二维斑点追踪技术评价维持性血液透析患者左心室整体收缩功能及肺动脉高压影响因素研究  

Evaluation of Global Left Ventricle Systolic Function of Maintenance Hemodialysis Patients by Two Dimensional Speckle Tracking Imaging and Influencing Factors for Pulmonary Hypertension

作　　者：任永凤[1] 郑慧[2] 王洲[1] 

机构地区：[1]安徽医科大学亳州市人民医院临床学院,安徽省亳州市236800 [2]安徽医科大学第一附属医院超声科

出　　处：《中国全科医学》2016年第3期359-363,共5页Chinese General Practice

摘　　要：目的利用二维斑点追踪技术(2DSTI)评价维持性血液透析患者左心室整体收缩功能,并初探患者肺动脉高压(PH)发生的影响因素。方法选取2014年5月—2015年9月在亳州市人民医院经前臂动静脉内瘘法行维持性血液透析治疗的晚期肾病患者68例作为透析组,同期选取与透析组年龄、性别匹配的健康志愿者30例作为对照组。根据肺动脉压分级标准将透析组患者分成无PH组〔肺动脉收缩压(PASP)<30 mm Hg(1 mm Hg=0.133 k Pa)〕及PH组(PASP≥30 mm Hg)。进一步将PH组又分为轻度PH组(30 mm Hg≤PASP<50 mm Hg)、中度PH组(50 mm Hg≤PASP<70 mm Hg)、重度PH组(PASP≥70 mm Hg)。收集患者一般资料〔年龄、性别、体质指数(BMI)、心率、收缩压(SBP)、舒张压(DBP)、维持性血液透析时间、动静脉通路流量(Qa)〕,测量患者PASP、左心室射血分数(LVEF)、整体环向应变(GCS)、整体纵向应变(GLS)。结果无PH组和PH组患者性别构成、SBP、维持性血液透析时间比较,差异有统计学意义(P<0.05)。无PH组和PH组患者年龄、BMI、心率、DBP、Qa比较,差异无统计学意义(P>0.05)。对照组、无PH组、轻度PH组、中度PH组及重度PH组LVEF、GCS、GLS比较,差异均有统计学意义(P<0.05)。中度PH组和重度PH组LVEF低于对照组、无PH组及轻度PH组,重度PH组LVEF低于中度PH组(P<0.05)。无PH组、轻度PH组、中度PH组及重度PH组GCS、GLS低于对照组,轻度PH组、中度PH组及重度PH组GCS、GLS低于无PH组,中度PH组及重度PH组GCS、GLS低于轻度PH组,重度PH组GCS、GLS低于中度PH组(P<0.05)。PASP与维持性血液透析时间呈正相关(r=0.32,P<0.001)。PASP与GCS、GLS呈负相关(r=-0.34、-0.45,P<0.01)。结论 2DSTI可用于评价维持性血液透析患者左心室整体收缩功能下降情况;PASP升高可能与维持性血液透析时间和左心室收缩功能的下降有关。Objective To evaluate the overall left ventricle systolic function of maintenance hemodialysis patients by two dimensional speckle tracking imaging （2DSTI） and to investigate the influencing factors for pulmonary hypertension （PH）. Methods The study enrolled 68 patients with end - stage renal disease who were administrated with maintenance hemodialysis through forearm arterioveuous fistula in Bozhou People＇s Hospital from May 2014 to September 2015 as dialysis group. And 30 healthy volunteers with matched age and gender with dialysis group were enrolled as control group. According to the grading standard of pulmonary artery pressure, the subjects were divided into non -PH group [ pulmonary artery systolic pressure （PASP） 〈30 mm Hg （1 mm Hg=0. 133 kPa） ]and PH groupg （PASP≥30 mm Hg） . The PH group was divided into mild PH group （30 mm Hg≤PASP 〈50 mm Hg） , medium PH group （50 mm Hg≤〈PASP 〈70 mm Hg） and severe PH group （PASP ≥70 mm Hg） . General data of the patients were collected, including age, gender, BMI, heart rate, SBP, DBP, maintenance hemodialysis time and arterlovenous access flow （Qa） . And PASP, LVEF, GCS, GLS were measured. ResultsNon - PH group and PH group were significantly different in gender composition, SBP and maintenance hemodialysis time （P 〈 0.05） . Non - PH group and PH group were not significantly different in age, BMI, heart rate, DBP and Qa （P 〉 0. 05）. Contrtd group, non -PH group, mild PH group, medium PH group and severe PH group were significantly different in LVEF, GCS and GLS （ P 〈 0. 05 ） . Medium PH group and severe PH group were lower than control group, non - PH group and mild - PH group, and secvere PH group was lower than medium PH group in LVEF （ P 〈 0. 05 ） . Non - PH group, mild PH group, medium PII group and severe PIt group were lower than control group in GCS and GLS; mild PH group, medium PH group and severe PH group were lower than non - PH group in GCS and GLS; medium PH group and severe PH gr

关 键 词：透析 心室功能 左 高血压 肺性 心血管疾病 肾功能不全 慢性 二维斑点追踪技术 

分 类 号：R459.5[医药卫生—治疗学]