三维超声心动图预测STEMI再灌注患者预后的临床价值

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摘要目的：探讨三维斑点追踪成像技术（3D-STI）评价急性ST段抬高型心肌梗死（STEMI）患者再灌注预后情况的价值。方法：选取2013年3月—2014年11月就诊于我院经PCI治疗的STEMI患者70例，记录其一般临床资料。于再灌注治疗后第3天和治疗后1月，采集患者面积应变（AS）、周边应变（CS）、纵向应变（LS）以及径向应变（RS）等3D-STI检测指标。对所有患者进行为期1年的随访，预后良好的患者定义为A组，预后不良的患者定义为B组，分析A、B两组基本资料、心脏彩超值、再灌注治疗后第3天及1月后的AS、CS、LS、RS数值差异；做生存曲线及COX比例风险模型评价3D-STI预测STEMI患者再灌注预后的能力；ROC曲线显示AS、CS、LS及RS预测STEMI再灌注预后情况的敏感性和特异性。结果：A组患者术后proBNP、TNT、左室射血分数（LVEF）、左室收缩末期容积（LVESV）均显著大于B组，且治疗后第3天及治疗后1月的AS、CS、LS及RS的数值亦较大，差异有统计学意义（P<0.05）；生存曲线及COX比例风险模型结果显示：治疗后第3天及1月的AS、治疗后第3天的LS、治疗后第3天及1月的RS明显影响STEMI患者预后情况，A、B两组之间差异均有统计学意义（P<0.05）；治疗后第3天AS、治疗后1月AS、治疗后第3天LS、治疗后第3天RS及治疗后1月RS的ROC曲线下面积（AUC）分别为0.796、0.799、0.798、0.743、0.790，5个指标差异近似，均能较好预测再灌注治疗患者的预后情况。结论：治疗后第3天AS及治疗后1月的AS、治疗后第3天的LS、治疗后第3天及治疗后1月的RS等3D-STI检测指标能较好的评价STEMI再灌注患者的预后情况，有望作为早期监测急性心肌梗死再灌注患者预后风险的指标之一。

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	徐荣
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	王迎春

关键词 ：心肌梗塞, 超声心动描记术, 多普勒, 彩色

Abstract：Objective: To explore the value of 3D-STI in assessing the prognosis of ischemia reperfusion patients in acute ST segment elevation myocardial infarction(STEMI). Methods: Seventy ischemia reperfusion patients with STEMI were enrolled from March 2013 to November 2014 and their clinical data were recorded. The 3D-STI markers of patients including AS, CS, LS and RS were collected at the end of 3-day and 1-month treatment. Then, follow-up was given to all the 70 patients 1 year after treatment. Patients with favorable prognosis were defined as group A while patients with unfavorable prognosis were defined as group B. The differences of the baseline data and AS, CS, LS and RS of two groups at the end of 3-day and 1-month treatment were analyzed. Meanwhile, survival curves and COX’s proportional hazard regression model analysis were applied to evaluate the ability of 3D-STI in assessing the prognosis of patients with STEMI. The sensitivity and specificity of the AS, CS, LS and RS in predicting prognosis of patients were calculated by ROC curves. Results: Compared with group A, the proBNP, TNT after treatment and LVEF, LVEDV, LVESV, LAD, AS, CS, LS and RS in group B were lower, and the differences were statistically significant(P<0.05). The prognosis of ischemia reperfusion patients was significantly affected by AS and RS at the end of 3-day and 1-month treatment and LS at the end of 3-day treatment. The ROC analysis showed that the AUC of AS at the end of 3-day treatment, AS at the end of 1-month treatment, LS at the end of 3-day treatment, RS at the end of 3-day treatment and RS at the end of 1-month treatment were 0.796, 0.799, 0.798, 0.743, and 0.790. The AUC of the 5 indexes were similar, and can predict the prognosis of ischemia reperfusion patients. Conclusion: 3D-STI markers may assess the prognosis of ischemia reperfusion patients, which is might be used as an indicator of predicting the prognosis of patients with STEMI.

收稿日期: 2017-04-25

PACS:	Ｒ542.2
	Ｒ540.45

基金资助:上海市科委医学引导项目（134119b2300）；上海市卫生与计划生育委员会科研项目（201440598）。

通讯作者: 王迎春，上海市嘉定区中心医院超声影像科，201800。E-mail：wyc-us@163.com

作者简介: 徐荣（1980-），男，上海人，主治医师。E-mail：xurongultrasound@sina.com

引用本文:

徐荣，尹小花，王静，封岚，周洁，王迎春. 三维超声心动图预测STEMI再灌注患者预后的临床价值[J]. 中国临床医学影像杂志, 2018, 29(1): 18-22.
XU Rong, YIN Xiao-hua, WANG Jing, FENG Lan, ZHOU Jie, WANG Ying-chun. Clinical value of 3D-STI in predicting the prognosis of ischemia reperfusion patients. JOURNAL OF CHINA MEDICAL IMAGING, 2018, 29(1): 18-22.

链接本文:

http://www.jccmi.com.cn/CN/ 或 http://www.jccmi.com.cn/CN/Y2018/V29/I1/18

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