超声心动图在慢性肾脏病患者心血管疾病筛查中的应用价值

Application value of echocardiography in screening of cardiovascular disease in patients with chronic kidney disease

目的探讨超声心动图在慢性肾脏病(CKD)患者心血管疾病筛查中的应用价值。方法选择2013年9月~2016年7月北京中医医院顺义医院(以下简称"我院")诊治的CKD患者78例作为CKD组,选择同期在我院进行体检的健康志愿者78例作为对照组,调查两组的一般资料,观察两组患者的超声心动图检查结果与肾功能常规指标检测结果,同时进行相关性分析。结果两组性别、年龄、收缩压、舒张压、体重指数等差异无统计学意义(P>0.05)。CKD组的左房内径(LAD)、左室舒张末期内径(LVDd)、左室收缩末期内径(LVDs)、左室收缩末容积(LVESV)、左室舒张末容积(LVEDV)、舒张早期跨二尖瓣血流速度/舒张晚期跨二尖瓣血流速度(E/A)值分别为(37.11±2.19)cm、(5.11±0.44)cm、(3.69±0.83)cm、(49.20±11.49)mL、(108.33±22.19)mL和(1.02±0.32),对照组分别为(34.11±3.10)cm、(4.72±0.44)cm、(2.93±0.44)cm、(25.02±5.66)mL和(76.20±13.10)mL和(1.27±0.44),两组比较差异有统计学意义(P<0.05)。CKD组的尿素氮(BUN)、肌酐(Cr)值明显高于对照组,差异有统计学意义(P<0.05),两组的血红蛋白(Hb)、尿酸(UA)、低密度脂蛋白-胆固醇(LDL-C)、三酰甘油(TG)值差异无统计学意义(P>0.05)。在CKD组中,Pearson相关分析显示:LAD、LVDd、LVDs、LVESV、LVEDV与Cr呈正相关(r=0.334、0.514、0.442、0.298、0.332,P<0.05),与E/A呈负相关(r=-0.345,P<0.05),LAD、LVDd与BUN呈正相关(r=0.442、0.301,P<0.05)。多因素回归分析显示LAD、LVDd、LVDs、E/A为影响Cr的主要独立危险因素(P<0.05),LAD、LVDd为影响BUN的主要独立危险因素(P<0.05)。结论超声心动图在CKD患者心血管疾病筛查中的应用能有效反映患者的心功能状态与病情,与肾功能常规指标密切相关。

Objective To investigate the value of echocardiography in screening of cardiovascular disease in patients with chronic kidney disease （CKD）. Methods From September 2013 to July 2016, in Shunyi Hospital of Beijing Chinese Medicine Hospital （＂our hospital＂ for short）, 78 CKD patients were selected as the CKD group, and 78 healthy volunteers in our hospital were selected as the control group at the same period, the general survey data, echocardiography imaging and renal function index were recorded and given correlation analysis. Results There were no statistically significant differences in gender, age, systolic blood pressure, diastolic blood pressure, body mass index between the two groups （P 〉 0.05）. The LAD, LVDd, LVDs, LVESV, LVEDV, E/A in the CKD group were （37.11±2.19） cm, （5.11± 0.44） cm, （3.69±0.83） cm, （49.20±11.49） mL, （108.33±22.19） mL and （1.02±0.32）, thoes in the control group were （34.11±3.10） era, （4.72±0.44） cm, （2.93±0.44） cm, （25.02±5.66） mL and （76.20±13.10） mL and （1.27±0.44）, there were statistically significant differences between the two groups in this index （P 〈 0.05）. The Cr and BUN values of the CKD group were significantly higher than those of the control group, the differences were statistically significant （P 〈 0.05）. There were no significant differences in UA, Hb, TG and LDL-C between the two groups （P 〉 0.05）. In the CKD group, Pearson coefficient correlation analysis showed that LAD, LVDd, LVDs, LVESV, LVEDV were significantly positively correlated with Cr （r = 0.334, 0.514, 0.442, 0.298, 0.332, P 〈 0.05）, E/A was negatively correlated with Cr （r = -0.345,P 〈 0.05）, LAD, LVDd were positively correlation to BUN （r = 0.442, 0.301, P 〈 0.05）. Multivariate regression analysis showed that LAD, LVDd, LVDs, E/A were the main independent risk factors for Cr （P 〈 0.05）, LAD and INDd were the main independent risk factors for BUN （P 〈 0.05）. Conclusion The application of echocardiography in the screening of cardiovascular disease in patients with chronic kidney disease can effectively reflect the state of the heart function and the condition of the patients, and it is closely related to the routine indexes of renal function.