峰值应变离散度和纵向心肌应变评价不同替代疗法的尿毒症患者左心室收缩功能  

Peak strain dispersion and global longitudinal peak strain for evaluating left ventricular function and systolic synchrony in patients with end-stage renal disease receiving different replacement therapies

作　　者：李卡娜 郑哲岚[1] 王江涛 Li Kana;Zheng Zhelan;Wang Jiangtao(Cardiovascular Ultrasound Center,the First Affiliated Hospital,College of Medicine,Zhejiang University,Hangzhou 310003,China;Clinical Education Department,General Electric Medical Clinical Education Team,Beijing 100176,China)

机构地区：[1]浙江大学医学院附属第一医院心血管超声中心,杭州310003 [2]通用电气临床科研部,北京100176

出　　处：《中华医学超声杂志（电子版）》2021年第3期258-265,共8页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的探讨峰值应变离散度(PSD)和整体纵向峰值应变(GLPS)评价不同替代治疗的终末期肾病患者左心室整体纵向收缩功能和左心室收缩同步性的价值。方法选取2018年7月至10月在浙江大学医学院附属第一医院就诊并进行替代治疗的慢性肾病V期患者89例,根据不同替代治疗方法分为3组,分别是肾移植组30例;血液透析组31例和腹膜透析组28例。同时选取健康成年人33名作为对照组。采集心尖两腔心切面、三腔心切面及四腔心切面3个长轴切面连续3个心动周期的二维灰阶动态图像,分析得出左心室心肌纵向峰值收缩应变曲线和纵向应变达峰时间牛眼图,并自动计算出PSD和GLPS。符合正态分布的计量资料多组间比较采用单因素方差分析,组间两两比较采用LSD-t检验法;不服从正态分布的计量资料多组间比较采用秩和检验,组间两两比较采用秩和检验。应用受试者操作特征(ROC)曲线分析PSD诊断左心室收缩非同步性的临床价值;符合正态分布的变量采用Pearson相关分析,否则使用Spearman相关分析。随机抽取20例患者进行PSD的观察者内和观察者间的重复性检验。结果治疗终末期肾病3组左心室各节段纵向应变达峰时间差异增大,PSD均较对照组明显增高(P<0.05/6),血液透析组和腹膜透析组的GLPS绝对值均较对照组明显下降(P<0.05/6),而肾移植组GLPS绝对值与对照组比较,差异无统计学意义(P>0.05/6)。肾移植组PSD和GLPS绝对值与血液透析组、腹膜透析组比较,差异有统计学意义(P<0.05/6);血液透析组、腹膜透析组的PSD和GLPS比较,差异无统计学意义(P>0.05/6),血液透析组PSD[(50.29±17.12)ms]和腹膜透析组PSD[(56.21±19.85)ms]高于对照组[(30.48±7.12)ms;t=-6.101、-6.467,P均<0.05/6]和肾移植组[(39.80±5.65)ms;t=-3.234、-4.179,P均<0.05/6]。血液透析组GLPS绝对值[(16.12±3.35)%]和腹膜透析组GLPS绝对值[(16.61±3.84)%]低于对照组[(21.34±2.88)Objective To evaluate the value of peak strain dispersion(PSD)and global longitudinal peak strain(GLPS)in evaluating left ventricular global longitudinal systolic function and left ventricular systolic synchrony in patients with end-stage renal disease(ESRD)receiving different replacement therapies.Methods Eighty-nine patients with ESRD who were treated at the First Affiliated Hospital,College of Medicine,Zhejiang University from July to October 2018 were divided into three groups according to the replacement therapy used:kidney transplantation group(n=30),hemodialysis group(n=31),and peritoneal dialysis group(n=28).Meanwhile,33 heathy adults were selected as a control group.Two dimensional gray-scale dynamic images of apical two chamber view,three chamber view,and four chamber view were collected for three consecutive cardiac cycles.The longitudinal peak contraction strain curve and the time to peak longitudinal strain bull's eye plot of the left ventricular myocardium(17 segments)were analyzed,and the PSD and GLPS were automatically calculated with AFI software.Normally distributed measurement data among multiple groups were compared by one-way ANOVA;comparisons between two groups were performed by LSD-t method.Non-normally distributed measurement data among multiple groups and between two groups were compared by the rank sum test.The clinical value of PSD in the diagnosis of left ventricular systolic non-synchronization was analyzed using the receiver operating characteristic(ROC)curve.Pearson correlation analysis was used for normal distribution variables,otherwise Spearman correlation analysis was used.Twenty patients were randomly selected for PSD intraobserver and interobserver reproducibility tests.Results The longitudinal strain peak time in each segment of the left ventricle in the three treatment groups was increased,and the PSD was significantly higher than that of the control group(P<0.05/6).The absolute values of GLPS in the hemodialysis group and peritoneal dialysis group were significantly lower t

关 键 词：峰值应变离散度 整体纵向峰值应变 同步性 腹膜透析 血液透析 肾移植 超声心动图 二维斑点追踪成像 肾病 终末期 

分 类 号：R692.5[医药卫生—泌尿科学] R445.1[医药卫生—外科学]