心肌运动定量分析技术在评价多囊卵巢综合征合并胰岛素抵抗患者左室收缩功能中的应用价值

doi:DOI:10.12117/jccmi.2018.12.006

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摘要目的：探讨心肌运动定量分析（Cardiac motion quantification，CMQ）技术在评价多囊卵巢综合征合并胰岛素抵抗（PCOS-IR）患者左室收缩功能中的应用价值。方法：选择临床明确诊断为PCOS-IR患者55例作为病例组，另选55例体检健康者作为对照组。应用CMQ技术测量收缩期心肌心内膜下、心外膜下及整体纵向应变（Ls）、径向应变（Rs）、圆周应变（Cs）并计算出跨壁阶差，同时测量左室短轴水平旋转角度及扭转角度，并计算出跨壁旋转角度梯度峰值及跨壁扭转角度梯度峰值，比较两组间各参数差异。结果：①左室收缩期Ls：从基底段到心尖段可见其呈现出递增的趋势，在相同水平的心内膜下心肌峰值应变大于心外膜下（P<0.05）；且病例组Ls及跨壁阶差均小于对照组（P<0.05）。②左室短轴Rs：乳头肌水平最大，二尖瓣水平次之，心尖水平最小，且两组间比较无统计学意义（P>0.05）。③左室短轴Cs：从二尖瓣水平到心尖水平逐渐增大，且同一水平心内膜下心肌峰值应变大于心外膜下（P<0.05）；病例组左室收缩期Cs及跨壁阶差较对照组减低（P<0.05）。④心肌旋转及扭转角度：同一水平两组心内膜下均高于心外膜下（P<0.05）；病例组心尖切面的各旋转角度、左室短轴二尖瓣水平心外膜下的旋转角度以及左室的各扭转角度均高于对照组（P<0.05），对照组左室心尖水平跨壁旋转角度梯度及跨壁扭转角度梯度峰值均高于病例组（P<0.05）；病例组二尖瓣水平心内膜下旋转角度及整体旋转角度较对照组增高，而跨壁旋转角度梯度低于对照组（P<0.05）。结论：CMQ技术可较敏感的检出PCOS-IR患者的左心收缩功能的相关变化，这为临床诊断中评估PCOS-IR患者心肌收缩功能早期变化提供新的诊断依据。

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	杜启亘
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	陈巍

关键词 ：多囊卵巢综合征, 胰岛素抗药性, 心室功能, 左, 超声检查

Abstract：Objective: To investigate the clinical value of cardiac motion quantification(CMQ) technique in evaluating left ventricular systolic function in patients with polycystic ovary syndrome complicated with insulin resistance(PCOS-IR). Methods: Fifty-five patients with polycystic ovary combined with insulin resistance were selected as PCOS-IR group and 55 healthy volunteers were selected as control group. The CMQ technique was used to measure the subendocardial, epicardial and global longitudinal strain(Ls), radial strain(Rs) and circumferential strain(Cs) of systolic myocardium, and the difference of cross wall was calculated. At the same time, the rotation angle and torsional angle of the left ventricular short axis were measured, and the peak value of rotation angle gradient of cross wall and the peak value of torsional angle gradient of cross wall were calculated. The difference of all the parameters between the two groups was compared. Results: ①Left ventricular systolic Ls: From the basal to apical segments, it showed an increasing trend. The peak strain of the subendocardial myocardium at the same level was greater than that under the epicardial(P<0.05). The Ls and difference of cross wall in the PCOS-IR group were lower than those in the control group(P<0.05). ②Left ventricular short axis Rs: The level of papillary muscle was the largest, the mitral valve was the second, and the apical level was the smallest. And there was no statistical significance between the two groups(P<0.05). ③Left ventricular short axis Cs: Increasing from mitral valve level to apical level, the peak strain of the subendocardial myocardium at the same level was greater than that under the epicardial(P<0.05). Left ventricular systolic Cs and difference of cross wall in the PCOS-IR group were lower than those in the control group(P<0.05). ④Myocardial rotation and torsion angle: Those of subendocardium were higher than those of epicardial myocardium at the same level in the two groups(P<0.05). The rotation angles at the apical level, the rotation angles of left ventricular short axis mitral valve epicardium, and the torsional angles of the left ventricle in the PCOS-IR group were higher than those in the control group(P<0.05). The peak value of rotation angle gradient of cross wall and the peak value of torsional angle gradient of cross wall of left ventricular apical level in the control group were higher than those in the PCOS-IR group(P<0.05). The subendocardial rotation angle and the whole rotation angle of mitral valve in the PCOS-IR group were higher than those in the control group, and the angle gradient of transmural rotation in PCOS-IR group was lower than that of control group(P<0.05). Conclusion: CMQ technique can accurately detect the changes of left ventricular systolic function in patients with PCOS-IR, and can provide a new diagnostic basis for evaluating the early changes of myocardial systolic function in patients with PCOS-IR.

Key words： Polycystic ovary syndrome Insulin resistance Ventricular function, left Ultrasonography

收稿日期: 2018-05-15

PACS:	Ｒ711.75
	Ｒ587.1
	Ｒ445.1

通讯作者: 陈巍，黑龙江中医药大学附属第二医院超声科，150001。

作者简介: 杜启亘（1971-），男，黑龙江人，副主任医师。

引用本文:

杜启亘，米香琴，徐宏伟，商玮珉，周立平，陈巍. 心肌运动定量分析技术在评价多囊卵巢综合征合并胰岛素抵抗患者左室收缩功能中的应用价值[J]. 中国临床医学影像杂志, 2018, 29(12): 860-865.
DU Qi-gen, MI Xiang-qin, XU Hong-wei, SHANG Wei-min, ZHOU Li-ping, CHEN Wei. Evaluation of left ventricular systolic function in patients with polycystic ovary and insulin resistance by cardiac motion quantification. JOURNAL OF CHINA MEDICAL IMAGING, 2018, 29(12): 860-865.

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http://www.jccmi.com.cn/CN/DOI:10.12117/jccmi.2018.12.006 或 http://www.jccmi.com.cn/CN/Y2018/V29/I12/860

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