[1]陈玲,胡威,潘婧,等.超声左室心肌应变检查在非ST段抬高型急性冠状动脉综合征临床诊断中的应用[J].陕西医学杂志,2026,(1):58-62.[doi:DOI:10.3969/j.issn.1000-7377.2026.01.010]
　CHEN Ling,HU Wei,PAN Jing,et al.The application of ultrasound left ventricular myocardial strain examination in the clinical diagnosis of non-ST-segment elevation acute coronary syndrome[J].,2026,(1):58-62.[doi:DOI:10.3969/j.issn.1000-7377.2026.01.010]
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超声左室心肌应变检查在非ST段抬高型急性冠状动脉综合征临床诊断中的应用

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
期数:
2026年1期
页码:
58-62
栏目:
临床研究
出版日期:
2026-01-05

文章信息/Info

Title:
The application of ultrasound left ventricular myocardial strain examination in the clinical diagnosis of non-ST-segment elevation acute coronary syndrome
作者:
陈玲1; 胡威1; 潘婧1; 何鹏2
（1.武汉科技大学附属孝感医院急诊科，湖北 孝感 432000；2.武汉科技大学附属孝感医院重症医学科，湖北 孝感 432000）
Author(s):
CHEN Ling1; HU Wei1; PAN Jing1; HE Peng2
(1.Emergency Department,Wuhan University of Science and Technology Affiliated Xiaogan Hospital,Xiaogan 432000，China;2.Intensive Care Medicine,Wuhan University of Science and Technology Affiliated Xiaogan Hospital,Xiaogan 432000,China)
关键词:
二维追踪斑点超声技术; 非ST段抬高型; 急性冠状动脉综合征; 分层应变技术; 急性冠状动脉事件; 临床诊断
Keywords:
Two-dimensional tracking speckle ultrasound technology; Non-st-segment elevation type; Acute coronary syndrome; Layered strain technology; Acute coronary artery event; Clinical diagnosis
分类号:
R 541.4
DOI:
DOI:10.3969/j.issn.1000-7377.2026.01.010
文献标志码:
A
摘要:
目的：探讨非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者接受二维追踪斑点超声技术（2D-STI）测定左心分层应变参数的临床价值。方法：选取收治的急性胸痛且确诊为NSTE-ACS患者160例作为NSTE-ACS组，选取无冠脉病变的80例志愿者作为对照组，比较两组研究对象的左心分层应变参数，根据冠脉造影靶血管的狭窄程度将NSTE-ACS组患者分为完全闭塞、狭窄组进行分层分析，并采用Pearson分析法分析全球急性冠状动脉事件注册研究（GRACE）危险积分与NSTE-ACS患者左心分层应变参数的相关性。结果：NSTE-ACS组患者的左心室整体纵向应变（LS）、径向应变（RS）及圆周应变（CS）、左室心肌整体收缩期峰值纵向应变（GLS）、分支区域收缩期峰值应变（TLS）测定值与对照组患者比较均明显的降低，差异有统计学意义（均P<0.05）；NSTE-ACS组和对照组的心尖部扭转角度（RA）测定值比较，差异无统计学意义（P>0.05）。160例NSTE-ACS组患者中，靶血管重度狭窄的有76例患者、轻度狭窄患者有84例，靶血管重度狭窄的NSTE-ACS患者LS、RS、CS、TLS、GLS测定值显著低于靶血管轻度狭窄的NSTE-ACS患者，差异有统计学意义（均P<0.05）；靶血管重度狭窄和轻度狭窄的NSTE-ACS患者的RA测定值比较，差异无统计学意义（P>0.05）。NSTE-ACS组患者的GRACE危险积分与患者左心室LS、RS、CS、TLS、GLS测定值呈显著的负相关关系（均P<0.05）；各项指标诊断NSTE-ACS患者ROC曲线下面积AUC值分别为[LS：AUC=0.605（0.510～0.699）；RS：AUC=0.632（0.540～0.725）；CS：AUC=0.646（0.554～0.738）；TLS：AUC=0.643（0.552～0.735）；GLS：AUC=0.608（0.515～0.702）],各项指标联合[AUC=0.894（0.842～0.947）]。结论：2D-STI检测左心分层应变各项参数单独应用诊断NSTE-ACS患者的价值不高，但是各项指标联合应用其诊断价值显著增高，临床可进行综合考虑。
Abstract:
