实时三维斑点追踪成像技术在维持性血液透析病人左心功能评价中的应用  

Application of real-time three-dimensional speckle tracking imaging in evaluating left ventricular function in patients undergoing maintenance hemodialysis

作　　者：杨攀玉 宋晓霞[1] 孙品[1] 何香芹[1] 王小凡[1] 姜志荣[1] YANG Panyu;SONG Xiaoxia;SUN Pin;HE Xiangqin;WANG Xiaofan;JIANG Zhirong(Department of Cardiac Ultrasound,The Affiliated Hospital of Qingdao University,Qingdao 266000,China)

机构地区：[1]青岛大学附属医院心脏超声科,山东青岛266000

出　　处：《青岛大学学报（医学版）》2024年第2期233-238,共6页Journal of Qingdao University(Medical Sciences)

基　　金：青岛市科技惠民重大项目(19-6-1-2-nsh)。

摘　　要：目的探讨实时三维斑点追踪成像技术(RT3D-STI)用于评价射血分数保留尿毒症病人心肌功能的临床价值。方法选取就诊于我院诊断为尿毒症的病人118例,根据是否接受维持性血液透析分为透析组和未透析组(21例),透析组进一步分为A组(45例,透析时间<1年)、B组(28例,1年≤透析时间≤3年)和C组(24例,3年<透析时间≤5年);选取同期健康志愿者30例作为对照组。应用RT3D-STI检测左心室整体纵向、径向、圆周应变(GLS、GRS、GCS),左心室整体纵向、径向及圆周应变心肌运动达峰时间(TLS、TRS、TCS),分析各组参数的差异及超声与临床参数相关性。结果与对照组比较,未透析组及透析组GLS、GRS明显减低,TLS、TRS均明显延长(F=9.234~21.592,P<0.05);与未透析组相比,透析组GLS升高,TLS降低,差异有统计学意义(P<0.05);与A组比较,B、C组GLS减低,TLS延长,差异有统计学意义(P<0.05)。尿毒症病人GLS、GRS与左心室心肌质量指数(LVMI)、左心室舒张末期容积(EDV)呈负相关(r=-0.609~-0.446,P<0.01),与左心室射血分数(LVEF)呈正相关(r=0.553、0.513,P<0.01)。结论RT3D-STI可通过检测射血分数保留的尿毒症病人左心室整体应变及整体运动达峰时间,追踪其心肌运动,对病人左心室心肌运动变化情况进行准确评价,并可评估左心室整体及局部功能,有重要的临床应用价值。Objective To investigate the clinical value of real-time three-dimensional speckle tracking imaging(RT3D-STI)in assessing myocardial function of uremia patients with preservation of left ventricular ejection fraction.Methods A total of 118 patients who attended our hospital and were diagnosed with uremia were enrolled in this study,and according to whether the patient received maintenance hemodialysis,they were divided into hemodialysis group and non-hemodialysis group with 21 patients;the hemodialysis group was further divided into group A with 45 patients(duration of hemodialysis<1 year),group B with 28 patients(duration of hemodialysis≥1 year and≤3 years),and group C with 24 patients(duration of hemodialysis>3 years and≤5 years);30 healthy volunteers during the same period of time were enrolled as control group.RT3D-STI was used to measure the global longitudinal strain(GLS),global radial strain(GRS),and global circumferential strain(GCS)of the left ventricle and the time to peak longitudinal strain(TLS),time to peak radial strain(TRS),and time to peak circumferential strain(TCS)of myocardial exercise of the left ventricle,and the differences in parameters between groups were analyzed,as well as the correlation between ultrasound and clinical parameters.Results Compared with the control group,the non-hemodialysis group and the hemodialysis group had significant reductions in GLS and GRS and significant increases in TLS and TRS(F=9.234-21.592,P<0.05);compared withthe non-hemodialysis group,the hemodialysis group had a significant increase in GLS and a significant reduction in TLS(P<0.05);compared with group A,groups B and C had a significant reduction in GLS and a significant increase in TLS(P<0.05).In the patients with uremia,GLS and GRS were negatively correlated with left ventricular mass index and end-diastolic velocity(r=-0.609 to-0.446,P<0.01)and were positively correlated with left ventricular ejection fraction(r=0.553,0.513,P<0.01).ConclusionBy measuring the global strains of the left ventricle an

关 键 词：尿毒症 肾透析 超声心动描记术 三维 成像 三维 心室功能 左 

分 类 号：R692.5[医药卫生—泌尿科学] R540.45[医药卫生—外科学]