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目的 探讨瞬时波强(WI)技术在鉴别肥厚型非梗阻性心肌病与高血压心脏病中的应用价值.方法 随机选取肥厚型非梗阻性心肌病(NOHCM)患者30例、高血压心脏病(HHD)向心性肥厚患者36例及正常对照组36例,进行常规超声心动图检查及右颈总动脉WI检测,分别获得常规参数:室间隔舒张末期厚度(IVSTd)、左室后壁舒张末期厚度(LVPWd)、左室舒张末期内径(LVIDd)和WI参数:第一个正向峰(W1)、第二个正向峰(W2)、负向波面积(NA)、心电图R波顶点到W1峰顶点的时间(R-1st)、W1顶点到W2顶点的时间(1st-2nd),统计分析各组参数的差异.结果 ①三组IVSTd比较差异均有统计学意义(P ＜0.01)；HHD组LVPWd高于对照组及NOHCM组(P＜0.01),而后两者比较差异无统计学意义(P＞0.05)；三组LVIDd比较差异均无明显统计学意义(P＜0.05).②与对照组比较,NOHCM组W1明显升高,W2、R-1st明显降低(P＜0.01)；HHD组W1、NA明显升高(P＜0.01).与HHD组比较,NOHCM组W2、R-1st明显减小(P＜0.01).③以W2=850 mmHg·m·s-3为截断值鉴别两种疾病的敏感性和特异性分别为76.3％、72.4％.以R-1st=98.5 ms为截断值鉴别两种疾病的敏感性和特异性分别为63.2％、72.4％.结论 WI能够有效检测出NOHCM与HHD的差异,为这两种疾病的鉴别提供量化依据,进而为临床上鉴别NOHCM与HHD提供了一个新的思路.

Objective To assess the value of wave intensity (WI) on the discrimination of hypertension with concentric hypertrophy and non-obstructive hypertrophic cardiomyopathy(NOHCM).Methods 36 patients with hypertension with concentric hypertrophy,30 patients with NOHCM and 36 healthy volunteers were randomly selected to perform routine ultrasound examination and carotid arterial WI test.The conventional parameters,inlcuding interventricular septal thickness in diastole (IVSTd),left ventricular posterior wall thickness in diastole(LVPWd),left ventricular diameter in diastole(LVIDd) and WI parameters,including the first peak (W1),the second peak (W2),negative area (NA),the interval between the R wave of the ECG and the peak of W1 (R-1st),the interval between the peaks of W1 and W2 (1st-2nd) were archived and compared among the different groups.Results ① There were statistical significances in IVSTd among the three groups(P ＜0.01).LVPWd of hypertension group was obviously higher than that of normal and NOHCM groups (P ＜0.01),but there were no statistical significances in NOHCM and normal groups(P ＞0.05).There were no statistical significances in LVIDd among different groups(P ＞ 0.05).②Compared with the normal group,W1 in NOHCM group increased significantly,whereas W2 and R-1st was much lower (P ＜0.01);W1 and NA in hypertension group was obviously higher(P ＜0.01).W2 and R-1st in NOHCM group were much smaller than those of hypertension group (P＜0.01).③W2 in 850 mmHg · m · s-3 was an optimal cutoff value to identify NOHCM and hypertension and to yield the sensitivity of 78.9％ and specificity of 72.4％.R-1st in 98.5 ms was a cutoff point to discriminate NOHCM and hypertension and to bring the sensitivity 65.8％ and specificity 72.4％.Conclusions WI analysis can effectively distinguish the difference of NOHCM and hypertension and provide a new viewpoint for the discrimination of hypertension with concentric hypertrophy and non-obstructive hypertrophic cardiomyopathy.