三维斑点追踪技术对慢性肾功能不全患者左心室收缩功能和右心室功能的评估价值研究

Evaluation Value of Left Ventricular Systolic Function and Right Ventricular Function in Patients with Chronic Renal Insufficiency by Three-Dimensional Speckle Tracking Technology

目的:探讨慢性肾功能不全患者应用三维斑点追踪技术对其左心室收缩功能和右心室功能的评估价值。方法:选择我院收治的慢性肾功能不全患者82例,根据患者肾功能将其分为轻度慢性肾功能不全组[慢性肾脏病(CKD)2期,47例],中-重度慢性肾功能不全组(CKD 3~5期,35例),另选取同期医院体检的健康志愿者30例作为对照组,应用二维超声及三维斑点追踪技术检测各组心脏指标,比较三组二维超声指标、三维斑点追踪技术指标,应用受试者工作特征(ROC)曲线分析三维斑点追踪技术对患者左心室收缩功能和右心室功能的评估价值。结果:中-重度慢性肾功能不全组室间隔舒张末期厚度(IVSTd)、肺动脉收缩压(PASP)显著高于轻度慢性肾功能不全组、对照组,右心室面积变化分数(RVFAC)、组织运动三尖瓣环位移(TAPSE)、左心室射血分数(LVEF)显著低于轻度慢性肾功能不全组、对照组(P<0.05)。中-重度慢性肾功能不全组左室整体圆周收缩期峰值应变(LGCS)、左室整体纵向收缩期峰值应变(LGLS)、右室整体圆周收缩期峰值应变(RGCS)右室整体纵向收缩期峰值应变(RGLS)、显著高于轻度慢性肾功能不全组、对照组,左室整体径向收缩期峰值应变(LGRS)、三维左室射血分数(3D-LVEF)、右室整体径向收缩期峰值应变(RGRS)、三维右室射血分数(3D-RVEF)显著低于轻度慢性肾功能不全组、对照组(P<0.05)。ROC曲线分析显示,三维斑点追踪技术对慢性肾功能不全患者左心室收缩功能和右心室功能的评估价值较高。结论:三维斑点追踪技术可以准确检测心脏的纵向运动、圆周运动、径向运动,为临床早期发现慢性肾功能不全患者的心脏功能异常提供依据。

Objective: To evaluate the value of three-dimensional speckle tracking in the evaluation of left ventricular systolic function and right ventricular function in patients with chronic renal insufficiency. Methods: 82 patients with chronic renal insufficiency who were treated in our hospital were selected, which were divided into mild renal insufficiency group(chronic kidney disease(CKD)stage 2, 47 cases), moderate to severe chronic renal insufficiency group(CKD stage 3 ~ 5, 35 cases) according to their renal function, in addition, 30 healthy people who underwent physical examination in the hospital in the same period were selected as the control group.The cardiac indexes of each group were detected by two-dimensional ultrasound and three-dimensional speckle tracking technology. The two-dimensional ultrasound indexes and three-dimensional speckle tracking technical indexes of three groups were compared. The receiver operating characteristic(ROC) curve was used to analyze the value of three-dimensional speckle tracking technology in the evaluation of left ventricular systolic function and right ventricular function in patients with chronic renal insufficiency. Results: The ventricular septal end diastolic thickness(IVSTd) and pulmonary systolic pressure(PASP) in moderate to severe chronic renal insufficiency group were significantly higher than those in mild chronic renal insufficiency group and control group, and the right ventricular area change fraction(RVFAC), tissue movement tricuspid annulus displacement(TAPSE) and left ventricular ejection fraction(LVEF) were significantly lower than those in mild chronic renal insufficiency group and control group(P<0.05). The left ventricular global circumferential systolic peak strain(LGCS), left ventricular global longitudinal systolic peak strain(LGLS), right ventricular global circumferential systolic peak strain(RGCS) and right ventricular global longitudinal systolic peak strain(RGLS) in moderate to severe chronic renal insufficiency group were significantly higher than those in mild chronic renal insufficiency group and control group. The left ventricular global radial systolic peak strain(LGRS), 3D-left ventricular ejection fraction(3D-LVEF), right ventricular global radial systolic peak strain(RGRS) and 3D-right ventricular ejection fraction(3D-RVEF) were significantly lower than those in mild chronic renal insufficiency group and control group(P<0.05). ROC curve analysis shows that three-dimensional speckle tracking technology had high evaluation value for left ventricular systolic function and right ventricular function in patients with chronic renal insufficiency. Conclusion: Three-dimensional speckle tracking technology can accurately detect the longitudinal motion, circular motion and radial motion of the heart, and provide a basis for early clinical detection of cardiac dysfunction in patients with chronic renal insufficiency.