Objective:To explore the clinical significance of two-dimensional tracking speckle ultrasound (2D-STI) in detecting left ventricular stratified strain in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).Methods：A total of 160 patients with acute chest pain diagnosed as NSTE-ACS who were admitted to Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from January 2024 to May 2025 were selected as the NSTE-ACS group,and 80 volunteers without coronary artery lesions were selected as the control group.The left ventricular stratified strain parameters of the two groups of research subjects were compared.According to the degree of stenosis of the target vessel in coronary angiography,patients in the NSTE-ACS group were divided into the complete occlusion group and the stenosis group for stratified analysis.The Pearson analysis method was used to analyze the correlation between the Global Acute Coronary Event Registry (GRACE) risk score and the left ventricular stratified strain parameters of NSTE-ACS patients.Results:The measured values of global longitudinal strain (LS),radial strain (RS),circumferential strain (CS) of the left ventricle,peak longitudinal systolic strain (GLS) of the left ventricular myocardium,and peak systolic strain (TLS) in the branch region of patients in the NSTE-ACS group were significantly lower than those in the control group,and the differences were statistically significant (all P<0.05).There was no statistically significant difference in the measured values of apical torsion Angle (RA) between the NSTE-ACS group and the control group (P>0.05).Among the 160 patients in the NSTE-ACS group,76 patients had severe target vessel stenosis and 84 patients had mild stenosis.The measured values of LS,RS,CS,TLS and GLS in NSTE-ACS patients with severe coronary artery stenosis were significantly lower than those in NSTE-ACS patients with mild coronary artery stenosis,and the difference was statistically significant (all P<0.05).There was no statistically significant difference in the RA measurement values between NSTE-ACS patients with severe coronary stenosis and those with mild coronary stenosis (P>0.05).The GRACE risk score of patients in the NSTE-ACS group was significantly negatively correlated with the measured values of LS,RS,CS,TLS and GLS in the left heart of the patients (all P<0.05).The area under the ROC curve AUC values of each index for diagnosing patients in the NSTE-ACS group were as follows[LS：AUC=0.605(0.510-0.699);RS：AUC=0.632(0.540-0.725)；CS：AUC=0.646(0.554-0.738);TLS：AUC=0.643(0.552-0.735);GLS：AUC=0.608(0.515-0.702)],Combined indicators：AUC=0.894 (0.842-0.947).Conclusion:The value of using each parameter of left ventricular stratified strain detected by 2D-STI alone in the diagnosis of patients with NSTE-ACS is not high.However,the combined application of various indicators significantly increases its diagnostic value,and comprehensive consideration can be made in clinical practice.

