基于时空概念研究慢性肾脏病患者心内外膜的旋转

Evaluation of endocardial and epicardial rotation based on the concept of space-time in chronic kidney disease patients

目的：通过二维斑点追踪技术（STI）探讨慢性肾脏病（CKD）患者心内、外膜旋转角度在不同时相的改变。从时间、空间两个方面对不同分期的CKD患者心功能进行评价，了解其最初发生改变的部位及时相。方法：CKD患者1～3期为CKD1组．4．5期为CKD2组，每组各25例，正常对照组25例。将3组研究对象通过STI技术测得的心内外膜旋转角度进行比较。结果：①等容收缩期：CKD1，2组的基底段与心尖段心内外膜的旋转角度无明显改变。②射血期：基底段与心尖段的心内膜，CKD1．2组的旋转角度均减小；基底段与心尖段的心外膜，CKD2组的旋转角度减小，CKD1组无改变。⑧等容舒张期末：基底段与心尖段的心内膜CKD1，2组的解旋率均减小；基底段的心外膜，CKD1，2组的解旋率同样减小。结论：STI技术可以评价CKD患者心功能最初改变的具体时相及部位。

Objective： To discuss the change of endocardial rotation angle and epicardial rotation angle in different phases by two-dimensional speckle tracking technology （STI） on patients with chronic kidney disease （CKD）, we can evaluate cardiac function in patients with different stages of CKD from two aspects of time and space, and know its initial change in different planes and phases at the same time. Methods： Fifty patients with CKD were included. Among them stage 1-3 were assigned as CKD group 1, stage 4, 5 were assigned as CKD group 2. Each group included 25 cases. Twenty-five normal patients were in control group. The mean rotation angle of endocardium and epicardium of the three groups were obtained at each phase using STI. Results： ①During isovolumic contraction period, the rotation angle of endocardium and epicardium in both the basal and apical cardiac planes in CKD 1 and CKD 2 had no significant change. ②During ejection period, the rotation angle of endocardium in both the basal and apical cardiac planes in CKD 1 and CKD 2 were decreased; The rotation angle of epi-cardium in both basal and apical cardiac planes in CKD 2 were decreased. ③At the end of isovolumic diastole, the rate of endocardial untwisting in both basal and apical planes in CKD 1 and CKD 2 reduced significantly; The rate of epicardial un-twisting in basal plane in CKD 1 and CKD 2 reduced at the same time. Conclusions： STI has a potential ability to evaluate when and where the heart function have changed first in patients with CKD by measuring the rotation of endocardium and epicardium of left ventricle.