Jiang W, Yu S W, Lyu X Z, Song Y G
Department of Ultrasound Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China.
Department of Occupational Medicine and Toxicology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China.
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2023 Jul 20;41(7):523-528. doi: 10.3760/cma.j.cn121094-20221114-00543.
To evaluate the right ventricular function using two-dimensional speckle tracking echocardiography (2-D STE) and analyze the associated risk factors of right ventricular dysfunction in patients with silicosis. All 104 patients with silicosis treated in the Department of Occupational Medicine and Toxicology in Beijing Chao-Yang Hospital, Capital Medical University from May 2021 to September 2022 were enrolled in this study in October 2022. The clinical information of patients such as general data, arterial blood gas analysis and pulmonary function test were collected. The right ventricular function of patients was evaluated by 2-D STE-derived right ventricular free wall longitudinal strain (RVFWLS) and conventional echocardiographic-derived parameters, including right ventricular fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE) and doppler tissue imaging-derived tricuspid lateral annular systolic velocity (S'), respectively. Based on their RVFWLS, the patients were divided into right ventricular dysfunction group and normal right ventricular function group. Risk factors for right ventricular dysfunction in patients with silicosis were analyzed using binary logistic regression analysis. A total of 104 silicosis patients were enrolled, with aneverage age (65.52±11.18) years old, among whom including 57 cases diagnosed with stage Ⅰ/Ⅱ silicosis and 47 cases diagnosed with stage Ⅲ silicosis. 26 (25.00%) patients concurrent right ventricular dysfunction. The abnormal rates of RVFAC, TAPSE and S' in patients were 16.35% (17 cases), 21.15% (22 cases) and 6.73% (7 cases), respectively. The RVFAC and TAPSE in right ventricular dysfunction group were lower than those in normal right ventricular function group, and the incidence of pulmonary arterial systolic pressure ≥36 mmHg was higher than that in normal right ventricular function group (<0.05). Logistic regression analysis showed that arterial partial pressure of oxygen (=0.932, 95%: 0.885-0.981, =0.007) was the protective factor, and the forced expiratory volume in 1 second (FEV(1)) /forced vital capacity (FVC) ratio<70% (=5.484, 95%: 1.049-28.662, =0.044) and stage Ⅲ silicosis (=6.343, 95%: 1.698-23.697, =0.007) were the risk factors for silicosis patients concurrent right ventricular dysfunction. The incidence of right ventricular dysfunction is higher in patients with stage Ⅲ silicosis than that in patients with stage Ⅰ/Ⅱ silicosis. Using 2-D STE can help the early detection of silicosis with right ventricular dysfunction. Hypoxemia, airflow limitation and the stage Ⅲ silicosis are the risk factors for silicosis patients concurrent right ventricular dysfunction.
采用二维斑点追踪超声心动图（2-D STE）评估矽肺患者的右心室功能，并分析右心室功能障碍的相关危险因素。2022年10月，纳入了2021年5月至2022年9月在首都医科大学附属北京朝阳医院职业医学与毒理学科治疗的104例矽肺患者。收集患者的一般资料、动脉血气分析、肺功能检查等临床信息。分别采用2-D STE得出的右心室游离壁纵向应变（RVFWLS）和传统超声心动图得出的参数，包括右心室面积变化分数（RVFAC）、三尖瓣环平面收缩期位移（TAPSE）以及多普勒组织成像得出的三尖瓣侧环收缩期速度（S'）来评估患者的右心室功能。根据RVFWLS将患者分为右心室功能障碍组和右心室功能正常组。采用二元逻辑回归分析矽肺患者右心室功能障碍的危险因素。共纳入104例矽肺患者，平均年龄（65.52±11.18）岁，其中Ⅰ/Ⅱ期矽肺57例，Ⅲ期矽肺47例。26例（25.00%）患者并发右心室功能障碍。患者RVFAC、TAPSE及S'异常率分别为16.35%（17例）、21.15%（22例）和6.73%（7例）。右心室功能障碍组的RVFAC和TAPSE低于右心室功能正常组，肺动脉收缩压≥36 mmHg的发生率高于右心室功能正常组（<0.05）。逻辑回归分析显示，动脉血氧分压（=0.932，95%：0.885 - 0.981，=0.007）是保护因素，1秒用力呼气量（FEV(1)）/用力肺活量（FVC）比值<70%（=5.484，95%：1.049 - 28.662，=0.044）和Ⅲ期矽肺（=6.343，95%：1.698 - 23.697，=0.007）是矽肺患者并发右心室功能障碍的危险因素。Ⅲ期矽肺患者右心室功能障碍的发生率高于Ⅰ/Ⅱ期矽肺患者。使用2-D STE有助于早期发现合并右心室功能障碍的矽肺患者。低氧血症、气流受限和Ⅲ期矽肺是矽肺患者并发右心室功能障碍的危险因素。
