二维斑点追踪成像技术评价腹膜透析对尿毒症患者左心室功能影响的临床研究
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摘要
目的探讨二维斑点追踪成像技术(2D-STI)评价腹膜透析对尿毒症患者左心室功能影响的价值。方法选取2014年12月至2015年12月经山西医科大学第一医院诊断明确且尚未透析的尿毒症患者30例,作为尿毒症患者组,常规超声示左心室射血分数(LVEF)>50%,与年龄、性别、体重相匹配的健康对照组30例比较。2组均测量基础资料与心脏常规超声参数,采集图像并采用QLab软件分析,得出左心室16节段时间-应变曲线,测出各节段纵向、径向、圆周方向收缩期峰值应变。对2组基础资料、常规超声参数及左心室各节段2D-STI参数行两独立样本t检验。腹膜透析6个月后再次检查,采用配对t检验比较尿毒症患者腹膜透析前后左心室各节段心肌收缩情况。结果 (1)尿毒症患者组(未透析)与健康对照组比较:尿毒症患者组收缩压、舒张压及脉压升高,差异均有统计学意义(t=-4.445、-4.531、-2.203,P均<0.05);尿毒症患者左心房前后径、左心室舒张末及收缩末内径、左心室舒张末及收缩末容积及左心室质量指数增大,室间隔厚度、左心室后壁厚度及相对室壁厚度增厚,差异均有统计学意义(t=-6.461、-5.168、-4.660、-3.578、-2.872、-6.819、-6.251、-7.108、-2.659,P均<0.05),LVEF差异无统计学意义(P>0.05);尿毒症患者组左心室16节段纵向、径向及圆周方向收缩期峰值应变均减小,差异均有统计学意义(纵向t=-7.063、-5.391、-3.351、-5.323、-5.586、-7.842、-5.265、-5.587、-5.037、-3.051、-4.584、-3.936、-4.168、-9.783、-9.175、-3.805;径向t=3.659、3.581、5.368、2.649、2.928、4.344、2.754、5.031、5.025、2.277、2.691、2.731、3.187、4.179、5.292、4.429;圆周方向t=-5.158、-3.959、-2.164、-3.592、-2.324、-5.672、-4.946、-7.184、-7.748、-5.014、-2.439、-6.299、-8.072、-8.410、-7.884、-8.854,P均<0.05)。(2)尿毒症患者透析前后比较:尿毒症患者透析治疗后收缩压降低,差异有统计学意义(t=2.833,P<0.05);透析治疗后左心房前后径与左心室质量指数减小,差异均有统计学意义(t=4.805,2.631,P均<0.05);透析治疗后,左心室前间隔、前壁、后壁、下壁、后间隔基底段、前间隔、侧壁、后壁中间段、前壁、侧壁心尖段纵向收缩期峰值应变增加,差异均有统计学意义(t=5.199、4.127、3.781、3.380、4.114、3.116、2.840、3.243、4.003、5.605,P均<0.05);侧壁基底段、侧壁、后间隔中间段、室间隔、侧壁、下壁心尖段径向收缩期峰值应变增加,差异均有统计学意义(t=-3.343、-3.687、-2.488、-2.921、-3.826、-3.339,P均<0.05);左心室各节段心肌圆周方向收缩期峰值应变有所增加,但差异均无统计学意义(P均>0.05)。结论尿毒症患者左心室结构发生改变且各节段心肌收缩功能减弱,腹膜透析后,部分节段心肌收缩功能有所改善。2D-STI能够定量、客观评价尿毒症患者透析前后左心室心肌收缩功能变化。
Objective To evaluate the left ventricular systolic function of uremic patients after peritoneal dialysis measured by two-dimensional speckle tracking imaging. Methods Thirty uremic patients with their left ventricular ejection fraction(LVEF) > 50% who had not been underwent dialysis were enrolled in this study. Thirty healthy volunteers were involved as controls. For both groups, the basic data and routine cardiac ultrasound parameters were measured, and the images were collected to be analyzed by QLab software. The left ventricular 16-segment time-strain curves were obtained, and the peak strain of the systolic phase of each segment was measured. The data of 2 groups were analyzed by two independent samples t-test. After 6 months of peritoneal dialysis, the uremic patients were checked again. By using paired t-test, we analyzed the difference in left ventricular systolic dysfunction of uremic patients before and after peritoneal dialysis. Results(1) Comparison between uremia group(nondialysis patients) and control group: systolic arterial pressure, diastolic arterial pressure and pulse pressure of uremic patients increased(t=-4.445,-4.531 and-2.203, P < 0.05); left atrial anterior and posterior diameter(LAAPD), left ventricular end diastolic diameter(LVEDD), left ventricular end systolic diameter(LVESD), left ventricular end diastolic volume(LVEDV), left ventricular end systolic volume(LVESV) and left ventricular mass index(LVMI) of uremic patients were larger. Interventricular septum thickness(IVST), left ventricular posterior wall thickness(LVPWT) and relative wall thickness(RWT) were thicker(t=-6.461,-5.168,-4.660,-3.578,-2.872,-6.819,-6.251,-7.108 and-2.659, P < 0.05); the longitudinal, radial and circumferential directions peak systolic strain of 16 segment myocardial of uremic patients decreased(the longitudinal strain: t=-7.063,-5.391,-3.351,-5.323,-5.586,-7.842,-5.265,-5.587,-5.037,-3.051,-4.584,-3.936,-4.168,-9.783,-9.175 and-3.805; the radial strain: t=3.659, 3.58, 5.368, 2.649, 2.928, 4.344, 2.754, 5.031, 5.025, 2.277, 2.691, 2.731, 3.187, 4.179, 5.292 and 4.429; the circumferential strain: t=-5.158,-3.959,-2.164,-3.592,-2.324,-5.672,-4.946,-7.184,-7.748,-5.014,-2.439,-6.299,-8.072,-8.410,-7.884 and-8.854, P < 0.05).