射血分数保留的终末期肾病患者左室质量指数与左室心肌做功指数的关系

Relationship between left ventricular mass index and left ventricular myocardial work index in patients with end-stage renal disease with preserved ejection fraction

目的应用左室压力-应变环(PSL)技术量化评价射血分数保留的终末期肾病(ESRD)患者的左室心肌做功指数(MWI),并根据左室质量指数(LVMI)进行分组,旨在对比研究不同LVMI水平对左室MWI的影响。方法选取81例慢性肾病5期患者,其中男43例,女38例。根据LVMI不同,分为左室肥厚组(LVH组)(44例)和非左室肥厚组(NLVH组)(37例);另随机选取37名年龄、性别与ESRD患者相匹配的正常人作为对照组。比较3组一般临床资料、常规超声心动图测量参数、左室整体纵向应变(GLS)以及心肌做功指数(MWI),MWI包括整体做功指数(GWI)、整体有效功(GCW)、整体无效功(GWW)、整体做功效率(GWE);并分析ESRD患者的MWI与各参数的相关性及其独立影响因子。结果3组的年龄、性别、身高、体质量等其他一般临床资料以及左室射血分数(LVEF)比较差异无统计学意义(P>0.05)。NLVH组及LVH组的GWW高于对照组、GWE低于对照组,且均以LVH组更为显著(P<0.05)。ESRD患者中,LVMI分别与GWW呈正相关、与GWE呈负相关,且具体独立相关性(P<0.05)。结论GWW、GWE可以早期发现ESRD患者的左室收缩功能受损,LVH组的心肌功能受损较NLVH组更加严重。LVMI是GWW的独立正向影响因子,是GWE的独立负向影响因子。

Objective To quantitatively evaluate the left ventricular myocardial work index(MWI)of patients with end-stage renal disease(ESRD)with preserved ejection fraction using left ventricular pressure-strain loop(PSL),and group them according to left ventricular mass index(LVMI),in order to compare the effect of different LVMI levels on left ventricular MWI.Methods 81 patients with stage 5 chronic kidney disease,including 43 males and 38 females,were divided into left ventricular hypertrophy group(LVH group)(n=44)and non-left ventricular hypertrophy group(NLVH group)(n=37)according to LVMI,and 37 healthy people matched in age and sex with the ESRD groups were randomly selected as the control group.The general clinical data,conventional echocardiographic parameters,global longitudinal strain(GLS),and MWI namely global work index(GWI),global constructive work(GCW),global wasted work(GWW)and global work efficiency(GWE)of the three groups were compared.The correlation between MWI and various parameters were analyzed,and the independent predictors of MWI were analyzed too.Result The results showed that there were no significant differences in age,gender,height,weight and other general clinical data as well as left ventricular ejection fraction(LVEF)among the three groups.In two ESRD groups,GWW was higher than that in control group,GWE was lower than that in control group,and were more significant in LVH group(P<0.05).LVMI was positively correlated with GWW,and negatively correlated with GWE,respectively,with specific independent correlation.Conclusion GWW and GWE can detect early impairment of left ventricular systolic function in ESED patients,and myocardial function impairment in LVH group is more serious than that in NLVH group.LVMI is an independent positive factor of GWW and an independent negative factor of GWE.