三维斑点追踪技术评价单次透析对尿毒症患者左心室收缩功能的影响

Application of 3-dimensional speckle tracking imaging in assessing the left ventricular systolic function of patients with uremia after a single hemodialysis

目的 应用三维超声斑点追踪成像（3-dimensional speckle tracking imaging,3D-STI）技术评价单次透析对尿毒症患者左室整体收缩功能的影响.方法 选取门诊维持血液透析稳定的尿毒症患者37例,于透析前、后30 min内各行一次心脏超声检查.选取29例年龄、性别匹配的健康志愿者为正常对照组.测量超声常规指标并计算左室心肌质量指数（LVMI）,并用组织多普勒显像（TDI）测量二尖瓣环收缩期峰值速度（S ＇）.3D-STI测量指标：取标准心尖四腔观采集左室全容积图像并存储,应用3D-STI软件进行脱机分析,自动计算出左室舒张末期容积（LVEDV）、左室收缩末期容积（LVESV）、左室射血分数（LVEF）以及左室整体纵向收缩期峰值应变（LVGLS）、径向收缩期峰值应变（LVGRS）、圆周收缩期峰值应变（LVGCS）和面积收缩期峰值应变（LVGAS）.比较透析前与正常对照组,透析前、后超声常规指标及3D-STI指标结果的差异.结果 ①常规超声结果：与对照组比较,尿毒症透析前左室舒张末期内径（LVDD）、室间隔舒张末期厚度（IVSD）、左室后壁舒张末期厚度（LVWPD）、左房内径（LAD）测值均显著增大,差异有统计学意义（P＜0.05）,而S＇则降低（均P＜0.05）.与对照组比较,尿毒症透析前LVMI明显高于正常对照组（P＜0.05）.透析后LVDD、LAD、左房容积指数（LAV index）测值均较透析前显著降低（均P＜0.05）,而S ＇在透析前后无显著变化（P＞0.05）.②3D-STI结果：与对照组比较,尿毒症透析前LVEF、LVGLS、LVGCS、LVGRS、LVGAS测值均显著降低（均P＜0.05）;LVEDV、LVESV较对照组显著升高（均P＜0.05）;透析后LVEDV、LVESV、LVGLS较透析前测值均显著降低（均P＜0.05）,而LVEF、LVGRS、LVGCS、LVGAS较透析前无显著变化（均P＞0.05）.结论 单次血透前、后左室整体收缩功能无显著改变,但LVGLS在透析后短期显著降低,表明该参数对前负荷的变化较敏感,呈容量负荷依赖性.故在测量尿毒症患者的LVGLS时要充分考虑到患者的前负荷状态.

Objective To assess the impact of a single hemodialysis on the left ventricular systolic function of uremia patients with 3-dimensional ultrasound speckle tracking imaging （3D-STI）.Methods Thirty-seven clinically stable outpatients with uremia undergoing hemodialysis were studied.The echocardiographic examinations were obtained in 30 minutes before and after homodialysis.Twenty nine normal subjects with age and sex matched were selected as control groups.Conventional ultrasound was recorded and then left ventricular mass index（LVMI） was calculated.The peak systolic mitral annular velocity S＇ was recorded by tissue Doppler imaging.3D-STI imaging were recorded from standard left ventricular apical 4-chamber views before and after a single hemodialysis.Left ventricular end diastolic volume （LVEDV）,left ventricular end systolic volume （LVESV）,left ventricular ejection fraction （LVEF）,and left ventricular global longitudinal peak systolic strain （LVGLS）,left ventricular global radial peak systolic strain （LVGRS）,left ventricular global circumferential peak systolic strain （LVGCS）,left ventricular global area peak systolic strain （LVGAS） were measured.The indicators of conventional ultrasound and 3D-STI were compared between the pre-hemodialysis group and the normal control group,and also between pre-and post-hemodialysis groups.Results ①Compared with the control group,the left ventricular end-diastolic diameter （LVDD）,interventrieular septal thickness at diastole （IVSD）,left ventricular posterior wall thickness at diastole（LVWPD）,left atrial diameter（LAD） in the group before a single hemodialysis were significantly higher （P ＜0.05 for all）.Meanwhile,the S＇ was significantly lower （P ＞0.05） and LVMI was significantly higher in the pre-hemodialysis group than the control group（P ＜ 0.05）.The LVDD,LAD,left atrial volume index（LAVI） were significantly lower in the post-hemodialysis group than that in the pre-hemodialysis group（P ＜0.05 for all）.②Results of 3D-STI showed that the LVEF,LVGLS,LVGCS,LVGRS,LVGAS was significantly lower,however LVEDV,LVESV were higher in the pre-hemodialysis group compared with the control group （P ＜ 0.05 for all）.After a single hemodialysis,LVEDV,LVESV,LVGLS were significantly lower than before（P ＜0.05 for all）,but LVEF,LVGRS,LVGCS,LVGAS were not significantly changed （P ＞ 0.05 for all）.Conclusions After a single hemodialysis,the whole systolic function of the left ventricular was not changed.but the left ventricular global longitudinal peak systolic strain was significantly lower.The parameter of LVGLS was sensitive to the change of preload and was volume-load dependent.The preload of the patients should be sufficiently considered when the LVGLS are measured in the patients with uremia undergoing hemodialysis.