无创左室压力应变曲线在评估血液透析患者左室心肌做功中的应用  

Application of non-invasive left ventricular pressure-strain curve in evaluating left ventricular myocardial work in hemodialysis patients

作　　者：申凯凯 朱好辉[1] 丁晓[1] 徐瑞[1] 王一洒[1] 袁建军[1] Shen Kaikai;Zhu Haohui;Ding Xiao;Xu Rui;Wang Yisa;Yuan Jianjun(Department of Ultrasound,Henan Provincial People′s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院超声科,郑州450003

出　　处：《中华超声影像学杂志》2020年第6期505-510,共6页Chinese Journal of Ultrasonography

基　　金：河南省卫健委2016年度科技攻关(201602212)。

摘　　要：目的探讨无创左室压力应变曲线评估维持性血液透析(MHD)患者左室心肌做功的价值。方法选择2019年4-10月河南省人民医院MHD患者48例为病例组,另选择33例健康体检者为对照组,比较两组一般临床资料、二维超声基本参数[左室舒张末期内径(LVDd)、左室收缩末期内径(LVDs)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、每搏排出量(SV)、室间隔厚度(IVSd)、左室后壁厚度(LVPWd)、左室舒张期质量(LVDm)、左室收缩期质量(LVSm)、a′、E/e′、A峰及每分排出量(CO)]、纵向峰值应变离散度(PSD)、整体做功指数(GWI)、整体做功效率(GWE)、整体有效功(GCW)、整体无效功(GWW)及整体长轴应变(GLS)的变化,并分析心肌做功参数与常规心脏参数的相关性。结果①两组间比较,MHD组LVDd、LVDs、LVEDV、LVESV、SV、IVSd、LVPWd、LVDm、LVSm、收缩压(SBP)、舒张压(DBP)、a′、E/e′、A峰及CO高于对照组(均P<0.05),MHD组e′低于对照组(P<0.05)。②两组间比较,MHD组PSD、GWW高于对照组(均P<0.05),MHD组GLS、GWE低于对照组(均P<0.05),GCW、GWI差异无统计学意义(均P>0.05)。③GWI与SBP、DBP、左室射血分数(LVEF)呈正相关(r1=0.442,P1=0.030;r2=0.477,P2=0.019;r3=0.431,P3=0.040),与GLS、LVDs呈负相关(r1=-0.576,P1=0.003;r2=-0.404,P2=0.050);GWW与GLS、PSD呈正相关(r1=0.584,P1=0.003;r2=0.564,P2=0.004);GWE与LVEF呈正相关(r=0.424,P=0.044),与EDV、ESV、PSD、GLS、LVDm呈负相关(r1=-0.444,P1=0.034;r2=-0.490,P2=0.018;r3=-0.721,P3<0.001;r4=-0.738,P4<0.001;r5=-0.442,P5=0.035);GCW与LVEF、DBP呈正相关(r1=0.494,P1=0.017;r2=0431,P2=0.035),与GLS、LVDs呈负相关(r1=-0.630,P1=0.001;r2=-0.419,P2=0.042)。结论无创左室压力应变曲线结合了血压和应变,与GLS相比,能准确评估MHD患者左室心肌做功情况,预测MHD患者潜在的左室功能变化。Objective The evaluate left ventricular myocardial work in maintenance hemodialysis(MHD)patients by non-invasive left ventricular pressure strain curve.Methods Forty-eight patients undergoing maintenance hemodialysis were selected as the MHD group,and 33 healthy subjects were selected as the control group from Apr to Oct 2019 in Henan Provincial People′s Hospital.The differences of general clinical data,basic parameters of two-dimensional ultrasound including left ventricular end-diastolic diameter(LVDd),left ventricular end-systolic diameter(LVDs),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),stroke volume(SV),diastolic interventricular septal thickness(IVSd),left ventricular diastolic posterior wall thickness(LVPWd),left ventricular diastolic mass(LVDm),left ventricular systolic mass(LVSm),late diastolic tissue velocity(a′),early diastolic peak velocity/early diastolic tissue velocity(E/e′),A peak and cardiac output(CO),peak strain dispersion(PSD),and global work index(GWI),global work efficiency(GWE),global constructive work(GCW),global wasted work(GWW)and global long-axis strain(GLS)between two groups were compared,and the correlation between myocardial work parameters and conventional cardiac parameters was analyzed.Results①In terms of comparison,LVDd,LVDs,LVEDV,LVESV,SV,IVSd,LVPWd,LVDm,LVSm,systolic blood pressure(SBP),diastolic blood pressure(DBP),a′,E/e′.A peak and CO of the MHD group were greater than those in the control group(all P<0.05),and e′of the MHD group was lower(P<0.05).②In terms of comparison,PSD and GWW of the MHD group were greater than those of the control group(all P<0.05),while GLS and GWE of the MHD group was lower(all P<0.05).There were no statistically significant differences in GCW and GWI between two groups(all P>0.05).③GWI was positively correlated with SBP,DBP and left ventricular ejection fraction(LVEF)(r1=0.442,P1=0.030;r2=0.477,P2=0.019;r3=0.431,P3=0.040),and negatively correlated with GLS and LVDs(r1=-0.576,P1=0.003;r

关 键 词：超声检查 心肌做功 应变 肾透析 心肌功能 

分 类 号：R540.45[医药卫生—心血管疾病] R692.5[医药卫生—内科学]