三维斑点追踪技术评价老年肾源性继发性甲状旁腺功能亢进患者左心室收缩功能的研究

Evaluation of Left Ventricular Systolic Function with Maintenance Hemodialysis Complicated with Secondary Hyperparathyroidism Using Three-dimensional Speckle-tracking Imaging

目的应用三维斑点追踪成像(3D-STI)评价老年肾源性继发性甲状旁腺功能亢进(SHPT)患者的早期左心室收缩功能。方法选取2019年6月-12月于我院治疗的60例老年维持性血液透析(MHD)患者60例,根据甲状旁腺激素(PTH)分为低水平PTH(L-PTH)组30例、正常水平PTH(N-PTH)组30例;另选取我院同期老年健康体检者30例为对照组。比较三组常规超声指标、左心室的整体纵向应变(GLS)、整体径向应变(GRS)、整体圆周应变(GCS)、整体面积应变(GAS),并对3D-STI应变参数与PTH进行相关性分析,3D-STI预测SHPT患者左室收缩功能受损的ROC曲线分析。结果三组IVSd、LVPWd、LVEDd、LVEDs、LVEDV、LVESV、LVEF水平比较,差异无统计学意义(P>0.05);N-PTH组GLS、GCS、GRS、GAS低于对照组,L-PTH组GLS、GCS、GRS、GAS均低于N-PTH组和对照组,差异有统计学意义(P<0.05)。PTH与GLS、GRS、GCS、GAS呈负相关(r=-0.692、-0.433、-0.463、-0.453,P<0.05);GLS、GRS、GCS、GAS预测SHPT患者左室收缩功能受损的曲线下面积分别为0.921、0.623、0.811、0.796,GLS诊断效能最大,GLS截断值为21.55%时,对应的敏感性为95.12%,特异性为69.13%,Youden指数为0.64。结论3D-STI技术能够早期评估老年肾源性SHPT患者左心室整体收缩功能损伤情况。

Objective To evaluate the early left ventricular systolic function in elderly patients with renal secondary hyperparathyroidism(SHPT)using three-dimensional speckle-tracking imaging(3D-STI).Methods Sixty elderly patients with maintenance hemodialysis(MHD)who were treated in our hospital from June to December 2019 were selected.According to the level of parathyroid hormone(PTH),they were divided into low level PTH(L-PTH)group(30 cases)and normal level PTH(N-PTH)group(30 cases),another 30 cases of elderly health examination in our hospital were selected as the control group.The conventional ultrasound indexes,the global longitudinal strain(GLS),global radial strain(GRS),global circumferential strain(GCS),global area strain(GAS)of the left ventricle in the three groups were compared,and the correlation between 3D-STI strain parameters and PTH was analyzed.The ROC curve analysis of 3D-STI prediction of left ventricular systolic dysfunction in SHPT patients was performed.Results There was no significant difference in IVSd,LVPWd,LVEDd,LVEDs,LVEDV,LVESV and LVEF levels among the three groups(P>0.05);the GLS,GCS,GRS and GAS in the N-PTH group were lower than those in the control group,and the GLS,GCS,GRS and GAS in the L-PTH group were lower than those in the N-PTH group and the control group,and the difference was statistically significant(P<0.05).PTH was negatively correlated with GLS,GRS,GCS and GAS(r=-0.692,-0.433,-0.463,-0.453,P<0.05).The areas under the curve predicted by GLS,GRS,GCS and GAS for left ventricular systolic dysfunction in SHPT patients were 0.921,0.623,0.811 and 0.796,respectivel;the diagnostic efficacy of GLS was the highest.When the cutoff value of GLS was 21.55%,the corresponding sensitivity was 95.12%,the specificity was 69.13%,and the Youden index was 0.64.Conclusion 3D-STI can early evaluate left ventricular global systolic dysfunction in elderly patients with renal SHPT.