超声心动图评价左心室射血分数正常终末期肾病患者左心室重构和功能的价值研究  

Echocardiographic Evaluation of the Left Ventricular Remodeling and Function in End Stage Renal Disease Patients with Preserved Left Ventricular Ejection Fraction

作　　者：张志华[1] 莫为春[2] 郑风雅 黄雷军[1] 龚辉 ZHANG Zhihua;MO Weichun;ZHENG Fengya;HUANG Leijun;GONG Hui(Department of Echocardiography,Jinshan Hospital of Fudan University,Shanghai 200540,China;Department of Emergency,Jinshan Hospital of Fudan University,Shanghai 200540,China;Department of Cardiology,Jinshan Hospital of Fudan University,Shanghai 200540,China)

机构地区：[1]复旦大学附属金山医院心超室,上海市200540 [2]复旦大学附属金山医院急诊室,上海市200540 [3]复旦大学附属金山医院心内科,上海市200540

出　　处：《中国全科医学》2020年第12期1497-1503,共7页Chinese General Practice

基　　金：上海市金山区科委资助项目2015-3-4(区科委)。

摘　　要：背景心血管疾病是终末期肾病(ESRD)死亡率升高的最主要原因,其病理基础是心脏结构及功能的改变。在临床工作中,比较关注心功能衰竭尤其是左心室射血分数(LVEF)的异常,而忽略其他重要指标的异常。目的应用常规超声心动图评价LVEF正常ESRD患者的左心室重构及功能。方法选取2016年1月—2018年6月首次于复旦大学附属金山医院透析治疗且随访LVEF正常的ESRD患者121例作为病例组;另选取同期年龄、性别相匹配,体格检查、心电图检查及常规超声心动图检查均正常的50例健康体检者作为对照组。比较两组一般资料,主动脉根部内径(AOd)、腔室大小[左心房内径(LAd)、左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVESd)、左心房容积(LAV)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室整体舒张末期容积(gLVEDV)、左心室整体收缩末期容积(gLVESV)]及其经体表面积(BSA)校正值、左心室构型[室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左心室质量(LVM)、左心室质量指数(LVMI)及相对室壁厚度(RWT)]、左心室收缩功能参数[左心室短轴缩短率(LVFS)、LVEF、左心室整体射血分数(gLVEF)及左房室瓣环左心室收缩期峰值运动速度(S’)]、左心室整体功能(左心室Tei指数)、舒张功能参数[左房室瓣左心室舒张早期峰值流速(E峰)、左房室瓣左心室舒张晚期峰值流速(A峰)、E/A、左房室瓣E峰减速时间(DT)、等容舒张时间(IVRT)、左房室瓣环左心室舒张早期峰值运动速度(E’)、左房室瓣环左心室舒张晚期峰值运动速度(A’)、E’/A’及E/E’)];分析ESRD舒张功能障碍患者左心室构型、gLVEF情况,ESRD患者左心室构型与gLVEF情况。结果病例组患者体质量、BMI、BSA小于对照组,收缩压(SBP)、舒张压(DBP)、脉压(DP)大于对照组(P<0.05)。病例组AOd、AOd/BSA、LAd、LAd/BSA、LVEDd、LVEDd/BSA、LVESd、LVESd/BSA、LAVBackground Cardiovascular diseases continue to be a leading cause of death in ESRD.The basic pathology may be the changes of cardiac structure and function.In daily clinical practice,more attention is often paid to heart failure,particularly when left ventricular ejection fraction(LVEF)is abnormal,while many other important cardiac parameters are ignored.Objective To assess the left ventricular remodeling and function in ESRD patients with preserved LVEF by using echocardiography.Methods Participants were selected from Jinshan Hospital of Fudan University from January 2016 to June 2018,including 121 ESRD patients receiving the initial dialysis in this hospital and with preserved LVEF during the followup period(case group),and 50 age-and sex-matched physical examinees with normal results of physical examination,electrocardiogram and routine echocardiography(control group).Intergroup comparisons were made in terms of general data,aortic diameter(AOd),parameters of chamber size(LAd,LVEDd,LVESd,LAV,LVEDV,LVESV,g LVEDV,g LVESV)and their values after body surface area(BSA)correction,left ventricular configuration(IVST,LVPWT,LVM,LVMI and RWT),systolic function parameters[LVFS,LVEF,gLVEF and peak systolic mitral annular velocity(S’)],global left ventricular function(LV Tei index),diastolic function parameters[peak early diastolic E-wave velocity(E peak),peak late diastolic A-wave velocity(A peak),E/A,deceleration time(DT),iso-volumic relaxation time(IVRT),peak early diastolic mitral annular velocity(E’),peak late diastolic mitral annular velocity(A’),E’/A’and E/E’].The left ventricular configuration and the status of the gLVEF were analyzed in ESRD patients,and were further analyzed in those with diastolic dysfunction.Results The case group showed lower mean weight,BMI,BSA,higher mean systolic blood pressure(SBP),diastolic blood pressure(DBP)and pulse pressure difference(DP)compared with the control group(P<0.05).The case group demonstrated greater mean AOd,AOd/BSA,LAd,LAd/BSA,LVEDd,LVEDd/BSA,LVESd,LVESd/BSA,

关 键 词：肾病 每搏输出量 心室重构 心室功能 左 超声心动描记术 病例对照研究 

分 类 号：R692[医药卫生—泌尿科学]