三维斑点追踪技术评价尿毒症腹膜透析患者右心室功能

Assessment of right ventricular function by three-dimensional speckle tracking in uremic patients underwent peritoneal dialysis

目的应用三维斑点追踪技术评价尿毒症腹膜透析患者右心室功能。方法选择行维持性腹膜透析的尿毒症患者69例（左室射血分数及右室射血分数值均正常），其中肺动脉收缩压（PASP）正常组36例（PASP≤40mmHg，1mmHg=0．133kPa），PASP升高组33例（PASP〉40mmHg），正常对照组31例（PASP≤40mmHg）。于心尖四腔观获取动态三维右室模型，储存图像后应用EchoPAC工作站进行分析。应用三维斑点追踪技术测量并比较各组右室整体纵向收缩期峰值应变（GLS）、右室整体圆周收缩期峰值应变（GCS）、右室整体径向收缩期峰值应变（GRS）。结果PASP正常组与PASP升高组右室GLS均较对照组显著减低，差异有统计学意义（P〈O．05），且PASP升高组右室GLS较PASP正常组减低，差异有统计学意义（P〈0．05）；而三组间右室GRS、GCS差异无统计学意义（P〉0．05）。结论尿毒症腹膜透析患者即使右室整体收缩功能尚处于正常水平，但其纵向心肌的形变能力已经早于右室整体收缩功能出现下降，且早于径向、圆周方向上的整体形变能力。应用三维斑点追踪技术可准确检测右心室亚临床功能异常，从而为临床早期干预提供依据。

Objective To assess right ventricular（RV） function in patients with uremia underwent peritoneal dialysis using three-dimensional speckle tracking imaging. Methods 69 uremic patients with normal left ventricular ejection fraction and right ventricular ejection fraction values underwent peritoneal dialysis were divided into two groups according to pulmonary artery systolic pressure （PASP）. Group A consisted of 36 patients with PASP≤40 mmHg（1 mmHg = 0. 133 kPa）. Group B contained 33 patients with PASP≤40 mmHg. A healthy control group including 31 subjects was designated group N. RV dynamic three-dimensional model was obtained from the apical four-chamber view, afterwards the images were stored and analyzed on EchoPAC workstation. RV global longitudinal peak systolic strain （GLS）,global circumferential peak systolic strain（GCS） and global radial peak systolic strain（GRS） from each group were measured and compared. Results RV GLS were significantly decreased in uremic patients group A and B compared with group N （ P〈0.05）. RV GLS were even lower in group B compared with group A（ P〈 0.05）. No significant difference was found in RV GRS, GCS among group A, group B and group N（ P〉 0.05）. Conclusions Even RV systolic function is still at a normal level in patients with uremic peritoneal dialysis,but its longitudinal myocardial deformation capacity has been as early as RV systolic function decline, and early in the radial, circumferential direction of the global deformation capacity. The application of three-dimensional speckle tracking technology can accurately detect subclinical RV dysfunction,providing the basis for early clinical intervention.