【摘要】 目的 探讨二维斑点追踪成像(2D-STI)联合右心室-肺动脉(RV-PA)耦连评估系统性红斑狼疮(SLE)伴肺动脉高压(PH)患者右心室收缩功能的价值。方法 前瞻性选取SLE患者44例，按肺动脉收缩压(PASP)分为A组(PASP<50 mmHg)和B组(PASP≥50 mmHg),另选健康人作为对照组(C组),每组各22例。2D-STI获取右心室心肌纵向及径向应变各参数，比较各组差异；Pearson线性相关分析各参数与PASP的相关性；绘制受试者工作特征(ROC)曲线评估应变参数预测PH程度的效能。使用右心室游离壁纵向应变(RV FWS)/PASP评估RV-PA耦连。结果 与C组比较，随着PASP递增，病例组右心室纵向应变均递减，右心室各径向应变值先递增后递减(P<0.05)。Pearson相关性分析显示PASP与RV FWS及右心室整体径向应变(FW GRS)相关性最佳(r=-0.701、-0.810);ROC曲线显示二者区分PH程度的灵敏度分别为81.82%、68.18%;特异度分别为90.91%、81.82%。结论 2D-STI是评估SLE患者肺动脉压升高时右心室收缩功能改变的有效方法，FW GRS及RV FWS评估PH程度的效能高。肺动脉压轻度增高时发生解耦连。更多还原

【Abstract】 Objective Discussing the value of two-dimensional speckle tracking imaging(2D-STI) combined with right ventricular-pulmonary arterial(RV-PA) coupling for assessing right ventricular systolic function in patients with systemic lupus erythematosus(SLE) and pulmonary hypertension(PH). Methods Forty-four SLE patients were prospectively selected and divided into Group A(PASP<50 mmHg) and Group B(PASP≥50 mmHg) based on pulmonary artery systolic pressure(PASP), with 22 subjects in each group. Additionally, 22 healthy individuals were selected as the control group(Group C).2D-STI was used to obtain parameters of right ventricular(RV) myocardial longitudinal and radial strain. Differences in these parameters among the groups were compared; Pearson linear correlation analysis was performed to assess the correlation between each parameter and PASP;Receiver operating characteristic(ROC) curves were plotted to evaluate the efficacy of the strain parameters in predicting the severity of PH;RV-PA coupling was assessed using the ratio of RV free wall longitudinal strain(RV FWS)to PASP(RV FWS/PASP). Results Compared with Group C, as PASP increased, the right ventricular longitudinal strain progressively decreased in the patient groups, while the right ventricular radial strain values initially increased and then decreased(P<0.05).Pearson correlation analysis showed that PASP had the strongest correlation with RV FWS(r=-0.701) and RV GRS(r=-0.810).ROC curve analysis showed that the sensitivities for distinguishing the severity of PH were 81.82% and 68.18%, and the specificities were 90.91% and 81.82%, respectively. Conclusions 2D-STI is a valuable tool for assessing alterations in right ventricular systolic function associated with elevated pulmonary artery pressure in SLE patients.Both FW GRS and RV FWS demonstrate high diagnostic efficacy for evaluating the severity of PH.RV-PA uncoupling occurs even at mild elevations of pulmonary artery pressure.更多还原