压力-应变环评估血液透析患者左心室做功的临床价值

Application of pressure-strain ring in evaluation of left ventricular work in hemodialysis patients

目的探讨压力-应变环(PSL)定量评估血液透析(简称血透)患者左心室做功的临床价值。方法选取2021年10至12月在浙江大学医学院附属第一医院就诊的血透患者79例(血透组)和健康体检者53名(对照组),并根据透析时间、左心室构型、透析是否充分及血压是否正常分为低透析龄组51例和高透析龄组28例,正常构型组20例、向心性重构组10例、向心性肥厚组19例和离心性肥厚组30例,透析充分组50例和透析不充分组29例,血压正常组43名和高血压组36例。应用PSL获取左心室心肌做功参数,包括心肌整体做功指数(GWI)、整体有用功(GCW)、整体无用功(GWW)、整体做功效率(GWE),比较两组间及不同亚组间差异并绘制ROC曲线寻找,预测血透患者左心室心肌受损的最佳截断值。结果血透组GWW显著高于对照组,GWI、GCW、GWE均低于对照组,差异均有统计学意义(均P<0.01);GWE随左心室构型加重和透析龄增加而降低(均P<0.05);透析充分组GWE高于透析不充分组(P<0.01);血压正常组和高血压组GWE的比较差异无统计学意义(P>0.05);GWE、GWI、GCW均与左心室整体纵向应变(GLS)绝对值和左心室射血分数呈正相关,GWW与其呈负相关,其中GWE与GLS绝对值的相关性最强(r=0.700,P<0.01);ROC曲线结果显示GWE和GWW预测左心室心肌受损的效能较好,灵敏度分别为0.848、0.810,特异度分别为1.000、0.962,最佳截断值分别为94.5%、109.5 mmHg%(1 mmHg=0.133 kPa)。结论血透患者左心室心肌受损明显,充分透析患者心肌受损得到改善,PSL可以有效定量评价血透患者左心室心肌做功,且不受后负荷影响,为临床诊治提供可靠依据。

Objective To apply pressure-strain loop(PSL)in quantitative evaluatjion of left ventricular work in hemodialysis patients.Methods Seventy-nine hemodialysis patients admitted to the First Affiliated Hospital of Zhejiang University School of Medicine from October to December 2021,and 53 healthy subjects were enrolled in the study.According to dialysis age,left ventricular configuration,whether dialysis is adequate and whether blood pressure is normal,fifty-one cases were divided into low dialysis age group and twenty-eight cases were divided into high dialysis age group,twenty cases were in normal configuration group,ten cases were in centripetal remodeling group,nineteen cases were in centripetal hypertrophy group and thirty cases were in centrifugal hypertrophy group,fifty cases were in adequate dialysis group,twenty-nine cases were in insufficient dialysis group,forty-three cases were in normal blood pressure group and thirty-six cases were in hypertension group.PSL was used to obtain the left ventricular myocardial work parameters,including global myocardial work index(GWI),global constructive work(GCW),global myocardial wasted work(GWW),global myocardial work efficiency(GWE).ROC curve as used to analyse the value of PSL parameters for evaluating the left ventricular myocardial damage in hemodialysis patients.Results There were significant differences in parameters of myocardial work between hemodialysis patients the control group(P<0.01).In hemodialysis patients the GWE decreased with the increase of left ventricular configuration and dialysis age(P<0.05);the GWE was significantly higher in sufficient dialysis group than that in inadequate dialysis group(P<0.01);there was no significant difference in GWE with blood pressure(P>0.05).GWE,GWI and GCW were positively correlated with GLS absolute value and LVEF,while GWW was negatively correlated with GLS absolute value.The GWE was closely correlated with GLS absolute value(r=0.700,P<0.01).The ROC curve showed that the sensitivity of GWE and GWW was 0.848 and 0.810;and specificity was 1.000 and 0.962 for predicting left ventricular myocardial injury with cut-off values of 94.5%and 109.5 mmHg%(1 mmHg=0.133 kPa),respectively.Conclusion The damage of left ventricular myocardium may occur in hemodialysis patients,which is less severe in fully dialysis patients.PSL can quantitatively evaluate the left ventricular myocardium work in hemodialysis patients,and is not affected by the afterload,which may be used for clinical diagnosis and treatment.