二维斑点追踪成像技术评估尿毒症合并肺动脉高压患者右心功能的临床研究

Two-dimensional ultrasound speckle tracking imaging in the assessment of right ventricular function in patients with uremia and pulmonary arterial hypertension

目的:探讨二维斑点追踪成像技术对尿毒症合并肺动脉高压患者右心功能的临床应用。方法:选取2014年2月至2017年4月在本院行维持性腹膜透析的尿毒症患者84例,根据肺动脉收缩压(PASP)不同分为肺动脉高压组(PASP>5.32kPa,n=33)和肺动脉压正常组(PASP≤5.32kPa,n=51)。所有患者入院后均行常规超声心动图及二维斑点追踪成像技术检查,于心尖四腔切面测定右心室游离壁基底、中段、心尖段纵向收缩峰值应变(ε)、收缩峰值应变率(SRs)、舒张早期峰值应变率(SRe)、舒张晚期峰值应变率(SRa),并分析肺动脉高压组患者常规超声心动图指标与二维斑点追踪成像技术检查指标的相关性。结果:肺动脉高压组常规超声心动图指标右室前壁厚度(RVAW)、右心房横径(RAD)、右室舒张末期横径(RVED)、右室舒张期射血分数(RVEF)、肺动脉收缩压(PASP)高于肺动脉压正常组(P<0.05),右室舒张期射血分数(RVEF)低于肺动脉压正常组,差异均有统计学意义(均P<0.05);肺动脉高压组右心室游离壁基底段、中段及心尖段ε、SRs、SRe、SRa均低于肺动脉压正常组,差异均有统计学意义(均P<0.05);RAD与游离壁ε呈负相关关系(P<0.05),RVAW、PASP与游离壁ε、SRs呈正相关关系(P<0.05),RVEF与游离壁ε、SRs呈负相关关系(P<0.05),RVED、RVAW、PASP均与SRe呈负相关关系(P<0.05)。结论:二维斑点追踪成像技术可有效地定量评估尿毒症合并肺动脉高压患者的右心功能,且与常规超声心动图指标有较好的相关性。

Objective：To analyze the clinical value of two-dimensional speckle tracking imaging in the assessment of right ventricular function in patients with uremia and pulmonary arterial hypertension.Methods：84 patients with uremia who underwent continuous ambulatory peritoneal dialysis in our hospital from February 2014 to April 2017 were selected,and were divided into two groups according to the pulmonary arterial systolic pressure（PASP）：high pressure group（PASP〉5.32 kPa,n=33）and normal pressure group（PASP≤5.32 kPa,n=51）.All patients underwent conventional echocardiography and two-dimensional speckle tracking imaging examination after admission.The longitudinal systolic peak strain（ε）,systolic peak strain rate（SRs）,early diastolic peak strain rate（SRe）and advanced diastolic peak strain rate（SRa）of right ventricular free wall basal,middle and apical segments were determined through apical four chamber view.The correlation between the indexes of routine echocardiography and indexes of two-dimensional speckle tracking imaging of patients with uremia and pulmonary arterial hypertension was analyzed.Results：The conventional echocardiographic parameters right ventricular anterior wall thickness（RVAW）,right atrial diameter（RAD）,right ventricular end diastolic diameter（RVED）,right ventricular diastolic ejection fraction（RVEF）and pulmonary artery systolic pressure（PASP）in the high pressure group were higher than those in the normal pressure group（P〈0.05）,while the right ventricular diastolic ejection fraction（RVEF）was lower（P〈0.05）.Theε,SRs,SRe and SRa of right ventricular free wall basal,middle and apical segments in the high pressure group were lower than those in the normal pressure group（P〈0.05）.The RAD was negatively correlated withεof the free wall.RVAW and PASP were positively correlated withεof the free wall and SRs,while RVEF was negatively correlated withεof the free wall and SRs（P〈0.05）.RVED,RVAW and PASP were negatively correlated with SRe（P〈0.05）.Conclusion：Two-dimensional speckle tracking imaging technique could effectively evaluate the right cardiac function in patients with uremia and pulmonary arterial hypertension,and was correlated with the indexes of routine echocardiography.