of the whole function of heart. At present, Tei index has been confirmed having high accuracy on evaluating cardiac diastolic and systolic function by blood flow Doppler imaging, but it can’t be used in determing the local myocardial lesions. Tissue Doppler imaging (TDI) is a conventional method which could measure all parameters in one cardiac period and could provide real-time, quantitative myocardial velocity and time information. In this study, we evaluated the applicability and feasibility of pulsed-wave tissue Doppler imaging as a tool to calculate Tei index. Tei index was measured by TDI in 50 patients with myocardial infarction (MI group) and 31 healthy subjects, comparing with the parameters of left ventricular function from LVEF which be measured by Simpson’s method . The purposes of this study were:①Tei index in evaluating left ventreicular regional function.②Tei index in evaluating left ventreicular global function.③To seek the magnitude of the Tei index with TDI in health subjects of different age groups and to analyze the correlation between age、height、weight、blood pressure and Tei index.④To compare Tei index by TDI and LVEF by 2D in order to assess the feasibility and reliability of measuring Tei index by tissue Doppler imaging.Materials And Methods 50 MI patients and 31 normal persons were studied with GE-vivid7 ultrasound system. The normal subjects were divided into three groups. The heart rate, blood pressure and usual echocardiogragh parameters of all studied subjects were recorded. The echocardiographic parameters include:①LVDd, LVDs, LAD.②LVEF measured by Simpson’s method.③Tei index measured by pulse blood Doppler.④Tei index measured by tissue Doppler imaging.Results:①t-Tei index in six sits of mitral annulus all were longer than the health group,and there are different t-Tei values in different walls of MI(P<0.05).②The value of t-Tei index in the MI group was longer than the health group(P<0.001), and The value of t-Tei index in the EF reduced group was longer than the EF normal group(P<0.01). there were not different between t-Tei index and p-Tei index in MI group(P>0.05).③there were not different between E/A pseudo-normal group and normal group [(1.70±0.30)vs(1.5±0.50), (P>0.05)], but t-Tei index in E/A pseudo-normal group were longer than the normal group [(0.75±0.10)vs(0.39±0.04), P<0.001];④The value of t-Tei in the health group was 0.39+0.04, p-Tei was 0.38+0.05, there were not different between conventional Tei index and t-Tei(P>0.05) , there were not different in different ages and not different in six sits of mitral annulus (P>0.05).⑤There was a significant correlation between t-Tei and p-Tei (r=0.933, P<0.01) in MI group and the health group(r=0.836, P<0.001); Meanwhile, the correlation of t-Tei with LVEF(r=-0.859, P<0.001).Conclusion①It was indicated the method which t-Tei index measured by TDI is correct and precise,and it is more convenient than plused-wave Doppler imaging.②t-Tei index of different walls could evaluate left ventricular systolic regional systolic function in some degrees.③It was indicated that t-Tei index measured by TDI could evaluate left ventricular global function, There are clinical applications in evaluating left ventricular global function correctly using Tei index by Tissue Doppler imaging.④it showed that E/A combined Tei index can distinguish the E/A pseudo-normal patients and normal patients. It has a high clinical value in evaluating of diastolic function accurately.更多还原