慢性肾衰竭患者早期心脏结构及功能的初步观察

The preliminary observation of the change of cardiac structure and heart function in patients with early stage chronic renal failure

目的观察慢性肾衰竭(CRF)患者早期心脏结构及功能的改变情况。方法选择我院肾内科57例CRF早期患者,根据肌酐清除率(Ccr)水平分为肾功能不全代偿期(Ⅰ期,10例)、肾功能不全失代偿期(Ⅱ期,15例)、肾衰竭期(Ⅲ期,32例),另选20例正常人作对照组。分别用彩色多普勒超声心动图(UCG)进行心脏结构及心功能检测。结果与正常组比较,随着Ccr水平降低,CRF早期各组患者室间隔厚度、左心室后壁厚度及左心室质量均明显增加(P<0.01);Ⅲ期左心房、室内径明显增加(P<0.01),二尖瓣E、A峰值流速增加,E/A比值明显降低,左心室舒张功能减低,但收缩功能指标FS、EF改变无统计学差异(P>0.05),肾功能不全失代偿期、肾衰竭期患者瓣膜反流及心包积液增多,以二尖瓣反流为著(P<0.01)。结论CRF早期已存在左心扩大,左心室肥厚,舒张功能减退,但收缩功能尚无显著异常,随病情进展二尖瓣反流明显增多。

Objective It is to observe the changes of cardiac structure and heart function in patients with early stage chromic renal failure. Methods 57 patients with early stage chronic renal failure were divided into three groups based on the grade of blood creatinine clearance rate （Ccr）, Group 1 ： compensated stage（n= 10）, Group 2： decompensate stage（n= 15）, Group 3： mild uremia（ n= 32） ; and 20 healthy cases was included the control group. The cardiac structure and heart function were examined by echocardiogram each group. Results Compared with control group, the levels of IVSdT, LVPWdT and LVMI in patient group were increased significantly （P〈 0.01）; LA and LVEDd of group 3 increased markedly （P 〈 0.01）, E and A peak flow velocity of mitral valve was increased, and the E/A value and cordis diastolic function were decreased significantly. But the cordis systolic function indexes such as EF and FS were not decreased（ P 〉 0.05）. The frequencies of valvular regurgitation and hydropericardium of group 2 and 3 were increased, especially for mitral regurgitation （P〈0.01）. Conclusion Patients of early stage chronic renal failure have left ventricular hypertrophy （LVH）, left ventricle dilation and decreased diastolic function. But there is no significant abnormality in systolic function, and the frequency of mitral regurgitation is increased with the development of pathogenetic condition.