慢性肾脏病患者左室整体纵向应变与肾功能的相关性研究

Correlation between left ventricular global longitudinal strain and renal function in patients with chronic kidney disease

目的应用二维斑点追踪应变成像(2D-STI)评估慢性肾脏病(CKD)患者左室功能,探讨左室整体纵向峰值应变(GLS)与肾功能的相关性。方法连续入选经我院确诊为CKD的患者69例,根据肾小球滤过率(eGFR)分为轻度CKD组36例(eGFR 30~89 ml/min)和中重度CKD组33例(eGFR<30 ml/min),另选与之年龄、性别相匹配的30例健康志愿者为对照组。收集各组临床、实验室肾功能检查资料,经胸超声心动图测量常规超声心动图参数,包括舒张末期室间隔厚度(IVSTd)、左室舒张末期内径(LVIDd)、左室心肌质量指数(LVMI)、左室射血分数(LVEF)、左房容量指数(LAVI)、二尖瓣口舒张期E峰与室间隔e峰的比值(E/e);2D-STI测量GLS。应用多元线性回归分析各超声检测参数与eGFR之间的相关性。结果与对照组比较,轻度CKD组IVSTd、LAVI、血肌酐均增高,eGFR、GLS均明显降低(均P<0.05);与轻度CKD组比较,中重度CKD组收缩压、总胆固醇、血肌酐均明显增高,IVSTd、LVMI、LAVI、E/e均增大,eGFR、GLS均减小(均P<0.05)。相关性分析显示,eGFR与收缩压、血肌酐、IVSTd、LVMI、LAVI均呈负相关,eGFR与GLS呈正相关(均P<0.05);经多元线性回归分析调整影响因素后,GLS与eGFR仍呈独立正相关(r=0.789,P=0.005)。结论 2D-STI能敏感反映不同阶段CKD患者左室功能改变;随着病情发展,CKD患者左房扩大、左室收缩功能减低,GLS与肾功能独立相关。

Objective To evaluate the left ventricular function in patients with chronic kidney disease(CKD) by twodimensional speckle tracking strain imaging(2D-STI),and to explore the correlation between the global longitudinal peak strain of the left ventricle and renal function.Methods A total of 69 CKD patients diagnosed in our hospital were continuously selected,according to glomerular filtration rate(eGFR),36 patients in mild CKD group(eGFR 30~89 ml/min) and 33 patients in moderate and severe CKD group(eGFR<30 ml/min).Thirty age and sex matched healthy volunteers were enrolled as control group.The basic clinical data and renal function indexes of all patients were collected,and the indexes of transthoracic echocardiography were measured including interventricular septal end diastolic thickness(IVSTd),left ventricular end diastolic diameter(LVDd),left ventricular mass index(LVMI),left ventricular ejection fraction(LVEF),left atrial volume index(LA VI)and E/e.The global longitudinal peak strain(GLS) of left ventricle was measured by 2 D-STI.Multiple linear regression was used to analyze the correlation between echocardiography parameters and eGFR.Results Compared with the control group,IVSTd,LAVI and serum creatinine in the mild CKD group were increased,eGFR and GLS were decreased significantly(all P<0.05).Compared with mild CKD group,systolic blood pressure,total cholesterol,serum creatinine,IVSTd,LVMI,LAVI,E/e were increased,eGFR and GLS were decreased in moderate and severe CKD group(all P<0.05).Correlation analysis revealed that eGFR were negatively correlated with systolic blood pressure,serum creatinine,IVSTd,LVMI and LAVI,while eGFR was positively correlated with GLS(all P<0.05).After adjusting the influencing factors by multiple linear regression analysis,GLS and eGFR was still independently and positively correlated(r=0.789,P=0.005).Conclusion 2D-STI can sensitively reflect the changes of left ventricular function in CKD patients at different stages.With the progression of the disease,the left atrium enlarged and the left ventricular systolic function decreased in patients with chronic renal insufficiency.GLS is independently related to renal function.