超声心动图评价透析方式对终末期肾脏病心脏结构及功能的影响  

Evaluation of cardiac structural and functional alterations by echocardiography in patients undergoing peritoneal dialysis or hemodialysis

作　　者：马忠超[1] 李雪[2] 杨瑞衡[1] 洪虹[1] 刘泽炜[1] 王怀国[1] MA Zhong- chao LI Xue YANG Rui- heng HONG Hong LIU Ze- wei WANG Huai-guo(Division of Nephrology, Liaocheng People＇s Hospital, Liaocheng 252000, Chin)

机构地区：[1]聊城市人民医院肾内科,聊城252000 [2]聊城市人民医院妇产科,聊城252000

出　　处：《中国血液净化》2016年第11期591-594,共4页Chinese Journal of Blood Purification

摘　　要：目的应用彩色多普勒超声心动图(color doppler echocardiography,ECHO)及组织多普勒速度成像(tissue velocity imaging,TVI)技术,探讨血液透析、腹膜透析治疗终末期肾脏病(end stage renal disease,ESRD)时,对心脏结构与功能的影响。方法应用ECHO及TVI技术对慢性肾脏病5期未透析组(chronic renal disease,CKD5)、维持性血液透析组(maintenance hemodialysis,MHD)、持续性非卧床腹膜透析组(continuous ambulatory peritoneal dialysis,CAPD)3组进行检查,比较各组间心脏结构及功能的超声变化。结果 1室间隔厚度(F=1.595,P=0.211)、左心室舒张末期内径(F=0.146,P=0.864)、左心室后壁厚度(F=1.543,P=0.222)、左心室心肌重量指数(F=0.904,P=0.410)、左心房内径(F=0.986,P=0.379)、二尖瓣血流频谱舒张早期血流峰值速度(E峰)和舒张晚期血流峰值速度(A峰)之比E/A比值(F=0.543,P=0.588)、射血分数(F=1.038,P=0.360)、二尖瓣环TVI舒张晚期峰值速度(Am峰)(F=1.330,P=0.270)3组间比较无显著性差异;CAPD组二尖瓣环TVI舒张早期峰值速度(Em峰)、Em/Am比值高于MHD组,2组比较有统计学差异[Em(t=2.375,P=0.021),Em/Am(t=2.940,P=0.005)]。2CKD5、MHD、CAPD3组左心室舒张功能障碍的发生率分别为77%、83%、66%,左心室肥厚的发生率分别为73%、83%、69%,3组间比较均无统计学差异(c2=2.570,P=0.277;c2=1.735,P=0.420)。心脏瓣膜返流主要为二尖瓣返流和三尖瓣返流,3组间返流率均无显著差异(c2=3.344,P=0.188;c2=2.067,P=0.356)。结论 1ESRD无论是否进行肾脏替代治疗,心脏结构和功能障碍主要表现为左心室肥厚、左心室舒张功能障碍,心脏瓣膜返流以二尖瓣返流为主,其次为三尖瓣返流,TVI技术比ECHO能更敏感的评价左心室舒张功能障碍。2MHD和CAPD无法改善左心室肥厚及心室收缩、舒张功能障碍,但CAPD相对于MHD可能延缓心室舒张功能障碍的发生及进展。Objective To investigate the effects of hemodialysis and peritoneal dialysis on cardiac structure and function in patients with end-stage renal disease by color Doppler echocardiography （ECHO） and tissue velocity imaging （TVI） technologies. Methods Chronic kidney disease 5 stage group （CKD5）, maintenance hemodialysis group （MHD）, and continuous ambulatory peritoneal dialysis （CAPD） group were enrolled in this cross-sectional study. ECHO and TVI technologies were used to acquire the changes of cardiac structure and function in different groups. Results ①Interventricular septum thickness （IVST）, left ventricular end-diastolic diameter （LVDd）, left ventricular wall thickness （LVPW）, left ventricular mass index （LV- MI）, left atrial diameter （LAD）, E/A ratio, ejection fraction （EF）, and peak late diastolic velocity （Am） showed no significant differences among the three groups （F=1.595, P=0.211 for IVST; F=0.146, P=0.864 for LVDd; F=1.543, P=-0.222 for LVPW; F=0.904, P=-0.410 for LVMI; F=0.986, P=0.379 for LAD; F=0.543, P=0.588 for E/A; F=1.038, P=0.360 for EF; F=1.330, P=0.270 for Am）. Peak early diastolic velocity （Em） and Em/ Am ratio were higher in CAPD group than in MHD group （t=2.375, P=0.021 for Em; t=2.940, P=0.005 for Em/Am）. （2）The prevalence of left ventricular diastolic dysfunction （LVDD） in CKD5, MHD, CAPD groups were 77%, 83% and 66% respectively, and the prevalence of left ventricular hypertrophy （LVH） in CKD5, MHD, CAPD groups were 73%, 83% and 69% respectively, without statistical differences among the three groups （c2=2.570, P=0.277 for LVDD; c2=1.735, P=0.420 for LVH）. The main reflux changes were mitral regurgitation （MR） followed by tricuspid regurgitation （TR）, and the reflux rates had no significant differences among the three groups （c2=3.344, P=0.188 for MR; c2=2.067, P=0.356 for TR）. Conclusions （1）Cardiac structure and function alterations mainly manifested left ventricular hypertrophy, diastolic dy

关 键 词：超声心动图 组织多普勒速度成像 血液透析 腹膜透析 心血管疾病 

分 类 号：R318.16[医药卫生—生物医学工程]