速度向量成像及实时三维超声心动图评估慢性肾脏病患者右心室功能  

Velocity vector imaging and real-time three-dimensional echocardiography for evaluation on right ventricular function in patients with chronic kidney disease

作　　者：乔荞 张艳[2] 张璐[2] 赵倩 彭芮[2] 邓爱云[2] QIAO Qiao;ZHANG Yan;ZHANG Lu;ZHAO Qian;PENG Rui;DENG Aiyun(The First Clinical Medical College of Lanzhou University,Lanzhou 730000,China;Department of Cardiology,the First Hospital of Lanzhou University,Lanzhou 730000,China)

机构地区：[1]兰州大学第一临床医学院,甘肃兰州730000 [2]兰州大学第一医院心内科,甘肃兰州730000

出　　处：《中国医学影像技术》2023年第11期1644-1648,共5页Chinese Journal of Medical Imaging Technology

基　　金：甘肃省自然科学基金(22JR5RA933)。

摘　　要：目的 观察常规超声心动图、速度向量成像(VVI)及实时三维超声心动图(RT-3DE)评估不同程度慢性肾脏病(CKD)患者右心室功能的价值。方法 前瞻性纳入70例CKD患者,按估算肾小球滤过率(eGFR)将其分为轻-中度组(G1~G3期,A组,n=30)及重度组(G4~G5期,B组,n=40),以30名健康志愿者作为对照组(C组);比较组间生化指标、右心室常规超声心动图、VVI及RT-3DE参数差异,以Pearson相关性分析评估VVI及RT-3DE参数与eGFR的相关性。结果 相比C组,A、B组右心室整体纵向应变(GLS)、游离壁应变(FWS)及右心室射血分数(RVEF)均降低(P均<0.05),右心室纵向应变达峰时间标准差(TLS-SD)及应变率达峰时间标准差(TLSR-SD)均升高(P均<0.05),且B组变化幅度均大于A组(P均<0.05)。相比A及C组,B组Tei指数、右心室舒张末期容积(RVEDV)、右心室收缩末期容积(RVESV)及容积指数(RVESVI)均增高(P均<0.05),右心室面积变化分数、三尖瓣环收缩期位移、右心室整体纵向应变率(GLSR)和右心室每搏量均降低(P均<0.05);而A、C组间差异均无统计学意义(P均>0.05)。右心室TLS-SD、TLSR-SD、RVEDV、右心室舒张末期容积指数(RVEDVI)、RVESV、RVESVI均与eGFR呈负相关(r=-0.879、-0.746、-0.567、-0.521、-0.720、-0.687,P均<0.05),GLS、GLSR、FWS、RVEF均与eGFR呈正相关(r=0.828、0.644、0.629、0.812,P均<0.05)。结论 VVI和RT-3DE,尤其TLS-SD、GLS和RVEF,可有效评估不同程度CKD患者右心室功能,对于显示肾功能损害早期右心室功能异常较为敏感。Objective To explore the value of velocity vector imaging(VVI)and real-time three-dimensional echocardiography(RT-3DE)for evaluation on right ventricular function in patients with different stage chronic kidney disease(CKD).Methods Totally 70 CKD patients were prospectively enrolled and divided into mild-moderate group(G1—G3 stages,group A,n=30)or severe group(G4—G5 stages,group B,n=40)based on estimated glomerular filtration rate(eGFR).Meanwhile,30 healthy adult volunteers were enrolled as controls(group C).The biochemical indicators,conventional echocardiography,VVI and RT-3DE parameters were compared among the groups,and Pearson correlation analysis was used to evaluate the correlations of VVI or RT-3DE parameters and eGFR.Results Compared with group C,right ventricular global longitudinal strain(GLS),free wall strain(FWS)and right ventricular ejection fraction(RVEF)decreased,while right ventricular standard deviation of the time to peak longitudinal strain(TLS-SD)and standard deviation of the time to peak longitudinal strain rate(TLSR-SD)increased in group A and B(all P<0.05).The amplitude of changes in group B were more obvious than those in group A(all P<0.05).Compared with group A and C,Tei index,right ventricular end-diastolic volume(RVEDV),right ventricular end-systolic volume(RVESV)and right ventricular end-systolic volume index(RVESVI)increased(all P<0.05),fraction area change,tricuspid annular plane systolic displacement,global longitudinal strain rate(GLSR)and right ventricular stroke volume decreased in group B(all P<0.05).No significant difference of the above parameters was observed between group A and C(all P>0.05).The right ventricular TLS-SD,TLSR-SD,RVEDV,right ventricular end-diastolic volume index(RVEDVI),RVESV and RVESVI were negatively correlated with eGFR(r=-0.879,-0.746,-0.567,-0.521,-0.720,-0.687,all P<0.05),while GLS,GLSR,FWS and RVEF were positively correlated with eGFR(r=0.828,0.644,0.629,0.812,all P<0.05).Conclusion VVI and RT-3DE,especially TLS-SD,GLS and RVEF could effectively

关 键 词：肾功能不全 慢性 心室功能 右 速度向量成像 超声心动描记术 三维 前瞻性研究 

分 类 号：R692[医药卫生—泌尿科学] R445.1[医药卫生—外科学]