(2) Comparison between uremic patients before and after dialysis: the systolic arterial pressure of uremic patients decreased after dialysis(t=2.833, P < 0.05); LAAPD and LVMI of uremic patients decreased after dialysis(t=4.805, 2.631, P < 0.05); BAS, BA, BIL, BI, BIS, MAS, MAL, MIL, APA and APL longitudinal systolic peak strain and the BAL, MAL, MIS, APS, APL and API radial systolic peak strain of uremic patients increased after dialysis(t=5.199, 4.127, 3.781, 3.380, 4.114, 3.116, 2.840, 3.243, 4.003 and 5.605, P < 0.05; t=-3.343,-3.687,-2.488,-2.921,-3.826 and-3.339, all P < 0.05). There were no statistical differences in circumferential peak systolic strain(P > 0.05). Conclusions In uremic patients, the structure of the left ventricle changed, the function of myocardial contraction decreased, and the function of myocardial contraction improved after peritoneal dialysis. 2 D-STI was able to quantitatively and objectively evaluate the function of the left ventricular myocardial constriction before and after dialysis.
Objective To evaluate the left ventricular systolic function of uremic patients after peritoneal dialysis measured by two-dimensional speckle tracking imaging. Methods Thirty uremic patients with their left ventricular ejection fraction(LVEF) > 50% who had not been underwent dialysis were enrolled in this study. Thirty healthy volunteers were involved as controls. For both groups, the basic data and routine cardiac ultrasound parameters were measured, and the images were collected to be analyzed by QLab software. The left ventricular 16-segment time-strain curves were obtained, and the peak strain of the systolic phase of each segment was measured. The data of 2 groups were analyzed by two independent samples t-test. After 6 months of peritoneal dialysis, the uremic patients were checked again. By using paired t-test, we analyzed the difference in left ventricular systolic dysfunction of uremic patients before and after peritoneal dialysis. Results(1) Comparison between uremia group(nondialysis patients) and control group: systolic arterial pressure, diastolic arterial pressure and pulse pressure of uremic patients increased(t=-4.445,-4.531 and-2.203, P < 0.05); left atrial anterior and posterior diameter(LAAPD), left ventricular end diastolic diameter(LVEDD), left ventricular end systolic diameter(LVESD), left ventricular end diastolic volume(LVEDV), left ventricular end systolic volume(LVESV) and left ventricular mass index(LVMI) of uremic patients were larger. Interventricular septum thickness(IVST), left ventricular posterior wall thickness(LVPWT) and relative wall thickness(RWT) were thicker(t=-6.461,-5.168,-4.660,-3.578,-2.872,-6.819,-6.251,-7.108 and-2.659, P < 0.05); the longitudinal, radial and circumferential directions peak systolic strain of 16 segment myocardial of uremic patients decreased(the longitudinal strain: t=-7.063,-5.391,-3.351,-5.323,-5.586,-7.842,-5.265,-5.587,-5.037,-3.051,-4.584,-3.936,-4.168,-9.783,-9.175 and-3.805; the radial strain: t=3.659, 3.58, 5.368, 2.649, 2.928, 4.344, 2.754, 5.031, 5.025, 2.277, 2.691, 2.731, 3.187, 4.179, 5.292 and 4.429; the circumferential strain: t=-5.158,-3.959,-2.164,-3.592,-2.324,-5.672,-4.946,-7.184,-7.748,-5.014,-2.439,-6.299,-8.072,-8.410,-7.884 and-8.854, P < 0.05).(2) Comparison between uremic patients before and after dialysis: the systolic arterial pressure of uremic patients decreased after dialysis(t=2.833, P < 0.05); LAAPD and LVMI of uremic patients decreased after dialysis(t=4.805, 2.631, P < 0.05); BAS, BA, BIL, BI, BIS, MAS, MAL, MIL, APA and APL longitudinal systolic peak strain and the BAL, MAL, MIS, APS, APL and API radial systolic peak strain of uremic patients increased after dialysis(t=5.199, 4.127, 3.781, 3.380, 4.114, 3.116, 2.840, 3.243, 4.003 and 5.605, P < 0.05; t=-3.343,-3.687,-2.488,-2.921,-3.826 and-3.339, all P < 0.05). There were no statistical differences in circumferential peak systolic strain(P > 0.05). Conclusions In uremic patients, the structure of the left ventricle changed, the function of myocardial contraction decreased, and the function of myocardial contraction improved after peritoneal dialysis. 2 D-STI was able to quantitatively and objectively evaluate the function of the left ventricular myocardial constriction before and after dialysis.
