基于冠状动脉CT血管成像的左心房测量参数对慢性肾病患者肾功能的评价  

The Evaluation of Left Atrial Parameters Measured on Coronary CT Angiography and Renal Function in Patients with Chronic Kidney Disease

作　　者：王之悦 朱建国[1] 刘斐[1] 臧汉杰 汪琼 曹波[1] 刘剑[1] 李海歌[1] WANG Zhiyue;ZHU Jianguo;LIU Fei(Department of Radiology,the Second Affiliated Hospital of Nanjing Medical University,Nanjing 210011,P.R.China)

机构地区：[1]南京医科大学第二附属医院医学影像科,210011

出　　处：《临床放射学杂志》2023年第11期1757-1762,共6页Journal of Clinical Radiology

摘　　要：目的探讨基于冠状动脉CT血管成像(CCTA)测得的左心房、左心耳形态和功能参数对慢性肾病(CKD)患者肾功能的评价。方法回顾性分析行CCTA的CKD 2~4级组(n=71)及CKD 5级组患者(n=77),并选取肾功能正常的对照组78例,搜集临床资料及常规超声心动图参数左室射血分数(LVEF)和二尖瓣口舒张期E峰与室间隔e峰的比值(E/e’)。采用图像后处理软件测得左心房最大(LAVmax)、最小(LAVmin)容积及左心耳最大(LAAVmax)、最小(LAAVmin)容积,并计算左心房及左心耳的射血分数(LAEF、LAAEF)。采用单因素方差分析、秩和检验或χ2检验比较组间各项指标的差异,采用Pearson相关分析及多元线性回归分析左心房参数与估计肾小球滤过率(eGFR)之间的相关性。结果CKD 5级组较CKD 2~4级组及对照组、CKD 2~4级组较对照组间的左心房功能参数LAEF及LAAEF显著减低(P<0.001),CKD 5级组的左心房形态参数LAVmax、LAVmin、LAAVmax及LAAVmin较对照组显著增大(P<0.01),但较CKD 2~4级组增大不显著。左心房功能参数LAEF及LAAEF与eGFR呈正相关(r=0.395和0.414,P<0.001),且为独立相关(P<0.01)。结论利用CCTA可对左心房的大小及功能进行一站式评价,其功能参数LAEF及LAAEF与CKD患者的肾功能相关,为早期评估、早期干预CKD患者诊治提供影像学量化依据。Objective To investigate the evaluation of renal function in patients with chronic kidney disease(CKD)based on morphological and functional parameters of the left atrium and left atrial appendage measured on coronary CT angiography(CCTA).Methods Seventy-one subjects with CKD stage 2-4 and 77 subjects with CKD stage 5 were all enrolled,78 healthy subjects were enrolled as control group.All subjects underwent CCTA were retrospectively analyzed.The basic clinical data and echocardiography parameters left ventricular ejection fraction(LVEF)and E/e'were contacted.The left atrium maximum volume(LAVmax),left atrium minimum volume(LAVmin),left atrial appendage maximum volume(LAAVmx)and left atrial appendage minimum volume(LAVmin)were measured by post-processing software.Left atrium ejection fraction(LAEF)and left atrial appendage ejection fraction(LAAEF)were also calculated.Parameters between the groups were compared by One-way ANOVA,rank sum test and Chi-square test.The correlations between left atrial parameters and eGFR were evaluated by Pearson correlation test and multiple linear regression.Results Left atrial functional parameters LAEF and LAAEF were significantly lower in CKD stage 5 group than those in CKD stage 2-4 group and control group,and lower in CKD stage 2-4 group than those in control group(P<0.001).Left atrial morphological parameters LAVmax,LAVmin,LAAVmax and LAVmn in CKD stage 5 group were significant larger than those in control group(P<O.O1),while there were no significant differences between two CKD groups.LAEF and LAAEF were positively correlated with eCFR(r=0.395 and 0.414,P<0.001),and the correlations were independent(P<0.01).Conclusion CCTA can provide an one-stop evaluation of the size and function of the left atrium.Left atrial functional parameters measured and calculated on CCTA correlated independently and positively with renal function in CKD patients,and may provide imaging quantitative indexes in early evaluation and intervention in their treatment.

关 键 词：慢性肾病 左心房 体层摄影术 X线摄影机 

分 类 号：R692[医药卫生—泌尿科学] R816.2[医药卫生—外科学]