RT-3DE评估透析类型对尿毒症患者左心房结构与功能的影响  

The effect of dialysis type on left atrial in patients with uremia by real time three-dimensional echocardiography

作　　者：刘原 郑丽丽 戴红艳 LIU Yuan;ZHENG Lili;DAI Hongyan(Department of Cardiac Ultrasound,Qingdao Municipal Hospital,Qingdao 266000,China)

机构地区：[1]大连医科大学附属青岛市市立医院心脏超声科,山东青岛266000

出　　处：《医学影像学杂志》2024年第4期24-27,32,共5页Journal of Medical Imaging

基　　金：山东省青岛市科技惠民示范引导专项任务书(编号:21-1-4-rkjk-9-nsh)。

摘　　要：目的探讨应用实时三维超声心动图(real time three-dimensional echocardiography,RT-3DE)从容积变化的角度观察比较不同透析方式对尿毒症患者左心房结构和功能的影响。方法选取在我院就诊的尿毒症患者81例。其中慢性肾脏病5期未透析组(CKD5组)20例,腹膜透析组(PD组)30例,血液透析组(HD组)31例。应用常规超声心动图及RT-3DE技术对3组进行检查,比较各组间左心房结构及功能的差异。结果常规超声心动图检查显示各组左心室舒张末期内径、室间隔厚度、左心室质量指数、左心室射血分数等参数三组间比较差异均无统计学意义(均P>0.05);左心室舒张功能障碍、左心室肥厚的发生率在各组差异无统计学意义(均P>0.05)。CKD5组和PD组、CKD5组和HD组间左心房容积参数LAVmax、LAVmin、LAVp以及LAVI差异均无统计学意义(均P>0.05)。PD组左心房容积参数LAVmax、LAVmin均明显小于HD组,差异有统计学意义(P=0.030、P<0.001)。HD组和PD组的容积参数LAVp差异无统计学意义(P>0.05)。PD组LAVI较HD组更低,差异有统计学意义(P=0.024)。PD组功能参数LAEF明显高于HD组(P<0.001),亦高于CKD5组但差异无统计学意义(P>0.05)。PD组和CKD5组功能参数LAAEF均显著高于HD组,测量结果间的差异有统计学意义(P<0.05)。各组间的LAPEF差异无统计学意义(P=0.780)。结论实时三维超声心动图可简便、准确地评价不同透析方式的尿毒症患者左心房结构改变和功能差异。PD组和HD组无法阻止左心房重构的发生,但PD组相对于HD组可能在保留和维持左心房结构和功能方面略好。Objective Real Time three-dimensional Echocardiography(RT-3DE)was used to compare the effects of different dialysis methods on left atrial volume and function in uremia patients from the perspective of volume changes.Methods A total of 81 patients with uremia in our hospital were selected.There were 20 cases in stage 5 chronic kidney disease group,30 cases in peritoneal dialysis group,and 31 cases in hemodialysis group.Conventional echocardiography and RT-3DE were performed in different groups to acquire the changes of the left atrial structure and function.Results Interventricular septum thickness(IVST),left ventricular end-diastolic diameter(LVEDD),left ventricular mass index(LVMI)and left ventricular ejection fraction(LVEF)showed no significant differences among the three groups(all P<0.05).The prevalence of left ventricular diastolic dysfunction(LVDD)and left ventricular hypertrophy(LVH)show no statistical differences among the three groups.There were no significant differences in left atrial volume parameters(LAVmax,LAVmin,LAVp and LAVI)between CKD5 and PD,CKD5 and HD.RT-3DE showed that left atrial maximun volume and left atrial minimum volume in PD group were significantly lower than those in HD group,with statistical differences(P=0.030,P<0.001).There was no significant difference in volume parameter LAVp between HD group and PD group.The Left atrial volume index in PD group was lower than that in HD group,and the difference was statistically significant(P=0.024).The left atrial ejection fraction of PD group was significantly higher than that of HD group(P<0.001)and also higher than that of CKD5 group,but the difference was not statistically significant.The left atrial active ejection fraction of PD group and CKD5 group was significantly higher than that of HD group,and the difference between the measured results was statistically significant(P<0.05).Conclusions RT-3DE can simply and accurately evaluate the structural changes and functional differences of left atrial in patients with uremia treated by diff

关 键 词：实时三维超声心动图 血液透析 腹膜透析 左心房 

分 类 号：R445.1[医药卫生—影像医学与核医学] R459.5[医药卫生—诊断学]