超声技术在肾移植术后患者心脏结构与功能改变评价中应用

Evaluation of kidney transplantation on left ventricular morphologic and functional changes by tissue Doppler imaging

目的探讨应用超声技术在评价肾移植术后患者心脏结构功能的改变中的应用。方法 30例进行肾移植术的患者,术前、术后6个月及12个月,分别在二维超声模式下测量左房及左室内径,室间隔及左室后壁厚度,每搏输出量及射血分数等。应用常规超声测量左房、左室大小,室间隔及左室后壁厚度。应用组织多普勒成像技术(TDI)检测左室二尖瓣环的收缩期和舒张早期峰值运动速度。各参数均取3个心动周期的平均值。结果常规超声心动图显示,肾移植术后1年,室间隔及左室后壁厚度明显下降(P<0.05),左房及左室内径略减小(P>0.05)。组织多普勒超声显示,二尖瓣环舒张早期运动速度略增加,但差异无统计学意义(P>0.05),而收缩期运动速度变化不明显。4例患者经过有效控制血压后,左室明显缩小并且舒张功能明显改善。结论肾移植术可以逆转左心室肥厚。肾移植术后1年,应用组织多普勒超声可以发现左室舒张功能轻微的改善。控制血压对肾移植患者有重要意义。

Objective To investigate the morphologic and functional changes of left ventricle in kidney transplant patients detected by tissue Doppler imaging （TD!）. Methods The study evaluated 30 patients with chronic kidney disease. The echocardiographic examinations were performed before transplantation and 6 and 12 months after renal transplantation. The following measurements were performed：left atrial diameter（ LA）, left ventricular end-diastole diameter（ LV）, interventricu- lar septal thickness （IVS）and posterior wall thickness of left ventricle （PWLV）, output per stroke and blood ejection frac- tion. The measurements were obtained in B-mode following the conventional recommendations. Quantitative Tissue Doppler Imaging （QTVI） studies were obtained from mitral annulus sites, from apical 4-chamber views,2-chamber views and 3-cham- ber views. The peak systolic mitral annular velocities （Sin）early diastolic mitral annular velocities （Em）measured by TDI. Average values of at least 3 cardiac cycles were used. Results The echocardiography showed that there was a reduction in IVS and PWLV after 1 year of kidney transplantation （ P 〈 0. 05 ） , the LA and LV reduced mildly （ P 〉 O. 05 ）. TDI showed that Em increased mildly and Sm had no significant variation（P 〉 0. 05 ）. Four patients diastolic function increased and LV reduced gradually after well control their blood pressure. Conclusion Kidney transplantation resulted in regression of LV hypertrophy. One year after the renal transplantation, a mild increase of diastolic function, that was mainly determined by TDI. It is important to well control of blood pressure to every patient.