引文
1杨可,赵景宏.尿毒症心肌病的研究进展[J].局解手术杂志,2013,33(6):656-662.
2 Stallworthy EJ,Pilmore HL,Webster MW,et al.Do echocardiographic parameters predict mortality in patients with end-stage renal disease?[J].Transplantation,2013,95(10):1225-1232.
3 葛均波,徐永健.内科学[M].8版.北京:人民卫生出版社,2013:524.
4 王海燕.肾脏病学[M].3版.北京:人民卫生出版社,2008:2049-2056.
5 王家玮.心肌疾病超声诊断[M].北京:人民卫生出版社,2002:275-283.
6 Lang RM,Badano LP,Mor-Avi V,et al.Recommendations for Cardiac Chamber quantification by echocardiography in adults:an update from the American society of Echocardiography and the Eurpean Association of Cardiovascular Imaging[J].Eur Heart J Cardiorasc Imaging,2015,16(3):233-270.
7 Longenecker JC,Coresh J,Powe NR,et al.Traditional cardiovascular disease risk factors in dialysis patients compared with the general population:the CHOICE Study[J].J Am Soc Nephrol,2002,13(7):1918-1927.
8 Semple D,Smith K,Bhandari S,et al.Uremic cardiomyopathy and insulin resistance:a critical role for AKT[J].J Am Soc Nephrol,2011,22(2):207-215.
9 Mark PB,Johnston N,Groenning BA,et al.Redefinition of uremic cardiomyopathy by contrast-enhanced cardiac magnetic resonance imaging[J].Kidney Int,2006,69(10):1839-1845.
10 覃琴,周春.超声斑点追踪成像在心血管疾病中的应用[J/CD].中华医学超声杂志(电子版),2011,8(6):1342-1347.
11 成珍珍,王建华,丁桂春.斑点追踪成像技术的临床应用研究进展[J/CD].中华医学超声杂志(电子版),2013,10(11):25-28.
12 Alhaj E,Alhaj N,Rahman I,et al.Uremic cardiomyopathy:an underdiagnosed disease[J].Congest Heart Fail,2013,19(4):E40-E45.
13 Wakatsuki T,Schlessinger J,Elson E L.The biochemical response of the heart to hypertension and exercise[J].Trends Biochem Sci,2004,29(11):609-617.
14 王泓,杨斌,傅宁华,等.射血分数正常的尿毒症患者心肌形变与左心室构型的关系[J/CD].中华医学超声杂志(电子版),2011,8(2):324-330.
15 杨洪涛,赵菁莉,邢海涛.腹膜透析治疗尿毒症心肌病的临床研究[J].中国中西医结合肾病杂志,2006,7(12):716-717.
16 Krmar RT,Manouras A,Berg UB.Left ventricular mass index and its relation to ambulatory blood pressure,haemoglobin,and renal function in paediatric renal transplant recipients:a retrospective longitudinal analysis[J].Arch Dis Child,2009,94(12):996-997.
17 李泉水,姜健,陈书文,等.缺血心肌区域性纵向应变与圆周向应变特点[J/CD].中华医学超声杂志(电子版),2010,7(8):37-40.
18 Kosmala W,Plaksej R,Strotmann JM,et al.Progression of left ventricular functional abnormalities in hypertensive patients with heart failure:an ultrasonic two-dimensional speckle tracking study[J].J Am Soc Echocardiogr,2008,21(12):1309-1317.
19 朱法望,郑哲岚,童孟立,等.实时三维超声心动图定量评价腹膜透析治疗对尿毒症患者左心功能疗效的研究[J].中国超声医学杂志,2012,28(12):1089-1093.
