慢性肾衰竭早期患者心脏结构及功能的超声心动图检查初步观察

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

目的探讨慢性肾衰竭(CRF)早期心脏结构及心功能的改变。方法 选择首都医科大学附属宣武医院心内科57例CRF早期患者,根据肌酐清除率(Ccr)水平将其分为3组,Ⅰ期组:肾功能不全代偿期(n=10);Ⅱ期组:肾功能不全失代偿期(n=15);Ⅲ期组:肾衰竭期(n=32);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。结果与正常对照组比较,随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重量均明显增加(P<0．01);肾衰竭期左心房、室内径明显增加(P<0．01),二尖瓣E、A峰值流速增加,以A峰增加明显(P<0．01),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 To investigate the changes of cardiac structure and heart function in patients with early stage chronic renal failure. Methods Fifty-seven subjects with early stage chronic renal failure were divided into three groups based on the grade of blood creatinine clearance rate. group Ⅰ：compensated stage（n=10）;groupⅡ：decompensate stage（n=15）; group Ⅲ：mild uremia（n=32）and control group（n：20）.All patients were examined by echocardiogram.Results Compared with control group, IVSdT, LVPWdT and LVMI in patient group were increased significantly （P〈0.01）;LA and LVIDd of group Ⅲ increased markedly（P〈0.01）, meanwhile,E、A peak flow velocity of mitral valve increased, ratio of E/A and cardia diastolic function decreased significantly, but indexes of cardio systolic function such as EF and FS did not decrease （P〉0.05）; the frequencies of mitral regurgitation and pericarditis of group Ⅱand Ⅲ were increased, especially for mitral regurgitation（P〈0.01）. Conclusions Patients with early stage chronic renal failure have left ventricular hypertrophy（LVH）, left ventricle dilation and decreased diastolic function, but do not have significant abnormd systolic function, the frequency of mitral regurgitation increased with the development of state of illness.