尿毒症患者心脏损伤评估中超声心动图、心肌损伤标志物检测的应用研究

Application of echocardiography and myocardial injury markers in cardiac injury assessment of uremia patients

目的探讨尿毒症患者心脏损伤评估中超声心动图、心肌损伤标志物检测的应用价值。方法选取2021年5月至2022年12月本院60例尿毒症患者纳入尿毒症组,另选同期健康体检者60例纳入对照组,所有纳入对象均进行超声心动图检查,检测血清心肌损伤标志物水平,对比尿毒症组与对照组超声心动图指标与血清心肌损伤标志物水平差异。结果尿毒症组超声心动图指标左房、左室内径(LAD、LVD)、右心房、右室舒张末期内径(RAD、RVDD)、舒张期、收缩期室间隔厚度(IVSD、IVSS)、左室后壁舒张期厚度(LVPWd)、左室后壁收缩期厚度(LVPWs)、左室收缩期内径(LVDS)水平高于对照组(P<0.05);尿毒症组心室舒张二尖瓣舒张早期峰值流速(E)、舒张晚期峰值流速(A)水平高于对照组,E/A比值水平低于对照组(P<0.05);尿毒症组心室收缩功能每搏输出量(SV)、心排血指数(CI)、左室射血分数(LVEF)水平低于对照组(P<0.05);尿毒症组血清B型脑钠肽(BNP)、肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)、同型半胱氨酸(Hcy)水平高于对照组(P<0.05)。结论超声心动图可准确直观观察心脏结构和功能情况,血清心肌损伤标志物高表达可反映心脏损伤的发生,二者是评估尿毒症患者心脏状况安全可靠的检查方法。

Objective To investigate the application value of echocardiography and myocardial injury markers in the evaluation of heart injury in patients with uremia.Methods From May 2021 to December 2022,60 patients with uremia hemodialysis in our hospital were selected to be included in the uremia group,and 60 healthy subjects were selected to be included in the control group during the same period.All included subjects were examined by echocardiography to detect serum markers of myocardial injury.The differences of echocardiographic indexes and serum markers of myocardial injury between uremia group and control group were compared.Results In uremia group,echocardiographic indicators were left atrial,left ventricular diameter(LAD,LVD),right atrial,right ventricular end-diastolic diameter(RAD,RVDD),diastolic,systolic septal thickness(IVSD,IVSS),left ventricular posterior diastolic thickness(LVPWd),left ventricular posterior systolic thickness(LVPWs),and left ventricular systolic diameter(LVDS)level was higher than that of control group(P<0.05);The early diastolic peak velocity(E)and late diastolic peak velocity(A)of mitral valve in uremia group were higher than those in control group,and the E/A ratio was lower than that in control group(P<0.05).Ventricular systolic function stroke output(SV),cardiac output index(CI)and left ventricular ejection fraction(LVEF)in uremia group were lower than those in control group(P<0.05).The levels of B-type brain natriuretic peptide(BNP),troponin T(cTnT),creatine kinase isoenzyme(CK-MB)and homocysteine(Hcy)in uremia group were higher than those in control group(P<0.05).Conclusion Echocardiography can accurately and intuitively observe the cardiac structure and function,and the high expression of serum markers of myocardial injury can reflect the occurrence of cardiac injury.Both are safe and reliable methods to evaluate the cardiac status of uremia hemodialysis patients.