压力-应变环在维持性血液透析伴贫血患者左心室心肌做功检测中的应用  

Application of pressure-strain loop in detecting left ventricular myocardial work in maintenance hemodialysis patients with anemia

作　　者：吕晴 戴丽雅 周宁[1] 陈方红[1] LYU Qing;DAI Liya;ZHOU Ning;CHEN Fanghong(Department of Ultrasound Medicine,Lishui Central Hospital,Lishui 323000,China)

机构地区：[1]丽水市中心医院超声医学科,323000

出　　处：《心电与循环》2024年第5期498-502,I0003,共6页Journal of Electrocardiology and Circulation

摘　　要：目的探讨压力-应变环(PSL)在维持性血液透析(MHD)伴贫血患者左心室心肌做功检测中的应用。方法回顾性选取2019年1月至2022年12月在丽水市中心医院就诊的MHD患者62例,包括贫血组36例和非贫血组26例。另选取同期本院健康体检者34人为正常对照组。采用常规超声心动图检查测定左心室结构和功能参数[包括室间隔厚度(IVSd)、左心室舒张末期内径(LVEDd)、左心室后壁厚度(LVPWd)、左心室收缩末期内径(LVESd)、左心室射血分数(LVEF)、左心室壁相对厚度(LVRWT)、左心室质量指数(LVMI)],采用二维斑点追踪技术获取整体纵向应变(GLS)和峰值应变离散度(PSD),采用PSL技术获取心肌做功参数[包括整体做功指数(GWI)、整体有用功(GCW)、整体无用功(GWW)和整体做功效率(GWE)]。比较3组对象上述参数的差异,采用ROC曲线分析心室斑点追踪超声心动图参数及心肌做功参数对左心室心肌受损的预测效能,采用组内相关系数(ICC)分析心肌做功参数重复性。结果与正常对照组比较,非贫血组、贫血组IVSd、LVEDd、LVPWd、LVESd、LVRWT、LVMI、PSD、GWW均明显增加(均P<0.05),GWE、GLS均明显减小(均P<0.05);与非贫血组比较,贫血组GWW增大而GWE减小(均P<0.05),而IVSd、LVEDd、LVPWd、LVESd、LVRWT、LVMI、PSD、GLS比较差异均无统计学意义(均P>0.05);3组对象LVEF、GWI、GCW比较差异均无统计学意义(均P>0.05)。GLS、GWW、GWE预测左心室心肌受损的AUC分别为0.909、0.942、0.947,最佳截断值分别为18%、147 mm Hg%、93%,灵敏度分别为0.934、0.869、0.885,特异度分别为0.714、0.971、0.971。观察者内和观察者间GWI、GCW、GWW和GWE的ICC均>0.75,提示重复性良好。结论PSL可用于评估贫血对MHD患者左心室收缩功能的影响。Objective To explore the application of pressure-strain loop(PSL)in detecting left ventricular myocardial work in maintenance hemodialysis(MHD)patients with anemia.Methods Sixty-two MHD patients who visited Lishui Central Hospital from January 2019 to December 2022 were enrolled retrospectively,including 36 anemic patients(anemia group)and 26 non-anemic patients(non-anemia group).Thirty-four healthy individuals who underwent physical examination in our hospital at the same time were selected as a control group.Left ventricular structure and function were measured by conventional echocardiography,including interventricular septal diameter(IVSd),left ventricular end-diastolic diameter(LVEDd),left ventricular posterior wall diameter(LVPWd),left ventricular end-systolic diameter(LVESd),left ventricular ejection fraction(LVEF),left ventricular relative wall thickness(LVRWT),left ventricular mass index(LVMI)].Two-dimensional speckle tracking echocardiography was used to obtain global longitudinal strain(GLS)and peak strain dispersion(PSD).PSL was constructed to obtain myocardial work parameters,including global work index(GWI),global constructive work(GCW),global wasted work(GWW),and global work efficiency(GWE).The parameters were compared among three groups.ROC curve analysis was used to assess the predictive efficacy of speckle tracking echocardiography parameters and myocardial work parameters for left ventricular dysfunction.The repeatability of myocardial work parameters was analyzed using interclass correlation coefficient(ICC).Results IVSd,LVEDd,LVPWd,LVESd,LVRWT,LVMI,PSD,and GWW were significantly higher(all P<0.05),GWE and GLS were significantly lower in non-anemia group and anemia group than in the control group(all P<0.05).Compared with the non-anemic group,the anemic group showed an increase in GWW and a decrease in GWE(all P<0.05),while there were no statistically significant differences in IVSd,LVEDd,LVPWd,LVESd,LVRWT,LVMI,PSD,and GLS(all P>0.05).LVEF,GWI and GCW were not significant difference between gr

关 键 词：维持性血液透析 贫血 压力-应变环 心肌做功 

分 类 号：R692.5[医药卫生—泌尿科学] R556[医药卫生—外科学] R540.45[医药卫生—临床医学]