应用二维斑点追踪成像评价肾移植和血液透析患者左心室与颈动脉功能变化  

Assessment of left ventricular and carotid artery function changes in patients with renal transplantation and hemodialysis by two-dimensional speckle tracking imaging

作　　者：韩玥 张佩佩 沈彬[1] 王艺璇 李菲 王蓓[1] HAN Yue;ZHANG Pei-pei;SHEN Bin;WANG Yi-xuan;LI Fei;WANG Bei(Department of Medical Ultrasound,the First Affiliated Hospital of Shandong First Medical University&Shandong Provincial Qianfoshan,Jinan 250014,China)

机构地区：[1]山东第一医科大学第一附属医院(山东省千佛山医院),山东济南250014

出　　处：《中国临床医学影像杂志》2022年第9期641-646,656,共7页Journal of China Clinic Medical Imaging

摘　　要：目的:应用超声二维斑点追踪成像(2D-STI)比较肾移植和血液透析患者颈动脉弹性功能与左心室收缩功能。方法:共收集107例终末期肾病(ESRD)患者,分为血液透析组(HD组)67例、肾移植组(RT组)40例,同时选择年龄、性别相匹配的健康受试者(健康对照组)40例,所有受试者均接受详细的临床评估、生化检测、超声心动图和颈动脉超声检查。应用2D-STI获得左室各节段收缩期纵向应变(4CGLS、3CGLS、2CGLS)、左心室整体收缩期纵向应变(LVGLS)及颈动脉周向应变(CCS)。比较3组受试者之间一般资料、常规超声心动图、左心室应变及颈动脉应变参数,并且对颈动脉应变和左心室应变参数进行相关性分析。结果:3组受试者在4CGLS、3CGLS、2CGLS、LVGLS及CCS之间差异均有统计学意义,并且任意两组之间的差异也有统计学意义(P<0.05)。相较于健康对照组,ESRD患者的左室射血分数(LVEF)均有一定程度的减低,但HD组和RT组两组间LVEF无统计学意义。对于颈动脉内中膜厚度(CIMT)来说,HD组高于RT组和健康对照组(P<0.05),在RT组和健康对照组之间差异无统计学意义。但对于CCS,RT组和HD组均小于健康对照组,且RT组的CCS高于HD组,差异均有统计学意义(P<0.05)。RT组和HD组CCS与4CGLS、3CGLS、2CGLS及LVGLS之间均呈负相关(r=-0.40、r=-0.33、r=-0.50、r=-0.53;r=-0.24、r=-0.26、r=-0.44、r=-0.40,P<0.05)。维持性血液透析持续时间与CCS呈负相关(r=-0.54,P<0.01),与LVGLS呈弱正相关(r=0.37,P<0.05)。结论:相比传统颈动脉超声及超声心动图,2D-STI定量评估维持性血液透析患者肾移植术后心血管功能改善的效果更好。且相较于血液透析,肾移植对心血管功能的恢复有良好的影响。Objective:To compare carotid artery elastic function and left ventricular systolic function in patients with renal transplantation(RT)and hemodialysis(HD)using two-dimensional speckle tracking imaging(2D-STI).Methods:A total of 107patients with end-stage renal disease(ESRD)were collected and divided into two groups:67 patients in the hemodialysis group(HD group)and 40 patients in the renal transplantation group(RT group),and 40 age-and gender-matched healthy subjects(Healthy control group)were selected.All subjects underwent detailed clinical assessment,biochemical tests,echocardiography and carotid ultrasonography.The 2D-STI was used to obtain the systolic longitudinal strain of left ventricular segments(4CGLS,3CGLS,2CGLS),the left ventricular global systolic longitudinal strain(LVGLS)and the carotid circumferential strain(CCS).The clinic data,echocardiography,left ventricular strain parameters and carotid artery strain parameters were compared between the three groups,and the correlation analysis was performed on carotid artery strain and left ventricular strain parameters.Results:There were significant differences in 4CGLS,3CGLS,2CGLS,LVGLS and CCS among the three groups,and the difference between any two groups was also statistically significant(P<0.05).Compared with the healthy control group,the left ventricular ejection fraction(LVEF)of ESRD patients was decreased(P<0.05),but there was no significant difference in LVEF between HD group and RT group.For carotid artery intima-media thickness(CIMT),HD group was higher than RT group and the healthy control group(P<0.05),and there was no significant difference between RT group and healthy control group.However,for CCS,RT group and HD group were both lower than the healthy control group,and the CCS in the RT group was higher than that in HD group(P<0.05).There were negative correlations between CCS and 4CGLS,3CGLS,2CGLS and LVGLS in RT group and HD group(r=-0.40,r=-0.33,r=-0.50,r=-0.53;r=-0.24,r=-0.26,r=-0.44,r=-0.40,P<0.05).The duration of maintenance hemodialys

关 键 词：心室功能 左 颈动脉 肾移植 肾透析 超声心动描记术 多普勒 彩色 

分 类 号：R692[医药卫生—泌尿科学] R540.45[医药卫生—外科学]