四维斑点追踪显像技术评价维持性血液透析尿毒症患者左心室心肌功能的研究  

Evaluation of left ventricular myocardial function with four-dimensional speckle tracking imaging in uremic patients undergoing maintenance hemodialysis

作　　者：高继康[1] 梅旭峰[2] 陈晓冰 惠姗姗 张雨濛 GAO Jikang;MEI Xufeng;CHEN Xiaobing;HUI Shanshan;ZHANG Yumeng(Department of Ultrasonography,First People's Hospital of Yuhang District,Hangzhou 311100,China)

机构地区：[1]杭州市余杭区第一人民医院(浙江大学医学院附属第二医院余杭院区)超声科,311100 [2]杭州市余杭区第一人民医院(浙江大学医学院附属第二医院余杭院区)肾内科,311100

出　　处：《浙江医学》2021年第14期1502-1508,共7页Zhejiang Medical Journal

基　　金：浙江省医学会临床科研基金项目(2019ZYC-A100)。

摘　　要：目的探讨四维斑点追踪显像技术评价维持性血液透析尿毒症患者左心室心肌功能的价值。方法选取2020年1至12月在杭州市余杭区第一人民医院维持性血液透析尿毒症患者74例(血液透析组)和健康体检者45例(正常对照组)进行超声心动图检查,并分别脱机分析其左心室全容积四维图,测定左心室前壁、下壁、前间隔、后间隔、前侧壁、后侧壁的中段,左心室心尖部和左心室整体心肌的纵向应变(LS)、圆周应变(CS)、面积应变(AS)、径向应变(RS);参照正常对照组,利用ROC曲线分析各左心室心肌四维应变参数预测维持性血液透析尿毒症患者存在左心室心肌收缩功能不全的效能;采用直线相关分析各参数与左心室射血分数(LVEF)的关系。结果血液透析组左心室整体心肌和前壁、下壁、前侧壁、后侧壁、前间隔中段心肌的LS、CS、AS和RS,后间隔中段LS、AS、RS均小于正常对照组(均P<0.01);血液透析组左心室心尖部CS和RS均大于正常对照组(均P<0.01)。根据ROC曲线分析,后间隔中段纵向应变(PSLSm)预测血液透析组存在左心室心肌收缩功能不全的诊断效能较高,当界值为-17.50%时,AUC为0.850,灵敏度和特异度分别为0.824,0.756;左心室整体心肌面积应变(GAS)与LVEF呈正相关(r=0.70,P<0.05),直线回归方程为Y=0.457X-1.355。结论四维斑点追踪显像技术能够定性和定量评价维持性血液透析尿毒症患者左心室整体心肌和不同节段心肌的收缩功能,且心肌面积应变参数能反映左心室整体心功能变化。Objective To explore the value of four-dimensional speckle tracking imaging(4D-STI)in evaluating left ventricular myocardial functions(LVEF)in uremic patients undergoing maintenance hemodialysis.Methods From January to December 2020,74 uremic patients with hemodialysis and 45 healthy subjects(control group)in the First People's Hospital of Yuhang District were enrolled in the study.The echocardiography were performed in all subjects,and the full volume four-dimensional maps of left ventricle were analyzed off-line.The longitudinal strain(LS),circumferential strain(CS),area strain(AS)and radial strain(RS)of the mid segments of the anterior wall,inferior wall,anterior septum,posterior septum,anterolateral wall,posterior lateral wall,apex and globolic myocardium of left ventricle were measured.The receiver operating characteristic(ROC)curve was used to evaluate parameters of 4D-STI in predicting left ventricular myocardial systolic dysfunction in uremic patients with maintenance hemodialysis.The linear correlation between 4D-STI parameters and LVEF was analyzed.Results In hemodialysis group,the LS,CS,AS and RS of the mid segments of left ventricular anterior wall,inferior wall,anterolateral wall,posterior lateral wall,anterior septum and the globolic myocardium were lower than those in normal control group(P<0.01),while the CS and RS of left ventricular apex in hemodialysis group were higher than those in normal control group(P<0.01).ROC curve analysis showed that the LS of the mid segment of posterior septum(PSLSm)had a high diagnostic value in pre-dicting left ventricular myocardial systolic dysfunction in uremic patients in hemodialysis group,the area under the ROC curve(AUC)was 0.850,when the cut-off value was-17.50%,the sensitivity and specificity were 0.824 and 0.756,respectively.There was a high correlation between left ventricular global area strain(GAS)and LVEF(r=0.70,P<0.05).The linear regression equation was Y=0.457X-1.355.Conclusion Four dimensional speckle tracking technique can qualitatively and quanti

关 键 词：超声心动图 尿毒症 四维斑点追踪显像技术 左心室 心肌功能 

分 类 号：R692.5[医药卫生—泌尿科学]