参考文献/References:

[1]周鹤,刘彬彬,裘淼涵,等.非ST段抬高型急性冠状动脉综合征患者介入术后血小板计数与长期临床预后相关性分析[J].临床军医杂志,2023,51(5)：502-506.
[2]周江荣,冯俊,高玉,等.急性ST段抬高型急性心肌梗死患者经皮冠状动脉介入术术后心血管不良事件发生的影响因素及血清N末端脑钠肽前体、胱抑素-C、血小板淋巴细胞壁纸的预测价值研究[J].陕西医学杂志,2024,53(4)：523-526,539.
[3]李俊逸,姚卫杰,付高见.血管造影X射线机下低剂量技术在急性冠状动脉综合征中的应用[J].中国医疗器械信息,2025,31(4)：24-26.
[4]王睿,王媛,李芳.新型炎症标记物对首发急性非ST段抬高型心肌梗死患者经皮冠状动脉介入治疗术后心肌灌注不良的预测价值[J].中国医刊,2025,60(1)：18-22.
[5]赵娟,柴仁杰,宋势波,等.斑点追踪超声心动图联合血浆miR-30a评估急性冠状动脉综合征患者近期预后的临床研究[J].中国临床新医学,2022,15(1)：45-50.
[6]刘睿涵,刘涛,黄鑫,等.三维超声心动图和二维斑点追踪成像评估老年急性心肌梗死患者的左心室收缩功能[J].中华老年心血管病杂志,2022,24(10)：1059-1063.
[7]陈梅香,刘芃,黄建玉,等.二维斑点追踪成像联合实时三维超声心动图对非ST段抬高型急性冠状动脉综合征疑诊患者冠状动脉显著狭窄的预测价值[J].中华超声影像学杂志,2022,31(2)：93-100.
[8]杨锦淑,刘燕,浦仕成,等.心脏超声斑点追踪在急性心肌梗死诊断及分型中的应用价值[J].临床医学,2022,42(9)：92-94.
[9]COLLET J P,THIELE H,BARBATO E,et al.2020 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation[J].Eur Heart J,2021,42(14)：1289-1367.
[10]礼希曦,刘闺男.GRACE危险积分与NSTEMI-ACS患者冠脉病变程度相关性分析[J].中国医科大学学报,2014,43(7)：646-650.
[11]中国心血管健康与疾病报告编写组.中国心血管健康与疾病报告2022概要[J].中国循环杂志,2023,38(6)：583-612.
[12]ATWOOD J.Management of acute coronary syndrome[J].Emerg Med Clin North Am,2022,40(4)：693-706.
[13]马清济,陈亮,潘美宇.冠状动脉计算机断层扫描血管造影对老年急性冠状动脉综合征患者斑块特征的诊断效能及对预后的预测价值[J].中华老年多器官疾病杂志,2024,23(1)：32-37.
[14]李傲,张兆志,李博,等.二维斑点追踪超声心动图在冠状动脉粥样硬化性心脏病中的研究进展[J].中国医刊,2025,60(1)：9-13.
[15]王昊冉,张彤,申思远,等.超声分层应变技术评价急性冠状动脉综合征患者的心肌功能受损的临床价值[J].分子影像学杂志,2024,47(4)：368-372.
[16]王国栋,刘慧珍,商娜,等.老年急性冠脉综合征1年内主要不良心脑血管事件预测评分体系的构建及效能评估[J].中华急诊医学杂志,2023,32(7)：881-888.
[17]张克成,郭艳娇,梁晶,等.急性冠脉综合征患者经皮冠状动脉介入术后半乳糖凝集素-3表达及其与左心室收缩功能的相关性研究[J].中国医刊,2022,57(1)：80-84.
[18]白敬淼,史苏娜,贾相科.血管内超声与二维斑点追踪参数对急性ST段抬高型心肌梗死患者心肌损伤及主要不良心血管事件的预测价值[J].中国心血管病研究,2024,22(11)：1040-1045.
[19]张玉莲,邓玮,周勇君,等.斑点追踪超声心动图指标与冠心病心肌纤维化程度的关系[J].中国医药导报,2024,21(19)：145-149.
[20]张松,陈艳青,陈允安,等.二维斑点追踪超声心动图参数评价妊娠期高血压心肌功能及其与患者血浆NT-proBNP水平的关系[J].川北医学院学报,2024,39(11)：1537-1540.
[21]周瑞,刘会宁,张璞,等.斑点追踪超声心动图评估全身麻醉对老年患者左心房容量和功能的影响[J].大连医科大学学报,2025,47(1)：38-43.
[22]王涵,刘琳,赵亚雯,等.二维斑点追踪超声心动图技术对法布雷病患者右心室功能及应变特征的评估[J].中国循环杂志,2024,39(10)：997-1002.
[23]相三婷,王文平,雍永宏,等.二维斑点追踪技术联合实时三维超声心动图评价肥胖对原发性高血压患者左房功能的影响[J].南京医科大学学报（自然科学版）,2024,44(3)：380-386.
[24]满达夫,铁宁,赵捷,等.二维斑点追踪超声心动图评价CTD合并PAH病人危险分层的价值[J].中西医结合心脑血管病杂志,2024,22(10)：1848-1853.
[25]周晓丹,王岩,项军,等.肌钙蛋白、SNYTAX积分、GRACE评分与老年冠心病PCI术后再次血运重建的关系[J].疑难病杂志,2023,22(8)：824-828.

备注/Memo

备注/Memo:
湖北省自然科学基金资助项目（2022CDB148）;湖北省孝感市自然科学计划项目（XGKJ2023010020）
更新日期/Last Update: 2026-01-05