二维斑点追踪成像技术评价慢性肾脏病患者的左心室分层应变特征

Left ventricular layer-specific strain measured by two-dimensional speckle tracking echocardiography in patients with chronic kidney disease

目的应用二维斑点追踪成像技术探讨慢性肾脏病(CKD)患者的左心室心肌分层应变特征。方法选取2020年3月至2021年8月于福建医科大学附属第一医院肾内科确诊的CKD患者85例,根据估算的肾小球滤过率(eGFR)水平分为三组:CKD 1~2期(n=29)、3~4期(n=20)和5期(n=36)组,以性别、年龄相匹配的40名健康志愿者(对照组)和40例单纯高血压患者(高血压组)做对照。观察超声常规指标[房室内径、室壁厚度及左室射血分数(LVEF)等]和二维应变指标[左心室整体纵向应变(GLS),心内膜层心肌纵向应变(SL-endo)、中间层心肌纵向应变(SL-ave)及心外膜层心肌纵向应变(SL-epi),心内膜层心肌周向应变(SC-endo)、中间层心肌周向应变(SC-ave)及心外膜层心肌周向应变(SC-epi),左心室整体径向应变(GRS)]。结果与对照组相比,CKD 1~2期和3~4期组左心结构及LVEF无明显改变,高血压组和CKD 5期组出现左心室重构、舒张功能降低,CKD 5期组出现LVEF值降低(均P<0.05)。与对照组相比,高血压组仅出现心内膜层纵向应变降低,CKD三组左心室各分层纵向应变均降低,且随eGFR降低而加重,CKD 5期组径向应变也降低(均P<0.05)。相关性分析显示纵向整体和分层应变与eGFR相关(r=0.541~0.559,均P<0.05),而LVEF与纵向及周向应变均相关(r=0.406~0.424,均P<0.05);多元线性回归分析显示左心室纵向各层应变与患者肾功能不同分期以及是否出现继发高血压独立相关(β=-0.443~-0.251,均P<0.05),左心室周向各层应变与继发高血压独立相关(β=-0.310~-0.255,均P<0.05)。结论CKD患者左心室应变受损的程度和范围与肾功能分期以及是否继发高血压有关,继发性高血压的出现可能通过累及周向应变从而影响整体收缩泵功能。

Objective eTo investigate the characteristics of left ventricular layer-specific strain in patients with chron-ic kidney disease(CKD).Methods Eighty-five patients with CKD in the Department of Nephrology from March 2020 to August 2021 were selected and divided into three groups according to the estimated glomerular filtration rate(eGFR):CKD stage 1-2(n=29),stage 3-4(n=20)and stage 5 group(n=36).Forty hypertensive patients without renal insufficiency were collected as hypertension(HT)group and 40 gender and age-matched healthy volun-teers were selected as the control group.Then,routine echocardiographic parameters,such as left ventricular diame-ter,left atrium diameter,wall thickness,left ventricular ejection fraction(LVEF),and myocardial strain parame-ters,such as global longitudinal strain(GLS),longitudinal strain in endocardium(SL-endo),longitudinal strain in average(SL-ave),longitudinal strain in epicardium(SL-epi),global circumferential strain(GCS),global circumfer-ential strain in endocardium(SC-endo),global circumferential strain in average(SC-ave),global circumferential strain in epicardium(SC-epi),and global radial strain(GRS)were analyzed.Results Compared with the control group,the left cardic structure and LVEF in stage 1-2 and stage 3-4 groups had no significant changes,left ven-tricular remodeling appeared and diastolic function declined in HT group and stage 5 group,LVEF decreased in stage 5 group(all P<0.05).Only SL-endo decreased in HT group.All of SL-endo,SL-ave and SL-epi reduced in CKD group and were lowest in stage 5 group.Radial strain decreased only in stage 5 group(all P<0.05).Correlation analysis showed that the global and layer-specific longitudinal strain were correlated with eGFR(r=0.541 to 0.559,all P<0.05),LVEF was correlated with longitudinal and circumferential strain(r=0.406 to 0.424,all P<0.05).Multiple linear regression analysis showed that longitudinal strain in different layers were independently correlated with different stages of CKD and the occurrence of secondary hypertension(β=-0.443 to-0.251,all P<0.05).Circumferential strain in all layers were independently correlated with the appearance of secondary hypertension(β=-0.310 to-0.255,all P<0.05).Conclusion The degree and range of the impairment of left ventricular strain in CKD patients are related to the stage of eGFR and secondary hypertension,which may affect the global systolic pump function by involving the circumferential strain.