摘要目的 应用超声三维应变技术评价左心室射血分数(left ventricular ejection fraction , LVEF)正常的阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome , OSA HS)患者左心室心肌收缩功能.方法 选取OSA HS患者100例(OSA HS组) ,按睡眠呼吸暂停指数(apnea hyopnea index , A HI)异常程度将其分为轻度组、中度组和重度组三个亚组,另选取32例健康志愿者为对照组.对各组进行常规超声心动图与三维超声心动图检查,获取三维LVEF 、整体纵向应变(global longitudinal strain , GLS) 、整体圆周应变(global circumferential strain , GCS ) 、整体面积应变(global area strain , GAS )及整体径向应变(global radial strain , GRS ) 、扭转(twist )和扭矩(torsion) .比较各组间上述参数的差异,同时分析A HI 、 LVEF与三维应变参数之间的相关性.结果①各组间三维 LVEF 、 twist与 torsion差异均无统计学意义( P ＞ 0 .05 ) ;② OSA HS 组各亚组 GLS 、GAS 、 GRS较对照组对应参数均降低(均 P ＜ 0 .05 ) ;重度组 GCS 较对照组对应参数减低( P ＜0 .01) ;③重度组GLS 、 GAS与轻度组对应参数比较均减低(均 P ＜0 .05) ;中、重度组GRS较轻度组对应参数降低(均 P ＜ 0 .05 ) ;重度组 GAS 、 GRS 较中度组降低( P ＜ 0 .05 ) ;④ OSA HS 组 GLS 、GAS 、 GRS与A HI均具有较低线性相关性( r ＝0 .342 , 0 .294 ,－0 .411 ;均 P ＜0 .01) ;所有受检者GCS 、 GAS 、 GRS与三维 LVEF 均具有较低线性相关性( r ＝ －0 .354 ,－0 .326 , 0 .300 ;均 P ＜0 .01) .结论 所有LVEF正常的OSAHS患者左心室均存在亚临床的心肌收缩功能受损,且随A HI严重程度增加,其受损程度趋于加重.应用超声三维应变成像技术能够早期发现并量化评价此类患者左心室心肌收缩功能障碍.

abstractsObjective To evaluate left ventricular myocardial systolic function in patients with obstructive sleep apnea hypopnea syndrome ( OSA HS) with normal left ventricular ejection fraction( LVEF) using three‐dimensional strain echocardiography . Methods One hundred patients with OSA HS were divided into mild group ,moderate group and severe group according to apnea hypopnea index ( A HI) w hile matched with 32 healthy people as control group . T he parameters such as three‐dimensional LVEF ,global longitudinal strain( GLS) ,global circumferential strain( GCS) ,global area strain( GAS) ,global radial strain ( GRS) ,twist and torsion based on standard three‐dimensional echocardiography were measured by three‐ dimensional strain echocardiography , the above parameters among the four groups were compared for difference .Linear correlationship between A HI ,LVEF and the three dimensional strain parameters was analyzed respectively . Results ①T here was no significant difference in three‐dimensional LVEF ,twist and torsion between each groups( P ＞0 .05 ) . ②GLS ,GAS and GRS were lower in mild ,moderate and severe group compared with control group ,decreasing along with the disease severity ( P ＜0 .01 or P ＜ 0 .05 ) . GCS in severe group was lower than that in control group ( P ＜0 .01 ) . ③GLS and GAS in severe group were lower than those in mild group ( all P ＜0 .05) .GRS in moderate and severe group were lower than that in mild group( all P ＜ 0 .05 ) ,GAS ,GRS in severe group was lower than those in moderate group ( P ＜0 .05) . ④T here was a mild correlation between GLS and A HI ( r ＝0 .342 , P ＜0 .01) ,GAS and A HI ( r＝0 .294 , P ＜0 .01) ,GRS and A HI ( r ＝ －0 .411 , P ＜0 .01 ) . T here was a mild correlation between GCS and three‐dimensional LVEF ( r＝ －0 .354 , P ＜0 .01 ) ,GAS and three‐dimensional LVEF ( r ＝ －0 .326 , P ＜0 .01) ,GRS and three‐dimensional LVEF ( r ＝0 .300 , P ＜0 .01) . Conclusions T he left ventricular myocardial systolic function is impaired in all patients with OSA HS even with normal LVEF and the dysfunction is aggravating with the disease severity . Ultrasonic three‐dimensional strain imaging technology can be used to detect the subclinical myocardial systolic dysfunction quantitatively in the early stage of OSA HS patients .