超声心动图定量评价慢性肾脏病患者左室结构与功能

Quantitative evaluation of left ventricular configuration and function in patients with chronic kidney disease by echocardiography

目的探讨超声心动图定量评价慢性肾脏病(CKD)患者左室结构与功能改变情况的临床价值。方法选取我院收治的131例CKD患者为研究对象,分为CKD 2～3期组68例和CKD 4～5期组63例,另选同期健康成人60例为对照组,应用超声心动图测量并比较各组左室质量(LVM)、左室质量指数(LVMI)、相对室壁厚度(RWT)、左室射血分数(LVEF)、左室舒张早期减速时间(DTE)、二尖瓣口舒张早期血流峰值速度(E)和舒张晚期血流峰值速度(A)、二尖瓣环舒张早期间运动速度(Em)及E/Em值等。分析RWT和E/Em的影响因素及其相关性。结果 CKD 4～5期组出现左室结构改变53例(84.1%),CKD 2～3期组出现左室结构改变19例(27.9%),两组比较差异有统计学意义(P<0.05)。CKD 2～3期组LVM、LVMI、RWT均明显高于对照组,差异均有统计学意义(均P<0.05);CKD 4～5期组LVM、LVMI、RWT、A、E/Em均明显高于CKD 2～3期组和对照组,Em、DTE、E/A均明显低于CKD 2～3期组和对照组,差异均有统计学意义(均P<0.05)。颈-股动脉脉搏波传导速度(PWVcF)、估计肾小球滤过率(eGFR)是RWT的独立相关因素;PWVcF、RWT是E/Em的独立相关因素,RWT与eGFR呈负相关(r=-0.442,P<0.05),RWT与PWVcF呈正相关(r=0.513,P<0.05),PWVcF、RWT与E/Em均呈正相关(r=0.487、0.368,均P<0.05)。结论超声心动图技术发现左室结构改变可发生在CKD早期,功能改变发生在CKD晚期;左室结构及功能的改变均与动脉僵硬度密切相关。

Objective To explore the clincal value of left ventricular configuration and function in patients with chronickidney disease （CKD）by echocardiography.Methods According to the level of glomerular filtration rate （GFR）, 131 cases withCKD were divided into CKD 2-3 group （n=68）and CKD 4-5 group （n=63） .60 normal subjects were enrolled as control group atthe same time.The structural parameters included left ventricular mass （LVM）, left ventricular mass index （LVMI）, relative wallthickness （RWT）, and functional parameters included left ventricular ejection fraction（LVEF）, early diastolic blood flow peakvelocity of mitral valve orifice （E）, late diastolic blood flow peak velocity of mitral valve orifice （A）, early diastolic movement rate（Em）, ratio of E/Em of left ventricularwere acquired by echocardiography, then those parameters were compared among threegroups.The influence factors and correlation of RWT and E/Em were analyzed.Results Left ventricular configuration changeswere found in 53 cases （84.1%）in CKD 4-5 group, while only 19 （27.9%）left ventricular configuration changes were found inCKD 2-3 group, there was significant difference （P〈0.05） .The LVM, LVMI and RWT in CKD 2-3 group were significantly higherthan those in control group（all P〈0.05） .The LVM, LVMI, RWT, A and E/Em in CKD 4-5 group were significantly higher thanthose in CKD 2-3 group and control group （all P〈0.05） .The Em, DTE and E/A in CKD 4-5 group were significantly lower thanthose in CKD 2-3 group and control group （all P〈0.05） .Carotid-femoral artery pulse wave conduction velocity （PWVcF）andestimated glomerular filtration rate （eGFR）were the independent relevant factors of RWT.PWVcF and RWT were the independentrelevant factors of E/Em.eGFR was negatively correlated with RWT （r=-0.442, P〈0.05）, PWVcF was positively correlated withRWT （r=0.513, P〈0.05） .PWVcF and RWT were positively correlated with E/Em, respectively （r=0.487, 0.368, both P〈0.05） .Conclusion Left ventricular configuration changes are found in patients with early phase of CKD by echocradiography, and thefunction changes are more obvious in the later period of CKD.The changes of left ventricular configuration and function are closelyrelated to arterial stiffness.