纠正贫血对维持性血液透析患者心肌背向散射特征的影响

Effect of anemia-correction on ultrasonic myocardial integrated backscatter in maintenance hemodialysis patients

目的采用超声组织定征技术测量尿毒症维持性血液透析(MHD)患者的心肌背向散射积分值,了解MHD患者心肌声学密度特征并探讨贫血对其影响。方法选择透析龄3-6 月的MHD患者共45例,30例贫血(男:女20:10),15例无贫血(男:女10:5),血压均控制稳定。同时设健康对照组15例(男:女10:5),均接受超声组织定征检测。所有患者随访1年后再次接受超声组织定征检查。随访期间患者血压控制平稳,透析方案无改变。贫血组患者随机分成2 组,各15例(男:女10:5),1组经调整红细胞生成素(EPO)等药物后,3月内Hb上升至(109．75± 4．29)g/L,并基本维持该水平;另1组Hb水平维持在100g/L以下。非贫血组患者Hb水平保持稳定。结果入选时非贫血组患者心肌平均背向散射积分值(AIB)为6．21±0．22,其周期变化幅度(CVIB)为9．88±0．61;贫血组患者AIB为8．20±0．19,CVIB为7．87±0．51;对照组AIB为 5．94±0．21,CVIB为10．52±0．86。随访1年后,贫血纠正组患者AIB及CVIB值得以改善,但与正常人群仍有显著差异;贫血未纠正组AIB较基础值上升,CVIB较前有下降;非贫血组患者无显著变化。结论透析初期无贫血且血压控制良好的患者,其心肌AIB及CVIB与正常人群相似。贫血是影响尿毒症心肌纤维化的重要因素之一,早期纠正贫血很重要。尿毒症患者一旦发生心肌纤维化,则难以逆转。

Objective To measure the ultrasonic baekscatter parameters of myocardium in maintenance hemodialysis （MHD） patients and to evaluate the effects of anemia-correction on the patients＇ myocardial properties. Methods Forty-five maintenance hemodialysis patients whose blood pressure were in good control and 15 healthy volunteers （M：F 10：5）were involved, with 30 anemia （M：F 20：10）and 15 non-anemia （M ：F 10：5）. With a history of 3 to 6 months maintenance hemodialysis, all the patients undertook eehocardiography for ultrasonic tissue characterization at the beginning of the study and at the end of one-year follow-up. Following the initial eehocardiography, anemic patients were randomly divided into two subgroups, one was to correct anemia within the first 3 months and to maintain it, the other was to keep a hemoglobin below 100 g/L. Non-anemic patients maintained their hemoglobin level within the normal range. During the follow-up, all patients＇ blood pressure were kept in good control in each group. Results At the beginning of the study, the value of the average integrated baekseatter （AIB） and the cyclic variation of integrated baekscatter （CVIB） was 6.21±0.22 and 9.88±0.61 in non-anemia group, 8.20±0.19 and 7.87±0.51 in anemia group, 5.94±0.21 and 10.52±0.86 in control gourp respectively. After one year＇s therapy,ultrasonicbackseatter parameters （AIB and CVIB） in anemia-corrected subgroup were improved, but the values were still different from those of the control group. As for the anemia-uncorrected subgroup, its AIB was elevated while CVIB was reduced compared with the initial values. There was no significant change in non-anemic group. Conclusions Anemic hemodialysis patients have a higher intergrated backscatter value than non-anemic patients, while non-anemic, non-hypertensive patients have a similar ultrasonic integrated values to the healthy people. Anemia may be one of the major factors contributing to myocardial fibrosis in the early stage of cardiomyopathy.