左室压力-应变环评估终末期肾病透析患者左室收缩功能的临床价值

Clinical value of left ventricular pressure-strain loop in evaluating left ventricular systolic function in dialysis patients with end-stage renal disease

目的探讨左室压力-应变环(LV-PSL)评估终末期肾病血液透析和腹膜透析患者左室收缩功能的临床应用价值。方法选取于我院就诊的79例慢性肾脏病5期患者,其中血液透析组29例、腹膜透析组27例及未透析组23例,均行常规超声心动图检查并获取相关参数,应用自动心肌功能成像分析软件获取左室整体纵向应变(GLS)及心肌做功指数(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),比较各组上述参数的差异。分析MWI与常规超声心动图参数、GLS、血压、透析时间、透析方式的相关性。结果各组常规超声心动图参数和GLS比较差异均无统计学意义。血液透析组GWI、GCW均低于腹膜透析组和未透析组,GWW高于腹膜透析组和未透析组,GWE低于腹膜透析组,差异均有统计学意义(均P<0.05)。相关性分析显示,GWI、GCW与GLS、左室射血分数(LVEF)、收缩压、舒张压均呈正相关,与室间隔厚度(IVS)、透析时间、透析方式均呈负相关(均P<0.05);GWW与透析方式呈正相关,与GLS呈负相关(均P<0.05);GWE与GLS、LVEF均呈正相关,与IVS、左室后壁厚度、透析方式均呈负相关(均P<0.05)。结论血液透析对终末期肾病患者左室收缩功能的影响较腹膜透析更大,LV-PSL能准确评估该类患者左室收缩功能,具有较好的临床应用价值。

Objective To investigate the clinical value of left ventricular pressure-strain loop(LV-PSL)in evaluating left ventricular systolic function in patients with end-stage renal disease(ESRD)on hemodialysis(HD)and peritoneal dialysis(PD).Methods Totally 79 patients with stage 5 chronic kidney disease were grouped according to dialysis status,29 cases in HD group,27 cases in PD group,and 23 cases without dialysis in ND group.Conventional echocardiography was performed and relevant parameters were obtained.Left ventricular global longitudinal strain(GLS)and myocardial work indexs(MWI),including global work index(GWI),global constructive work(GCW),global waste work(GWW)and global work efficiency(GWE)were automatically obtained by automatic myocardial functional imaging analysis software.The differences of the above parameters were compared among the groups.Correlations between the MWI and conventional echocardiographic parameters,GLS,blood pressure,dialysis time and dialysis types were analyzed.Results There were no significant differences in conventional echocardiographic parameters and GLS among three groups.In the HD group,GWI and GCW were significantly lower than those in the PD and ND groups,GWW was significantly higher than that in the PD and ND groups,GWE was significantly lower than that in the PD group,the differences were statistically significant(all P<0.05).The correlation analysis showed that GWI and GCW were positively correlated with GLS,left ventricular ejection fraction(LVEF),systolic blood pressure and diastolic blood pressure,while negatively correlated with interventricular septum thickness(IVS),dialysis time and dialysis types(all P<0.05).GWW was positively correlated with dialysis types,while negatively correlated with GLS(both P<0.05).GWE was positively correlated with GLS and LVEF,while negatively correlated with IVS,left ventricular posterior wall thickness and dialysis types(all P<0.05).Conclusion HD has a greater impact on left ventricular systolic function than PD in patients with ESRD.LV-PSL can accurately assess the left ventricular systolic function in such patients,which has better application value.