超声瞬时波强技术评价尿毒症患者心脏-动脉整体功能

Evaluation of cardiovascular systemic function in uraemia patients by wave intensity

目的应用瞬时波强(WI)技术评价尿毒症患者早期心脏-动脉系统整体功能的临床研究价值。方法选取2014年1月至6月川北医学院附属医院肾内科尿毒症患者(尿毒症组)30例和健康体检中心健康对照组(健康组)30名,应用WI技术分别评价心脏功能、动脉弹性参数,心脏参数包括瞬时加速度波强峰值(W1),瞬时减速度波强峰值(W2),负向波面积(NA)、心电图R波至W1波顶点时间(R-W1)、W1与W2的时间间隔(W1-W2),动脉弹性参数包括血管僵硬度指数(β),血管压力应变弹性系数(Ερ)、脉搏波传导速度(PWVβ)、血管顺应性(AC)、脉搏波反射增强(AI)等。同时应用M型超声于左心室长轴切面测量左心室舒张期直径(LVDd)、室间隔厚度(IVS)、左心室后壁厚度(LVPWT)、左心室射血分数(LVEF),计算左心室心肌质量指数(LVMI)。采用独立样本t检验比较尿毒症组和对照组多项WI曲线参数的变化情况。结果尿毒症组与健康对照组比较,尿毒症组LVDd、LVPWT、LVMI、W1、W2、NA、β、Ερ、PWVβ参数的测值均升高[(52.23±6.25)mm vs(44.20±2.20)mm,(10.67±1.45)mm vs(8.90±1.06)mm,(177034.05±44729.42)g/m2 vs(97542.50±15278.82)g/m2,(15.14±8.76)mm Hg·m/s3 vs(6.75±4.13)mm Hg·m/s3,(3.55±2.92)mm Hg·m/s3 vs(1.53±1.00)mm Hg·m/s3,(78.28±58.08)mm Hg·m/s2 vs(41.10±24.47)mm Hg·m/s2,9.35±4.13 vs 5.98±1.53,(146.66±74.06)k Pa vs(75.72±19.63)k Pa,(7.16±1.60)m/s vs(5.41±0.66)m/s,(1 mm Hg=0.133 k Pa)],而尿毒症组较健康对照组W1-W2降低[(237.03±23.72)ms vs(278.41±50.94)ms],差异均有统计学意义(t值分别为6.638、5.393、9.211、4.900、3.703、3.274、4.334、5.237、5.718、-4.165,P值均<0.05),与健康对照组比较,尿毒症组R-W1、AC降低,IVS、AI升高[(102.28±13.98)ms vs(113.69±32.71)ms、(0.86±0.37)mm2/k Pa vs(0.88±0.23)mm2/k Pa、(11.30±1.88)mm vs(8.97±1.40)mm、15.13±10.85 vs 15.08±28.54],但差异均无统计学意义(t值分别为-1.814、-0.251、5.453、0.010,P值均>0.05)。结论 WI技术可无创评价尿毒症患者早期心血管功能、外周阻力,对尿毒症的进展及治疗提供重要的临床信息。

Objective To investigate the clinical value of wave intensity technique in evaluating cardiovascular system function in uraemia patients. Methods Thirty patients with uraemia（uraemia group） in Renal Department of Internal Medicine and 30 healthy individuals（normal control group） in Health examination center underwent examination by wave intensity in this study in Affiliated Hospital of North Sichuan Medical College from January 2014 to June. Cardiac function and arterial elasticity parameters were evaluated by this technology. The following heart parameters were obtained, including instantaneous acceleration wave intensity（W1）, instantaneous deceleration wave intensity（W2）, negative wave area（NA）, the time between electrocardiogram R wave apex and W1 wave apex（R-W1） and internal time between W1-W2 wave（W1-W2）. And the arterial elasticity parameters were stiffness parameter（β）, elastic coefficient（Ερ）, pulse wave velocity（PWVβ）, compliance（AC） and argumentation index（AI）. At the same time LVDd, IVS, LVPWT and LVEF were measured by M-mode ultrasonography in left ventricular long-axis view. KVMI was calculated. Independent samples t-test was used to compare the changes of WI curve parameters in uraemia group and normal control group. Results In uraemia group LVDd, LVPWT, LVMI, W1, W2, NA, β, Ερ and PWVβwere significantly higher than those in the normal control group [（52.23±6.25） mm vs（44.20±2.20） mm,（10.67±1.45） mm vs（8.90±1.06） mm,（177034.05±44729.42） g/m2 vs（97542.50±15278.82） g/m2,（15.14±8.76） mm Hg·m/s3 vs（6.75±4.13） mm Hg·m/s3,（1 mm Hg=0.133 k Pa）,（3.55±2.92） mm Hg·m/s3 vs（1.53±1.00） mm Hg·m/s3,（78.28±58.08） mm Hg·m/s2 vs（41.10±24.47） mm Hg·m/s2, 9.35±4.13 vs 5.98±1.53,（146.66±74.06） k Pa vs（75.72±19.63） k Pa,（7.16±1.60） m/s vs（5.41±0.66） m/s,（t=6.638, 5.393, 9.211, 4.900, 3.703, 3.274, 4.334, 5.237, 5.718, all P〈0.05）], but W1-W2 was markedly decreased [（237.03±23.72） ms vs（278±50.94） ms, t=-4.165, P〈0.05）]. However, there were no significant differences between two groups for R-W1, AC, IVS, AI [（102.28±13.98） ms vs（113.69±32.71） ms,（0.86±0.37） mm2/k Pa vs（0.88±0.23） mm2/k Pa,（11.30±1.88） mm vs（8.97±1.40） mm, 15.13±10.85 vs 15.08±28.54, t=-1.814,-0.251, 5.453, 0.010, all P〈0.05]. Conclusion Wave intensity technique can noninvasively detect cardiac function, peripheral resistance, as well as elasticity of artery, and can also provide important clinical information for progress and intervention treatment of uraemia.