自动功能成像技术在慢性肾功能衰竭患者心脏早期受累诊断中的应用价值

Application value of automatic functional imaging technology in diagnosis of early cardiac involvement in patients with chronic renal failure

目的研究自动功能成像(AFI)技术在慢性肾功能衰竭(CRF)患者心脏早期受累诊断中的应用价值。方法采用前瞻性研究方法,选取2018年1月至2019年12月海南省中医院超声科收治的CRF患者200例作为观察组,并选取同期正常体检者100例作为对照组。比较两组患者的常规超声指标[左室舒张末期容积指数(EDVI)、收缩末期容积指数(ESVI)、左室舒张末期质量(EDMass)、收缩末期质量(ESMass)、左室相对室壁厚度(RWT)、左室质量指数(LVMI)、左室射血分数(LVEF)]、AFI指标[径向峰值应变(GPSR)、面积峰值应变(GPSA)、左室整体的纵向峰值应变(GLPS)],比较不同肾功能分级患者AFI指标、肾功能指标[血肌酐(Scr)、血尿素氮(BUN)、甲状旁腺激素(PTH)]水平,采用Pearson分析AFI指标与肾功能指标的相关性。结果观察组患者的LVEF低于对照组,EDVI、ESVI、EDMass、ESMass、LVMI、RWI高于对照组,差异具有统计学意义(P<0.05);观察组患者的GPSR、GPSA绝对值、GLPS绝对值均低于对照组,差异具有统计学意义(P<0.05);肾储备能力下降期、氮质血症期、肾衰竭期和尿毒症期患者随着肾功能分级递进,GPSR、GPSA绝对值、GLPS绝对值依次降低,组间比较差异具有统计学意义(P<0.05);肾储备能力下降期、氮质血症期、肾衰竭期和尿毒症期患者随着肾功能分级递进,Scr、BUN、PTH依次升高,组间比较差异具有统计学意义(P<0.05);GPSR、GPSA绝对值、GLPS绝对值均与Scr(r=-0.473、-0.594、-0.596)、BUN(r=-0.547、-0.465、-0.540)、PTH(r=-0.414、-0.367、-0.422)呈负相关(P<0.05)。结论AFI技术检测CRF患者GPSR、GPSA、GLPS,可无创、定量评估患者心脏早期受累情况,为医师决策、干预提供参考,且GPSR、GPSA、GLPS与肾功能具有显著相关性,临床应重视CRF患者肾功能与心功能的同时干预,以改善患者预后。

Objective To study the application value of automatic functional imaging(AFI)technology in the early cardiac involvement of patients with chronic renal failure(CRF).Methods 200 patients with CRF admitted to the ultrasound department of hainan hospital of traditional Chinese medicine from January 2018 to December 2019 were selected as the observation group,and 100 cases with normal physical examination during the same period were selected as the control group.The conventional ultrasound indicators[left ventricular end diastolic volume index(EDVI),end systolic volume index(ESVI),left ventricular end diastolic mass(EDMass),end systolic mass(ESMass),and left ventricular relative wall thickness(RWT),Left ventricular mass index(LVMI),left ventricular ejection fraction(LVEF)],AFI index[radial peak strain(GPSR),area peak strain(GPSA),overall longitudinal peak strain of the left ventricle(GLPS)]were compared in the two groups,the levels of AFI and renal function indicators[serum creatinine(Scr),blood urea nitrogen(BUN),parathyroid hormone(PTH)]in patients with different renal function grades were compared,the correlation between AFI index and renal function index was analyzed by Pearson.Results The LVEF of the observation group was lower than that of the control group,and EDVI,ESVI,EDMass,ESMass,LVMI,and RWI were higher than those of the control group,the differences were statistically significant(P<0.05).The absolute values of GPSR,GPSA and GLPS in the observation group were lower than those in the control group,the differences were statistically significant(P<0.05).Patients with decline in renal reserve capacity,azotemia,renal failure and uremia patients progress with the classification of renal function,the absolute values of GPSR,GPSA and GLPS decreased in turn,the comparison between groups was statistically significantly different(P<0.05).Patients with decline in renal reserve capacity,azotemia,renal failure and uremia patients progress with the classification of renal function,SCR,BUN and PTH increased in turn,and the differences between the groups were statistically significant(P<0.05).The absolute values of GPSR,GPSA,and GLPS were negatively correlated with Scr(r=-0.473,-0.594,-0.596),BUN(r=-0.547,-0.465,-0.540),and PTH(r=-0.414,-0.367,-0.422)(P<0.05).Conclusion The AFI technology can be used to detect GPSR,GPSA and GLPS in CRF patients,which can non-invasively and quantitatively evaluate the early cardiac involvement of patients,it provides reference for doctors'decision-making and intervention,and GPSR,GPSA,GLPS have significant correlation with renal function,in order to improve the prognosis of patients,clinical attention should be paid to the simultaneous intervention of renal function and cardiac function in patients with CRF.