二维斑点追踪显像技术评价早期慢性肾病患者左心室功能的临床研究

Two-dimensional speckle tracking imaging in the evaluation of left ventricular function in patients with early chronic kidney disease

目的左心室功能的评估对于早期慢性肾病(chronic kidney disease,CKD)患者具有重要的临床意义。文中探讨二维斑点追踪显像(two-dimensional speckle tracking imaging,2D-STI)技术评价早期CKD患者左心室功能的临床应用价值。方法选取Ⅱ-Ⅲ期CKD患者20例纳入CKD组,选取20例健康志愿者作为对照组。应用常规超声心动图评价左心室结构和功能,使用2D-STI技术定量检测左心室壁各向整体应变、应变率及左心室扭转指标。结果常规超声心动图测量指标CKD组左房内径、左心室舒张末内径、左心室射血分数与对照组比较差异无统计学意义(P>0.05)。2D-STI超声心动图测量指标CKD组左心室壁整体纵向应变(-19.8±2.4)%及应变率(-1.1±0.3)S-1显著低于对照组的(-22.6±2.1)%、(-1.8±0.2)S-1,左心室心尖部最大旋转角度(11.6±4.4)°及左心室扭转角度(19.6±3.8)°显著高于对照组的(8.2±3.7)°、(13.5±3.6)°,差异均有统计学意义(P<0.05);CKD组整体周向应变、整体周向应变率、整体径向应变、整体径向应变率及左心室基底部最大旋转角度与对照组比较差异无统计学意义(P>0.05)。结论 2D-STI技术可以灵敏地检出早期CKD患者亚临床型左心室功能异常。

Objective Evaluation of left ventricular （ LV） function has great clinical significance in patients with early chro-nic kidney disease （CKD）.The study was to evaluate whether two-dimensional speckle tracking imaging （2D-STI） technique can offer additional information of cardiac dysfunction in early CKD patients . Methods Conventional echocardiography and 2D-STI echocar-diography were performed in CKD group of 20 patients at stage Ⅱ-Ⅲ and control group of 20 healthy volunteers .LV structure and function were evaluated by conventional echocardiography .Multidirectional strain , strain rate and LV twist parameters were analyzed by 2D-STI technique. Results There was no statistical difference in conventional echocardiographic parameters such as left atrial diam -eter, end-diastolic LV diameter and ejection fraction between CKD group and control group .By applying 2D-STI technique, CKD group had significantly decreased value of global longitudinal strain （-19.8 ±2.4）%and strain rate（-1.1 ±0.3）S-1 in comparison to control group（-22.6 ±2.1）%、（ -1.8 ±0.2）S-1, along with significant increase in the values of maximum LV rotation （11.6 ± 4.4）°and LV twist（19.6 ±3.8）°in comparison to control group（8.2 ±3.7）°、（13.5 ±3.6）°（P〈0.05）.There was no differences in both global circumferential and radial deformation parameters as well as maximum rotation value of LV assist device between two groups（P〉0.05）. Conclusion 2D-STI can detect subclinical LV dysfunction sensitively in early CKD patients .