二尖瓣瓣环位移联合TEI指数评价尿毒症患者左室功能的可行性分析

Using TMAD combined with TEI index to evaluate left ventricular systolic function in uremia patients

目的探讨二尖瓣瓣环位移(TMAD)联合TEI指数早期评价尿毒症患者左室整体收缩功能变化的可行性。方法选择42例临床确诊尿毒症并且经胸常规二维超声心动图检查显示心内结构及左室收缩功能正常的患者为尿毒症组,选30例门诊体检结果正常人作为对照组,用STI技术测量TMAD,用组织多普勒法(TDI)测量左室TEI指数。分析尿毒症组与对照组TMAD、左室TEI指数差异是否具有统计学意义以及尿毒症组的TMAD与左室TEI指数的相关性。结果尿毒症组收缩期二尖瓣瓣环室间隔处位移(TMAD-S)、左室侧壁处位移(TMAD-L)、二尖瓣瓣环中点位移(TMAD-Midpt)及二尖瓣瓣环中点最大位移占左室长轴百分比(TMAD-Midpt%)均低于对照组,差异具有显著性意义(P<0.05)。尿毒症组TEI指数显著高于对照组,差异具有显著性意义(P<0.05)。尿毒症组TMAD值与TEI指数呈负相关(r=-0.592,P<0.05)。结论 TMAD技术联合TEI指数比常规二维超声心动图检查能够早期检测出尿毒症患者左室整体收缩功能减低,给临床早期预防、治疗提供可靠依据,是一种可行的方法。

Objective To determine Tissue Motion Annular Displacement（ TMAD） of the mitral valves combined with TEI index to evaluate changes of left ventricular systolic function in patients with uremia. Methods We selected 42 early uremia patients as research objects. Transthoracic conventional two- dimensional echocardiography showed no significant abnormality in cardiac structure and left ventricular systolic function. Analysis were performed on the measurement result of TMAD using STI and TEI index using Doppler（ TDI）. Another 30 cases were used as a normal control group,and compared to the uremia patient group. Results 2D- STI determination of systolic mitral valve annulus in patients with Ventricular septal（ TMAD- S）,the displacement of the left ventricle wall（ TMAD- L） and the displacement of midpoint of the mitral valve annulus（ TMAD- Midpt）,and the maximum displacement of the midpoint of the mitral valve annulus as a percentage of left ventricular long- axis（ TMAD- Midpt%） were lower than those in the control group; the differences were statistically significant（ P 〈0. 05）. The TEI index of case group measured with tissueDoppler Imaging（ TDI） was significantly higher than the control group,the difference was statistically significant（ P〈 0. 05）. TMAD value of case group was negatively correlated with TEI index（ r =- 0. 592,P〈 0. 05）. Conclusion TMAD technology combined with TEI index can find the left ventricular systolic dysfunction earlier than two dimensional echocardiography and provide reliable evidence for early prevention and treatment. It is a practical method.