超声心动图联合肺部超声评估维持性血液透析合并肺动脉高压患者右心室收缩功能的临床价值  

Clinical value of echocardiography combined with lung ultrasound in the assessment of right ventricular systolic function in patients with maintenance hemodialysis combined with pulmonary hypertension

作　　者：夏颖 刘昕[2] XIA Ying;LIU Xin(Graduate School of Chengde Medical College,Chengde 067000,China;Department of Ultrasound,the Baoding No.1 Central Hospital,Baoding 071000,China)

机构地区：[1]承德医学院研究生学院,河北承德067000 [2]保定市第一中心医院超声科,河北保定071000

出　　处：《临床超声医学杂志》2025年第4期314-320,共7页Journal of Clinical Ultrasound in Medicine

基　　金：保定市超声心动图诊断重点实验室(2463P003)。

摘　　要：目的探讨超声心动图联合肺部超声评估维持性血液透析(MHD)合并肺动脉高压患者右心室收缩功能的临床价值。方法选取95例MHD合并肺动脉高压患者,根据肺动脉高压程度分为轻度组42例、中度组29例、重度组24例,均行二维超声心动图、二维斑点追踪技术、实时三维超声心动图和肺部超声检查,比较各组超声心动图参数及肺超声评分(LUS)的差异;采用多因素Logistic回归分析筛选诊断MHD合并肺动脉高压患者右心室收缩功能障碍的影响因素。绘制受试者工作特征(ROC)曲线分析各超声心动图参数单独及其联合LUS诊断MHD合并肺动脉高压患者右心室收缩功能障碍的效能。结果与轻度组比较,中度组和重度组左心室射血分数(LVEF)、右心室面积变化分数(FAC)、三尖瓣环收缩期峰值速度(S’)、右心室射血分数(RVEF)、右心室游离壁纵向应变(RVFWLS)均减小,右心房横径(RAD)、右心室基底径(RVD1)、右心室中间径(RVD2)、主肺动脉内径(PAD)、右心室舒张末期容积指数(RVEDVI)、右心室收缩末期容积指数(RVESVI)、LUS均增大,差异均有统计学意义(均P<0.05)。与中度组比较,重度组LVEF、三尖瓣环收缩期位移(TAPSE)、FAC、S’、右心室每搏输出量指数、RVEF、RVFWLS均减小,RAD、RVD1、RVD2、PAD、RVEDVI、RVESVI、LUS均增大,差异均有统计学意义(均P<0.05)。多因素Logistic回归分析显示,RVFWLS、TAPSE、FAC、S’均为诊断MHD合并肺动脉高压患者右心室收缩功能障碍的独立危险因素(均P<0.05)。ROC曲线分析显示,LUS分别联合RVFWLS、TAPSE、FAC、S’诊断MHD合并肺动脉高压患者右心室收缩功能障碍的曲线下面积(AUC)分别为0.910、0.843、0.814、0.850,其中LUS分别联合TAPSE、S’的AUC均高于TAPSE、S’单独应用,差异均有统计学意义(均P<0.05)。结论超声心动图联合肺部超声在评估MHD合并肺动脉高压患者右心室收缩功能方面有一定的临床价值。Objective To explore the clinical value of echocardiography combined with lung ultrasound in the assessment of right ventricular systolic function in patients with maintenance hemodialysis(MHD)combined with pulmonary hypertension.Methods Ninety-five patients with MHD combined with pulmonary hypertension were selected,and divided into mild group(42 cases),moderate group(29 cases),and severe group(24 cases)according to the degree of pulmonary hypertension.Two-dimensional echocardiography,two-dimensional speckle tracking imaging,real-time three-dimensional echocardiography and pulmonary ultrasound were performed.The differences of echocardiographic parameters and lung ultrasound score(LUS)among three groups were compared.Multivariate Logistic regression was used to screen the independent influencing factors for right ventricular systolic function in patients with MHD combined with pulmonary hypertension.Receiver operating characteristic(ROC)curve was drawn to analyze the efficacy of echocardiographic parameters alone and in combination with LUS in diagnosing right ventricular systolic dysfunction in patients with MHD combined with pulmonary hypertension.Results Compared with mild group,the left ventricular ejection fraction(LVEF),right ventricular area change fraction(FAC),tricuspid annular peak systolic velocity(S’),right ventricular ejection fraction(RVEF)and right ventricular free wall longitudinal strain(RVFWLS)were decreased in moderate and severe groups,while the right atrial transverse diameter(RAD),right ventricular basal diameter(RVD1),right ventricular intermediate diameter(RVD2),and main pulmonary artery internal diameter(PAD),right ventricular end-diastolic volume index(RVEDVI),right ventricular end-systolic volume index(RVESVI)and LUS were increased,and the differences were statistically significant(all P<0.05).Compared with moderate group,the LVEF,tricuspid annular systolic displacement(TAPSE),FAC,S’,right ventricular stroke volume index,RVEF and RVFWLS were decreased in severe group,while the RAD,

关 键 词：超声心动描记术 三维 实时 斑点追踪技术 肺超声评分 肺动脉高压 右心功能 

分 类 号：R540.45[医药卫生—心血管疾病]