实时三维超声心动图评价慢性肾脏病患者左室收缩功能及同步性的异常

Real-time three-dimensional echocardiography in evaluating the changes of left ventricular systolic function for different degrees of chronic kidney disease patients

目的应用实时三维超声心动图(RT-3DE)评价慢性肾脏病(CKD)患者左心收缩功能及临床运用价值。方法将山西医科大学第二医院于2016年2~10月收治的30例CKD患者分为CKD2-3期组(15例),CKD4-5期组(15例);另选择年龄、性别及体重相匹配的健康人30例作为对照组。被检者先行常规二维超声心动图检查,测量参数:室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左心室舒张末期内径(LVEDD)及左心室射血分数(LVEF),再用RT-3DE技术得到左心室16节段达收缩期最小容积所用时间(Tmsv)的标准差(Tmsv16-SD、Tmsv12-SD和Tmsv6-SD)及最大时间差(Tmsv16-Dif、Tmsv12-Dif和Tmsv6-Dif),并对以上结果进行校正,排除不同心率造成的影响。结果与对照组比较,CDK组常规超声参数IVST、LVPWT、LVEDD增大,差异有统计学意义(t=-5.321、-6.473、-3.861,P<0.05);CDK组RT-3DE定量参数Tmsv16-SD、Tmsv16-Dif、Tmsv16-SD%、Tmsv16-Dif%均增大,差异有统计学意义(t=-4.622、-4.797、-4.791、-5.082,P<0.05)。与对照组比较,CKD2-3期和CKDG4-5期组的RT-3DE定量参数Tmsv16-SD、Tmsv16-Dif、Tmsv16-SD%、Tmsv16-Dif%均增大,差异有统计学意义(P<0.05),且CKD4-5期组RT-3DE定量参数Tmsv16-SD、Tmsv16-Dif、Tmsv16-SD%、Tmsv16-Dif%较CKD2-3期组明显增大,差异有统计学意义(P<0.05)。结论实时三维超声心动图能在慢性肾脏病患者常规超声心动图心功能正常时发现左室局部收缩异常。慢性肾脏病患者左心室收缩同步性较差,并随着肾小球滤过率的降低而加重。

Objective To assess the left ventricular systolic function and synchronicity for patients with different degrees of kidney disease by real-time three-dimensional echocardiography.Methods Collected30CKD patients and divided them into CKD2-3group,CKD4-5group.30healthy subjects whose age,sex and weight were matched with CKD patients were selected as control group.Two-dimensional ultrasonography was performed to obtain the conventional ultrasonic parameters(IVST,LVPWT,LVEDD,LVEF).Real-time three-dimensional echocardiography was used to obtain the16-segmental volume-time curves and standard the maximal difference of the time to the point with minimal systolic volume of16,12,6segments.Results Compared with control group,the IVST,LVPWT,LVEDD of patients in CKD group increased(t=-5.321,-6.473,-3.861,P<0.05),and Tmsv16-SD,Tmsv16-Dif,Tmsv16-SD%,Tmsv16-Dif%of patients in CKD group increased(t=-4.622,-4.797,-4.791,-5.082,P<0.05).Compared with control group,the Tmsv16-SD,Tmsv16-Dif,Tmsv16-SD%,Tmsv16-Dif%of patients in CKD2-3group increased(P<0.05).Compared with the CKD2-3group,Tmsv16-SD,Tmsv16-Dif,Tmsv16-SD%,Tmsv16-Dif%of patients in CKD4-5group increased(P<0.05).Conclusion The left ventricular systolic synchrony and part of the myocardial systolic function in patients with kidney disease is damaged.The synchronicity of left ventricular systolic function of patients with chronic kidney disease is rather poor,also it is aggravated with the reducing of glomerular filtration rate.