三维超声心动图对慢性肾脏疾病患者左心房容积和功能的评价  

Evaluation of left atrial volume and function in patients with chronic kidney disease by three-dimensional echocardiography

作　　者：张红安 段言峰 唐静 张乙慧 ZHANG Hong-an;DUAN Yan-feng;TANG Jing;ZHANG Yi-hui(Department of Ultrasound,Nanshan People’s Hospital of Shekou District,Shenzhen 518067,Guangdong,China)

机构地区：[1]深圳市南山区蛇口人民医院超声科,广东深圳518067

出　　处：《生物医学工程与临床》2020年第2期152-157,共6页Biomedical Engineering and Clinical Medicine

摘　　要：目的探究在评价慢性肾脏疾病(CKD)患者的左心房容积及功能中三维超声心动图(3DE)的应用价值。方法选择CKD 2~5期非透析慢性肾脏疾病患者101例,其中男性58例,女性43例;年龄20~65岁,平均年龄42.68岁。依据患者的肾小球滤过率(GFR)水平分为CKD 2~5组,其中CKD 2组(CKD 2期,GFR 60~89 mL/min)24例,CKD 3组(CKD 3期,GFR 30~59 m L/min)26例,CKD 4组(CKD 4期,GFR 15~29 mL/min)25例,CKD 5组(CKD 5期,GFR <15 mL/min)26例。同时另选择25例正常受试者作为对照组,其中男性15例,女性10例;年龄26~64岁,平均年龄43.85岁。对全容积3DE图像进行采集,采用软件脱机分析,收集左心房各3DE的容积参数,具体包括左心房前后径(LAD)、左心室舒张末期的前后径(LVIDd)、舒张末期的室间隔厚度(LAVImax)、收缩前容积指数(LAVIp)和最小容积指数(LAVImin),并计算左心房总排空指数(LAVItotal)、主动排空指数(LAVIact)、被动排空指数(LAVIpass)、主动排空分数(LAAEF)、被动排空分数(LAPEF)、总排空分数(LATEF),对比各组间不同参数的差异情况。结果左心房储备功能3DE容积参数比较:CKD各组LAVImax、LAVIp与对照组相比明显增高,且CKD 4组和CKD 5组增高更明显(P <0.05)。CKD 4组和CKD 5组LAVImin与对照组、CKD 2组和CKD 3组相比明显增高(P <0.05)。CKD 4组和CKD 5组LAVItotal、LATEF与对照组相比有明显增高(P <0.05)。左心房管道功能3DE容积参数比较:CKD各组LAPEF与对照组相比有明显降低,其中CKD 5组降低更明显(P <0.05)。左心房助力泵功能3DE容积参数比较:CKD各组LAVIact与对照组相比明显降低,其中CKD 5组降低更明显(P <0.05)。结论 CKD各期患者左心房储备、助力泵功能和容积指数均有明显增加,同时左心房的管道功能明显下降。3DE对早期评估CKD患者左心房容积与功能有着重要价值。Objective To explore the value of three-dimensional echocardiography(3 DE) in evaluating left atrial volume and function of patients with chronic kidney disease(CKD). Methods A total of 101 patients with CKD 2-5 non-dialysis chronic kidney were enrolled, which included 58 males and 43 females, aged 20-65 years old with mean age of 42.68 years old. According to glomerular filtration rate(GFR) level, all of them were divided into CKD 2 group(CKD stage 2, GFR 60-89 mL/min,n = 24), CKD 3 group(CKD stage 3, GFR 30-59 mL/min, n = 26), CKD 4 group(CKD stage 4, GFR 15-29 mL/min, n = 25),and CKD 5 group(CKD stage 5, GFR < 15 mL/min, n = 26). Twenty-five normal subjects were enrolled as control group, which included 15 males and 10 females, aged 26-64 years old with mean age of 43.85 years old. The volume parameters of left atrium were collected by software offline analysis, which included left atrial anteroposterior diameter(LAD), left ventricular end-diastolic anteroposterior diameter(LVIDd), left atrial maximum volume index(LAVImax), pre-contraction volume index(LAVIp) and minimum volume index(LAVImin), left atrial total emptying volume index(LAVItotal), left atrial active empyting volume index(LAVIact), left atrial passive emptying volume index(LAVIpass), left atrial active emptying fraction(LAAEF), left atrial passive emptying fraction(LAPEF), and left atrial total emptying fraction(LATEF). The different parameters in different groups were compared. Results For 3 DE volume parameters of left atrial reserve function: LAVImax and LAVIp in CKD groups were significantly higher than those of control group, especially in CKD 4 group and CKD 5 group(P < 0.05). LAVImin in CKD 4 group and CKD 5 group was significantly higher than that in control group, CKD 2 group and CKD 3 group(P < 0.05).LAVItotal and LATEF in CKD 4 group and CKD 5 group were significantly higher than those in control group(P < 0.05). For 3 DE volumetric parameters of left atrial duct function: LAPEF in CKD groups was significantly lower than that in control

关 键 词：左心房容积 左心房功能 慢性肾脏疾病 三维超声心动图 

分 类 号：R540.45[医药卫生—心血管疾病] R692[医药卫生—内科学]