超声组织多普勒技术对慢性肾脏病患者左右心室功能的评价

Evaluation of Ventricular Function in Patients with Chronic Kidney Disease by Using Ultrasound Tissue Doppler Imaging

目的：探讨组织多普勒技术（TDI）在慢性肾脏病（CKD）患者中的心肌运动速度频谱变化，评价其在心功能中的应用价值。方法：将37例CKD患者分成两组，1～3期为A组（15例），4～5期为B组（22例），选择健康成年人作为正常对照组C组（23例），在左室侧壁二尖瓣环、间隔二尖瓣、右室游离壁三尖瓣环3个位点，记录收缩期S波峰值（sm）、舒张早期E波峰值（Em）、舒张晚期A波峰值（Am）。结果：A、B两组3个瓣环位点Em及Em／Am比值均显著低于C组，右室游离壁Am显著高于C组，而两组在左室侧壁Am、间壁Am上与C组无差别。CKD患者右室游离壁Em、Am、Em／Am比均有显著性变化。慢性肾脏病患者左室侧壁二尖瓣环Sm与正常组存在显著性差异，而间隔二尖瓣环Sm、右室游离壁三尖瓣环Sm则无差异。左室EF值（LVEF）与左室侧壁二尖瓣环Sm、Em、Em／Am比及间隔二尖瓣环位点的Em／Am比具有较好的相关性（依次为：R=0．29，R=0．28，R=0．32，R=0．27，所有P〈0．05）。结论：CKD患者的左右心室舒张功能减退，且以右室减退为著，左室的收缩功能也有减退依据。TDI可以较好的评价此类患者的心室功能。

Objective To evaluate the feasibility of ultrasound tissue Doppler imaging （TDI） technology assessment of ventricular function in patients with chronic kidney disease （CKD）. Methods 37 cases of CKD patients were divided into two groups, 1-3 staging as groupA（15 cases）, 4-5 staging as group B （22 cases）, 23 healthy volunteers as group C. TDI measurement was taken at lateral and septal mitml annulus as well as tricuspidannulus in the apical 4-chanber view, to record contraction S-wave peak （Sm）, early diastolic E-wave peak（Em）, late diastolic A wave peak（Am）. Results The Emand Em/Am ratioat three annulus sites of A and B groups were all significantly lower than that of group C, while Am at right ventricular（RV） free wall was significantly higher than that of group C. On the otherwise, Am in lateral and septal mitral annulus of A and B groups were not different with that of group C. Em, Am, Em/Am at right ventricular free wall in CKD patients were all significantly changed. Comparing with group C, Sm at left ventricular lateral mitral annular and partition in patients with CKD was obviously different, while Sm at the interval mitral annular and right ventricular free wall tricuspid annulus was not different. Value of left ventricular EF （LVEF） had a good correlation with left ventricular lateral mitral annular Sm, Em, Em/Am ratio and the interval mitral annulus Ern/Am （in order： R= 0.29, R= 0.28, R= 0.32, R=0.27, all P〈0.05）. Conclusion The left and right ventricular diastolic functions in CKD patients were impaired, especially that of the right ventricular. The Left ventricular systolic function was also declined. TDI is a better evaluation of ventricular function in CKD patients.