多普勒超声对慢性肾功能不全患者心血管改变的诊断价值

Diagnostic value of Doppler ultrasound for cardiovascular changes in patients with chronic renal insufficiency

目的:观察分析多普勒超声在慢性肾功能不全(CKD)患者心血管改变评估中的诊断价值。方法:按照美国肾脏病与透析病人生存质量指导指南(KDOQI)选取轻中度肾功能不全即CKD 2~3期患者共80例,选取患者住院治疗同时间段80名健康志愿者作为对照组,使用彩色多普勒超声诊断仪检测两组患者左心室结构及功能参数和颈动脉血管结构及弹性参数,对比分析两组患者各项参数变化。结果:CKD组患者动脉血压收缩压及舒张压均高于健康对照组,CKD组患者心率较快,差异有统计学意义(P<0.05),CKD 2~3期患者左心室结构及功能参数与正常对照组比较,E/A值和Em值均明显降低,E/Em、EF、LVID、DTE、LAD、LVMI均明显升高,差异有统计学意义(P<0.05),E、RWT变化不明显,差异无统计学意义(P>0.05),CKD 2~3期患者颈动脉血管结构及弹性参数与正常对照组患者比较,PWVcf、PWVβ、Ep、IMT、D、β均明显升高,差异有统计学意义(P<0.05)。结论:多普勒超声技术可无创且准确地对CKD早期患者左室结构及功能、血管结构及弹性改变进行较为完整的评估,能为临床治疗提供准确有效的指导。

Objective To evaluate the diagnostic value of Doppler ultrasound in the assessment of cardiovascular changes in patients with chronic renal insufficiency(CKD).Methods According to Kidney Disease Outcomes Quality Initiative(KDOQI),80 patients with mild to moderate renal insufficiency,ie stage 2-3 CKD,were enrolled in the study,and 80 healthy volunteers in the same time period were selected as control group.The structural and functional parameters of the left ventricle as well as the structural and elastic parameters of carotid blood vessels were detected by color Doppler ultrasound.The changes of various parameters of the two groups were compared and analyzed.Results The systolic blood pressure and diastolic blood pressure of CKD patients were higher than those of healthy controls,and the heart rate of CKD patients was faster,with statistical significance(P<0.05).The comparison on structural and functional parameters of left ventricle in patients with stage 2-3 CKD and healthy controls showed that the E/A and Em in CKD patients were obviously decreased,while the E/Em,EF,LVID,DTE,LAD and LVMI were significantly increased,with statistical differences(P<0.05).E and RWT were similar in two groups,without statistical significance(P>0.05).Compared with healthy controls,patients with stage 2-3 CKD had remarkably increased PWVcf,PWVβ,Ep,IMT,D andβ,with statistical differences(P<0.05).Conclusion Doppler ultrasound can be used to achieve a non-invasive and accurate assessment of left ventricular structure and functions as well as vascular structure and elasticity changes in patients with early-stage CKD,providing effective and accurate guidance for clinical treatment.