3D-STI评价两种血液透析方式对尿毒症患者左心室整体收缩功能的影响  

Evaluate of the effect of two hemodialysis methods on the overall left ventricular systolic function in patients with uremia by three-dimensional speckle tracking technology

作　　者：张秉宜[1] 陈小蓉 陈红敏 王婷 陈璐 董梦 平杰[1] ZHANG Bingyi;CHEN Xiaorong;CHEN Hongmin;WANG Ting;CHEN Lu;DONG Meng;PING Jie(Department of Ultrasonography,the People’s Hospital of China Three Gorges Universitythe First People’s Hospital of Yichang,Hubei Province,Yichang 443003,China)

机构地区：[1]三峡大学人民医院湖北省宜昌市第一人民医院超声影像科,湖北宜昌443003

出　　处：《中国医药导报》2022年第10期89-93,共5页China Medical Herald

基　　金：湖北省卫生健康委员会联合基金项目(WJ2019H509);湖北省宜昌市医疗卫生研究项目(A19-301-29)。

摘　　要：目的应用三维斑点追踪技术(3D-STI)评价两种血液透析方式对尿毒症患者左心室整体收缩功能影响。方法选取2019年1月至2020年12月三峡大学人民医院血液透析中心病情稳定的尿毒症透析患者35例。按不同透析方式对上述患者进行血液透析和血液滤过。分别于透析前,透析后30 min内各行1次心脏彩超检查。比较心脏彩超参数[左室整体收缩期峰值应变(LVGPSL)、左室整体纵向应变(LVGLS)、左室整体环向应变(LVGCS)、左室整体面积应变(LVGAS)、左室整体径向应变(LVGRS)、左室射血分数(LVEF)、左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)]及患者相关临床及血液生化指标。分析两组血清β2微球蛋白(β2-MG)浓度变化值与3D-STI变化值的相关性。结果透析后血液透析及血液滤过左室舒张末期内径、左房内径、左房容积指数测值显著低于透析前,差异有统计学意义(P<0.05),而两法Sm值透析前后比较,差异无统计学意义(P>0.05)。单次透析后,血液透析LVGPSL、LVGLS、LVGCS、LVGAS、LVGRS、LVEDV、LVESV测值低于透析前,差异有高度统计学意义(P<0.01);LVEF透析前后比较,差异无统计学意义(P>0.05)。单次透析后,血液滤过LVESV显著低于透析前,差异有统计学意义(P<0.05)。两法单次透析后血尿素、血肌酐低于透析前,差异有高度统计学意义(P<0.01)。血液透析透析后血清β2-MG高于透析前,而血液滤过透析后血清β2-MG低于透析前,差异有高度统计学意义(P<0.01)。血液滤过透析前后血清β2-MG浓度变化值与LVGLS呈负相关(r=-0.45,P<0.05)。结论血液透析对患者左室整体收缩功能具有一定的损害,而血液滤过对左室整体收缩功能具有保护作用,可能的机制是通过滤除大分子物质的缘故。Objective To evaluate the effects of different hemodialysis methods on the overall systolic function of the left ventricle in patients with uremia by using 3D spot tracking technique(3D-STI).Methods Thirty-five uremic dialysis patients with stable condition in the People’s Hospital of China Three Gorges University from January 2019 to December 2020 were selected.Hemodialysis and hemofiltration were performed on the above patients according to different dialysis methods.Cardiac ultrasonography was performed once before dialysis and within 30 minutes after dialysis.Comparison of cardiac ultrasound parameters(left ventricular global peak systolic strain[LVGPSL],left ventricular global longitudinal strain[LVGLS],left ventricular global circumferential strain[LVGCS],left ventricular global area strain[LVGAS],left ventricular global radial strain[LVGRS],left ventricular ejection fraction[LVEF],left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume[LVESV])and patient-related clinical and blood biochemical indicators.The correlation between the changes of serumβ2-microglobulin(β2-MG)concentrations and the changes of 3D-STI in the two groups was analyzed.Results The measured values of left ventricular end-diastolic diameter,left atrium diamete,left ventricular volumes index in hemodialysis and hemofiltration after dialysis were significantly lower than those before dialysis,and the differences were statistically significant(P<0.05);however,there was no significant difference in Sm between the two methods before and after dialysis(P>0.05).After a single dialysis,the measured values of LVGPSL,LVGLS,LVGCS,LVGAS,LVGRS,LVEDV,and LVESV in the hemodialysis methods were lower than those before dialysis,and the differences were highly statistically significant(P<0.01);there was no significant difference in LVEF before and after dialysis(P>0.05).After a single dialysis,the LVESV in the hemofiltration methods was significantly lower than that before dialysis,and the difference was statistically signifi

关 键 词：三维 斑点追踪 尿毒症 血液透析 血液滤过 左心室功能 

分 类 号：R540.45[医药卫生—心血管疾病]