微创医学

目的探讨四维应变成像（4D-SI）技术评估青年H型高血压病患者左室心肌整体收缩功能的临床应用价值。方法选取89例青年高血压患者，将43例血浆同型半胱氨酸（Hcy）＞15 μmol/L的患者纳入青年H型高血压组，将46例血浆Hcy≤15 μmol/L的患者纳入青年高血压组，另选52例健康志愿者作为对照组。对比3组研究对象的血压及二维超声心动图心脏功能参数，并应用4D-SI比较3组左室整体纵向峰值应变(GLS)、左室整体圆周峰值应变(GCS)、左室整体面积峰值应变(GAS)、左室整体径向峰值应变(GRS)。结果青年H型高血压组、青年高血压组患者的收缩压、舒张压高于对照组（均P＜0.05），但两组间比较差异无统计学意义（均P＞0.05）。青年H型高血压组、青年高血压组的舒张末期室间隔厚度（IVSd）、舒张末期左室后壁厚度（LVPWd）、左室心肌质量指数（LVMI）高于对照组（均P＜0.05），但两组间上述指标比较差异无统计学意义（均P＞0.05）。3组的左室射血分数（LVEF）、早期二尖瓣血流速度/早期二尖瓣环运动速度的比值（E/Em）均在正常参考范围内，且3组比较差异无统计学意义（均P＞0.05）。青年H型高血压组、青年高血压组的GLS、GAS低于对照组，且青年H型高血压组水平低于青年高血压组（均P＜0.05）。青年H型高血压组的GCS、GRS低于青年高血压组、对照组（均P＜0.05），而青年高血压组和对照组的GCS、GRS比较，差异无统计学意义（均P＞0.05）。结论4D-SI技术可发现青年H型高血压患者左室心肌收缩功能的早期亚临床改变，并且能够提供较为准确的定量评估，为临床防治高血压提供客观的参考依据。

ObjectiveTo explore the clinical application value of four-dimentional strain imaging (4D-SI) technology for evaluating integral systolic function of left ventricular myocardium in young patients with H-type hypertension. MethodsA total of 89 young patients with hypertension were selected, among which 43 patients with plasma homocysteine (Hcy) > 15 μmol/L were enrolled in the young H-type hypertension group, whereas 46 patients with plasma Hcy ≤ 15 μmol/L in the young hypertension group; meanwhile, another 52 healthy volunteers were selected as the control group. The blood pressure, and cardiac function parameters via two-dimentional echocardiogram were compared between the three groups; furthermore, 4D-SI was employed to compare the global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS) between the three groups. ResultsBoth young H-type hypertension and young hypertension groups interpreted higher systolic and diastolic pressures as compared with the control group (all P＜0.05), but there were no statistically significant differences between the two groups (all P＞0.05). To compared with the control group, both young H-type hypertension and young hypertension groups yielded higher interventricular septum thickness at the end of diastole (IVSd), left ventricular posterior wall thickness at the end of diastole (LVPWd), left ventricular mass index (LVMI) (all P＜0.05), but no statistically significant difference of aforesaid indicators expressed in both groups (all P＞0.05). The left ventricular ejection fraction (LVEF), the ratio of early transmitral flow velocity to early mitral annular velocity (E/Em) of the three groups were within the normal reference range, and there were no statistically significant differences between the three groups (all P＞0.05). Both young H-type hypertension and young hypertension groups implied lower GLS and GAS as compared with the control group, and the young H-type hypertension group had lower levels as above than the young hypertension group (all P＜0.05). The young H-type hypertension group yielded lower GCS and GRS in the comparison of the young hypertension group and the control group (all P＜0.05), whereas there were no statistically significant differences of GCS and GRS between the young hypertension group and the control group (all P＞0.05). Conclusion4D-SI technology can detect the early subclinical changes of left ventricular myocardium systolic function in young patients with H-type hypertension; in addition, the technology can provide more accurate quantitative evaluation, to provide objective reference basis for clinical prevention and treatment of hypertension.【Key words】Four-dimentional strain imaging; H-type hypertension; Left ventricular myocardium integral systolic function; Youth