20 Yan P,Li H,Hao C,et al.2D-speckle tracking echocardiography contributes to early identification of impaired left ventricular myocardial function in patients with chronic kidney disease[J].Nephron Clin Pract,2010,118(3):c232-c240.
21 孟庆国,尹立雪,李春梅,等.超声斑点成像技术评价左心室长轴心肌节段应变与位移[J].中华超声影像学杂志,2006,15(10):721-724.
22 段利科,李玲,谢明星,等.三维斑点追踪技术评价正常人左心室心肌应变的初步研究[J/CD].中华医学超声杂志(电子版),2010,7(5):803-810.
2 Stallworthy EJ,Pilmore HL,Webster MW,et al.Do echocardiographic parameters predict mortality in patients with end-stage renal disease?[J].Transplantation,2013,95(10):1225-1232.
3 葛均波,徐永健.内科学[M].8版.北京:人民卫生出版社,2013:524.
4 王海燕.肾脏病学[M].3版.北京:人民卫生出版社,2008:2049-2056.
5 王家玮.心肌疾病超声诊断[M].北京:人民卫生出版社,2002:275-283.
6 Lang RM,Badano LP,Mor-Avi V,et al.Recommendations for Cardiac Chamber quantification by echocardiography in adults:an update from the American society of Echocardiography and the Eurpean Association of Cardiovascular Imaging[J].Eur Heart J Cardiorasc Imaging,2015,16(3):233-270.
7 Longenecker JC,Coresh J,Powe NR,et al.Traditional cardiovascular disease risk factors in dialysis patients compared with the general population:the CHOICE Study[J].J Am Soc Nephrol,2002,13(7):1918-1927.
8 Semple D,Smith K,Bhandari S,et al.Uremic cardiomyopathy and insulin resistance:a critical role for AKT[J].J Am Soc Nephrol,2011,22(2):207-215.
9 Mark PB,Johnston N,Groenning BA,et al.Redefinition of uremic cardiomyopathy by contrast-enhanced cardiac magnetic resonance imaging[J].Kidney Int,2006,69(10):1839-1845.
10 覃琴,周春.超声斑点追踪成像在心血管疾病中的应用[J/CD].中华医学超声杂志(电子版),2011,8(6):1342-1347.
11 成珍珍,王建华,丁桂春.斑点追踪成像技术的临床应用研究进展[J/CD].中华医学超声杂志(电子版),2013,10(11):25-28.
12 Alhaj E,Alhaj N,Rahman I,et al.Uremic cardiomyopathy:an underdiagnosed disease[J].Congest Heart Fail,2013,19(4):E40-E45.
13 Wakatsuki T,Schlessinger J,Elson E L.The biochemical response of the heart to hypertension and exercise[J].Trends Biochem Sci,2004,29(11):609-617.
14 王泓,杨斌,傅宁华,等.射血分数正常的尿毒症患者心肌形变与左心室构型的关系[J/CD].中华医学超声杂志(电子版),2011,8(2):324-330.
15 杨洪涛,赵菁莉,邢海涛.腹膜透析治疗尿毒症心肌病的临床研究[J].中国中西医结合肾病杂志,2006,7(12):716-717.
16 Krmar RT,Manouras A,Berg UB.Left ventricular mass index and its relation to ambulatory blood pressure,haemoglobin,and renal function in paediatric renal transplant recipients:a retrospective longitudinal analysis[J].Arch Dis Child,2009,94(12):996-997.
17 李泉水,姜健,陈书文,等.缺血心肌区域性纵向应变与圆周向应变特点[J/CD].中华医学超声杂志(电子版),2010,7(8):37-40.
18 Kosmala W,Plaksej R,Strotmann JM,et al.Progression of left ventricular functional abnormalities in hypertensive patients with heart failure:an ultrasonic two-dimensional speckle tracking study[J].J Am Soc Echocardiogr,2008,21(12):1309-1317.
19 朱法望,郑哲岚,童孟立,等.实时三维超声心动图定量评价腹膜透析治疗对尿毒症患者左心功能疗效的研究[J].中国超声医学杂志,2012,28(12):1089-1093.
20 Yan P,Li H,Hao C,et al.2D-speckle tracking echocardiography contributes to early identification of impaired left ventricular myocardial function in patients with chronic kidney disease[J].Nephron Clin Pract,2010,118(3):c232-c240.
21 孟庆国,尹立雪,李春梅,等.超声斑点成像技术评价左心室长轴心肌节段应变与位移[J].中华超声影像学杂志,2006,15(10):721-724.
22 段利科,李玲,谢明星,等.三维斑点追踪技术评价正常人左心室心肌应变的初步研究[J/CD].中华医学超声杂志(电子版),2010,7(5):803-810.