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目的应用心肌声学造影(MCE)及二维斑点追踪技术(2_DSTE)定量评价高血压患者心肌微循环功能的早期改变。方法选取2012年12月至2014年12月间经冠状动脉造影(CAG)或冠状动脉CT造影(CTA)证实冠状动脉主要分支无明显狭窄共60例天津市胸科医院心内科住院患者为研究对象,依据世界卫生组织(WHO)1999年高血压诊断标准,将高血压患者随机分为高血压组和非高血压组,每组完全随机抽取各30例。其中男性32例,女性28例,年龄38~75岁,平均(57.6±19.8)岁。分别对患者进行心功能检测和CAG或冠状动脉CTA后24 h行MCE及2_DSTE检查。分别测量左室各节段的造影剂回声强度及纵向、径向收缩期峰值应变和旋转。结果两组间常规超声指标差异无统计学意义(P>0.05)。高血压组的基底段、中间段及心尖段心肌造影剂回声强度较非高血压组降低,差异有统计学意义(P<0.05)。与非高血压组比较,高血压组基底段、中间段及心尖段纵向收缩期峰值应变升高,差异均有统计学意义(P<0.05)。径向收缩期峰值应变和旋转两组间比较,差异无统计学意义(P>0.05)。结论 MCE及2_DSTE技术可以发现高血压患者在左室整体收缩功能出现降低之前已存在的心肌微循环障碍及局部心肌功能损伤。
Objective To quantitatively evaluate the early changes of myocardial microcirculation function in hypertensive patients by using myocardial contrast echocardiography (MCE) and two-dimensional speckle tracking (2_DSTE). Methods Sixty patients with major coronary artery stenosis without coronary artery stenosis confirmed by coronary angiography (CAG) or coronary artery CT angiography (CTA) between December 2012 and December 2014 were selected as study subjects According to WHO diagnostic criteria for hypertension in 1999, patients with hypertension were randomly divided into hypertensive group and non-hypertensive group, with 30 cases randomly selected from each group. There were 32 males and 28 females, aged 38-75 years, with an average of 57.6 ± 19.8 years. Patients were examined for cardiac function and CCE or CTA 24 hours after the line MCE and 2_DSTE examination. The echo intensity of contrast medium and the peak strain and rotation in longitudinal and radial systolic phase were measured respectively. Results There was no significant difference in routine ultrasound between the two groups (P> 0.05). Echocardiographic intensity of basilar segment, middle segment and apical segment of hypertensive group was lower than that of non-hypertensive group, the difference was statistically significant (P <0.05). Compared with non-hypertensive group, peak systolic peak strain of basal segment, middle segment and apical segment of hypertensive group increased significantly, with significant difference (P <0.05). Radial systolic peak strain and rotation between the two groups, the difference was not statistically significant (P> 0.05). Conclusion MCE and 2_DSTE can detect myocardial microcirculation and regional myocardial damage before the reduction of left ventricular systolic function in hypertensive patients.