超声三维斑点追踪成像评价尿毒症患者血液透析前后左心室收缩功能的研究

Role of ultrasonic three - dimensional speckle tracking imaging in assessment left ventricular systolic function in patients with uremia before and after hemodialysis

目的应用超声三维斑点追踪成像（3D—STI）评价尿毒症患者行高通量血液透析（HFHD）前后左心室整体收缩功能的变化。方法收集新发尿毒症患者（尿毒症组）86例及健康志愿者（对照组）59例。对照组于3D-STI检查前行血浆脑钠肽（BNP）检测，尿毒症组患者接受HFHD治疗并分别于透析前及4周后行BNP检测及3D—STI检查，比较并分析两组左心室三维整体面积应变（GAS）、整体圆周应变（GCS）、整体纵向应变（GLS）、整体径向应变（GRS）参数以及各参数与BNP水平的相关性。结果尿毒症组左心室3D．STI参数GAS、GCS、GLS及GRS均低于对照组（t=7．564、6．866、7．946、5．477，均P〈0．05）；对照组、尿毒症组透析前血浆BNP水平分别为（60．75±17．22）ng／L、（792．68±184．56）ng／L，两组差异有统计学意义（t=30．876，P〈0．05）。尿毒症组接受HFHD4周后左心室GAS、GCS、GLS及GRS均高于治疗前（t=4．233、5．933、6．546、2．959，均P〈0．05），BNP水平低于治疗前（t=27．533）。左心室3D-STI参数GAS、GCS、GLS及GRS与BNP水平呈负相关（r=一0．51、一0．64、一0．46、一0．43，均P〈0．05）。结论3D．STI能够准确评估尿毒症患者HFHD前后左心室整体收缩功能的变化，为临床治疗及疗效评价提供可靠依据。

Objective To assess the left ventricular global systolic function changes using ultrasonic three - dimehsional speckle tracking imaging （ 3 D - STI ） in patients with uremia undergoing high - flux hemodialysis （HFHD） treatment. Methods 86 patients with uremia and 59 healthy volunteers were selected. Participants of control group underwent plasma brain natrinuretic peptide（BNP） examinations before 3D -STI examinations. All the uremia patients received HFHD therapy, and underwent BNP and 3D - STI examinations before and after 4 weeks HFHD therapy. Parameters of left ventricular three dimensional global area strain（ GAS）, global circumferential strain （GCS） , global longitudinal strain （GLS） and global radial strain （GRS） were measured in each group. The correlation between each 3D -STI parameters and BNP level were analyzed. Results Compared with the control group, GAS, GCS, GLS and GRS of left ventricular were significantly lower （ t = 7. 564,6. 866,7. 946,5. 477, all P 〈0. 05 ） and BNP level in the control group were significantly higher in the uremia group[ （60.75 ±17.22） ng/L vs. （792.68 ± 184.56 ） ng/L, t = 30. 876, P 〈 0.05 ]. After HFHD therapy 4 weeks, GAS, GCS, GLS and GRS of left ventricular were significantly higher （ t = 4. 233,5. 933,6. 546,2. 959, all P 〈 0.05 ） and BNP level were lower （ t = 27. 533, P 〈 0.05 ） than before treatment in the uremia group. GAS, GCS, GLS and GRS of left ventricular were negatively correlated with BNP level（ r = - 0.51,0.64, - 0.46, - 0.43, all P 〈 0.05 ）. Conclusion 3D - STI can accurately evaluate the changes of left ventricular global systolic function in patients with uremia before and after hemodialysis, and provide reliable basis for clinical treatment and efficacy assessment.