斑点追踪技术评价高血压患者左心房功能
Evaluation of Left Atrial Function in Patients with Hypertension by Speckle Tracking Technology

目的：探讨以QRS波为起点或者以P波为起点的左心房应变的差异，并探究血压及其控制情况对左心房应变的影响。方法：收集原发性高血压患者115例，根据服药控制情况分为病例组57例和控制良好组58例，并选取同时期34例健康体检人群作为对照组；获取常规二维超声心动图、频谱多普勒、组织多普勒等参数；使用斑点追踪技术测出左心房双平面储备期应变(S-R)，管道期应变(S-CD)、左心房收缩期应变(S-CT)以及其他左心房容积参数；分析三组之间各指标之间的差异。结果：S-R、S-CD在对照组与其他两组的差异均有统计学意义(P < 0.05)；以P波为起点的S-R比以R波为起点的S-R小，而S-CD和S-CT比以R波为起点的大，且他们之间的差异有统计学意义(P < 0.05)；左心房应变参数的ROC曲线分析：S-CD (R-Wave)的曲线下面积最大、S-R (R-Wave)的敏感度最大(89.5%)，特异度最高(41.2%)。结论：高血压患者左房各个功能减弱，控制血压对左心房功能的改善有一定作用，以QRS波为起点做出的结果比以P波为起点的显示出左房功能更好。
Objective: To investigate the difference of left atrial strain starting from QRS wave or P wave, and to explore the influence of blood pressure and its control on left atrial strain. Methods: 115 patients with essential hypertension were collected, and divided into case group (57 cases) and well-controlled group (58 cases) according to the control of medication. At the same time, 34 healthy people were selected as control group. Conventional two-dimensional echocardiography, spectrum Doppler, tissue Doppler and other parameters were obtained; left atrial biplane strain (S-R), left atrial conduit strain (S-CD), left atrial systolic strain (S-CT) and other left atrial volume parameters were measured by speckle tracking technology; the differences among the three groups were analyzed. Results: S-R, S-CD in the control group and the other two groups were statistically significant (P < 0.05); S-R starting from P wave was smaller than that starting from R wave, while S-CD and S-CT were larger than that starting from R wave, and the differences between them were statistically significant (P < 0.05); ROC curve analysis of left atrial strain parameters: S-CD (R-Wave) had the largest area under the curve, S-R (R-Wave) had the highest sensitivity (89.5%), and the highest specificity (41.2%). Conclusion: The function of left atrial in patients with hypertension is weakened, and controlling blood pressure has a certain effect on the improvement of left atrial function. The results made from QRS wave as the starting point showed better left atrial function than that from P wave as the starting point.