压力-应变环对终末期肾病不同替代治疗患者左心室做功的研究  

Pressure-strain loop study on left ventricular work in patients with end-stage renal disease treated with different alternative therapies

作　　者：李庆 李小燕 徐旭[1] 葛晓颖 郑哲岚[1] LI Qing;LI Xiaoyan;XU Xu;GE Xiaoying;ZHENG Zhelan(Department of Cardiovascular Ultrasound Center,the First Affiliated Hospital Zhejiang University School of Medicine,Hangzhou 310003,China;不详)

机构地区：[1]浙江大学医学院附属第一医院心血管超声科,杭州310003 [2]宁波市医疗中心李惠利医院超声科 [3]宁波市医疗中心李惠利医院病案统计室

出　　处：《心电与循环》2023年第2期134-139,144,F0003,共8页Journal of Electrocardiology and Circulation

摘　　要：目的探讨压力-应变环(PSL)评估肾移植和血液透析(下称血透)后左心室做功的价值。方法选取2021年10月至12月在浙江大学医学院附属第一医院就诊的左心室射血分数(LVEF)保留的肾移植患者77例(移植组)和血透患者76例(血透组),均行超声心动图检查并分为正常构型亚组、向心性重构亚组、向心性肥厚亚组和离心性肥厚亚组,又分为低透析龄亚组和高透析龄亚组、血压正常亚组和高血压亚组。另择同期本院体检者63名作为对照组。采用PSL获取心肌做功参数,包括心肌整体做功(GWI)、整体有用功(GCW)、整体无用功(GWW)、整体做功效率(GWE),比较3组间及不同亚组间心肌做功参数,采用Spearman秩相关分析心肌做功参数与其余各参数的相关性;绘制ROC曲线分析心肌做功参数及LVEF对左心室心肌受损的预测价值。结果肾移植组和血透组GWE均低于对照组,血透组最低(均P<0.05);GWW在向心性肥厚亚组和离心性肥厚亚组高于正常构型亚组和向心性重构亚组,高透析龄亚组高于低透析龄亚组,高血压亚组高于正常血压亚组(均P<0.05);GWE在向心性肥厚亚组和离心性肥厚亚组低于正常构型亚组,在高透析龄亚组低于低透析龄亚组(均P<0.05)。GWE与GLS绝对值、LVEF均呈正相关(r=0.662、0.422,均P<0.01);ROC曲线分析显示GWE预测左心室心肌受损能力最强,截断值为94.5%,在移植组和血透组特异度均为0.968,灵敏度为0.688、0.855。结论PSL较LVEF能更全面反映肾移植和血透患者左心室心肌受损情况。Objective To explore the value of pressure strain loop(PSL)in evaluating left ventricular myocardial work in patients underwent renal transplantation and hemodialysis.Methods Seventy-seven renal transplantation patients(transplantation group)and 76 hemodialysis patients(hemodialysis group)with preserved left ventricular ejection fraction(LVEF)were selected from the First Affiliated Hospital Zhejiang University School of Medicine from October to December 2021.All patients underwent echocardiography examination and were divided into normal configuration subgroup,concentric remodeling subgroup,concentric hypertrophy subgroup and eccentric hypertrophy subgroup.They were also divided into shorter dialysis duration subgroup and longer dialysis duration subgroup,and normal blood pressure subgroup and hypertension subgroup.63 people who underwent physical examination at the same time were selected as control group.PSL was used to derive cardiac work indices,including global work index(GWI),global constructive work(GCW),global wasted work(GWW)and global work efficiency(GWE).These indices were compared among different subgroups.Spearman rank correlation was used to analyze the correlation between myocardial work indices and other parameters.ROC curve was used to analyze the predictive value of myocardial work indices and LVEF for left ventricular myocardial damage.Results GWE was significantly lower in transplantation group and hemodialysis group than in the control group(all P<0.05).GWW was significantly higher in concentric hypertrophy subgroup and eccentric hypertrophy subgroup than in normal configuration group and concentric remodeling group,in longer dialysis duration subgroup than in shorter dialysis duration subgroup,in hypertension subgroup than in normal blood pressure subgroup(all P<0.05).GWE in the left ventricular concentric hypertrophy subgroup and eccentric hypertrophy subgroup was lower than that in the left ventricular normal configuration subgroup,and GWE in longer dialysis duration subgroup was lower tha

关 键 词：心肌做功 压力应变环 终末期肾病 肾移植 血液透析 

分 类 号：R692.5[医药卫生—泌尿科学]