相对压成像技术评估射血分数保留的慢性肾脏病患者左心室舒张功能  

Assessment of Left Ventricular Diastolic Function in Patients with Chronic Kidney Disease with Preserved Ejection Fraction by Relative Pressure Imaging

作　　者：夏侯宇 袁新春[1] 胡佳[1] 曾曦 冉洪玲 夏青青 张哲元 Xia Houyu;Yuan Xinchun;Hu Jia;Zeng Xi;Ran Hongling;Xia Qingqing;Zhang Zheyuan(Department of Ultrasound,The First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院超声医学科,南昌市330006

出　　处：《中国超声医学杂志》2023年第9期1003-1007,共5页Chinese Journal of Ultrasound in Medicine

摘　　要：目的使用相对压成像(RPI)技术评估射血分数保留的晚期慢性肾脏病(CKD)患者舒张期左心室相对压力分布,并探讨其对心脏舒张功能障碍(DD)的诊断价值。方法纳入60例CKD 5期患者,分为DDⅠ级组(DD1组)33例和DDⅡ、Ⅲ级组(DD2组)27例,对照组23例,比较3组间常规参数和相对压参数的差异,绘制受试者工作特征(ROC)曲线分析RPI参数对CKD患者DD的诊断效能。结果DD1组和DD2组4个时相中的心室内压差(IVPDs)绝对值均大于对照组(P<0.05),DD1组和DD2组在等容舒张期(IR)、快速充盈期(SF)和减慢充盈期(AC)3个时相的心室内压力梯度(IVPGs)绝对值大于对照组(P<0.05)。IVPDs-IR和IVPGs-IR对CKD患者Ⅰ级或Ⅱ、Ⅲ级DD具有很好的诊断效能,截断值分别为-0.56 mmHg(AUC=0.930)、-0.10 mmHg/cm(AUC=0.812),-1.37 mmHg(AUC=0.987)、-0.23 mmHg/cm(AUC=0.980),均P<0.001。结论RPI参数能反映慢性肾脏病患者血流动力学变化,可作为评价射血分数保留的慢性肾脏病患者舒张功能的潜在新指标。Objective To evaluate the distribution of left ventricular relative pressure in patients with advanced chronic kidney disease(CKD)with preserved ejection fraction by relative pressure imaging(RPI),and to explore its diagnostic value for diastolic dysfunction(DD).Methods Sixty patients with CKD 5 were divided into DDⅠgroup(group DD1)with 33 cases,DDⅡorⅢgroup(group DD2)with 27 cases,and the control group with 23 cases.The differences of routine parameters and relative pressure parameters among the three groups were analyzed,and the ROC curve was drawn to analyze the diagnostic efficacy of RPI parameters for diastolic dysfunction in CKD patients.Results The absolute values of intraventricular pressure differences(IVPDs)in DD1 group and DD2 group were all higher than those in the control group(P0.05).During the isovolumic relaxation period(IR),slow filling period(SF)and atrial systole period(AC),the absolute values of intraventricular pressure gradient(IVPGs)in DD1 group and DD2 group were higher than those in the control group(P0.05).During isovolumic diastole,IVPDs and IVPGs had good diagnostic efficacy for gradeⅠor gradeⅡandⅢdiastolic dysfunction in the study cohort,with cutoff values of-0.56 mmHg(AUC=0.930),-0.10 mmHg/cm(AUC=0.812),-1.37 mmHg(AUC=0.987),-0.23 mmHg/cm(AUC=0.980),respectively,all P0.001.Conclusions RPI parameters can reflect the hemodynamic changes of patients with chronic kidney disease,and can be used as a potential new index to evaluate diastolic function of patients with chronic kidney disease with preserved ejection fraction.

关 键 词：血流向量成像 相对压成像 慢性肾脏病 心室内压差 心室内压力梯度 

分 类 号：R445.1[医药卫生—影像医学与核医学] R692[医药卫生—诊断学]