학술논문
二维斑点追踪成像技术评价腹膜透析对尿毒症患者左心室功能影响的临床研究 / Clinical study of left ventricular systolic function of uremic treated with peritoneal dialysis measured by two-dimensional speckle tracking imaging
Document Type
Academic Journal
Author
Source
中华医学超声杂志（电子版） / Chinese Journal of Medical Ultrasound(Electronic Edition). 14(10):771-778
Subject
Language
Chinese
ISSN
1672-6448
Abstract
目的 探讨二维斑点追踪成像技术(2D-STI)评价腹膜透析对尿毒症患者左心室功能影响的价值.方法 选取2014年12月至2015年12月经山西医科大学第一医院诊断明确且尚未透析的尿毒症患者30例,作为尿毒症患者组,常规超声示左心室射血分数(LVEF)>50%,与年龄、性别、体重相匹配的健康对照组30例比较.2组均测量基础资料与心脏常规超声参数,采集图像并采用QLab软件分析,得出左心室16节段时间-应变曲线,测出各节段纵向、径向、圆周方向收缩期峰值应变.对2组基础资料、常规超声参数及左心室各节段2D-STI参数行两独立样本t检验.腹膜透析6个月后再次检查,采用配对t检验比较尿毒症患者腹膜透析前后左心室各节段心肌收缩情况.结果 (1)尿毒症患者组(未透析)与健康对照组比较:尿毒症患者组收缩压、舒张压及脉压升高,差异均有统计学意义(t=-4.445、-4.531、-2.203,P均<0.05);尿毒症患者左心房前后径、左心室舒张末及收缩末内径、左心室舒张末及收缩末容积及左心室质量指数增大,室间隔厚度、左心室后壁厚度及相对室壁厚度增厚,差异均有统计学意义(t=-6.461、-5.168、-4.660、-3.578、-2.872、-6.819、-6.251、-7.108、-2.659,P均<0.05),LVEF差异无统计学意义(P>0.05);尿毒症患者组左心室16节段纵向、径向及圆周方向收缩期峰值应变均减小,差异均有统计学意义(纵向 t=-7.063、-5.391、-3.351、-5.323、-5.586、-7.842、-5.265、-5.587、-5.037、-3.051、-4.584、-3.936、-4.168、-9.783、-9.175、-3.805;径向t=3.659、3.581、5.368、2.649、2.928、4.344、2.754、5.031、5.025、2.277、2.691、2.731、3.187、4.179、5.292、4.429;圆 周 方 向t=-5.158、-3.959、-2.164、-3.592、-2.324、-5.672、-4.946、-7.184、-7.748、-5.014、-2.439、-6.299、-8.072、-8.410、-7.884、-8.854,P均<0.05).(2)尿毒症患者透析前后比较:尿毒症患者透析治疗后收缩压降低,差异有统计学意义(t=2.833,P<0.05);透析治疗后左心房前后径与左心室质量指数减小,差异均有统计学意义(t=4.805,2.631,P均<0.05);透析治疗后,左心室前间隔、前壁、后壁、下壁、后间隔基底段、前间隔、侧壁、后壁中间段、前壁、侧壁心尖段纵向收缩期峰值应变增加,差异均有统计学意义(t=5.199、4.127、3.781、3.380、4.114、3.116、2.840、3.243、4.003、5.605,P均<0.05);侧壁基底段、侧壁、后间隔中间段、室间隔、侧壁、下壁心尖段径向收缩期峰值应变增加,差异均有统计学意义(t=-3.343、-3.687、-2.488、-2.921、-3.826、-3.339,P均<0.05);左心室各节段心肌圆周方向收缩期峰值应变有所增加,但差异均无统计学意义(P均>0.05).结论 尿毒症患者左心室结构发生改变且各节段心肌收缩功能减弱,腹膜透析后,部分节段心肌收缩功能有所改善.2D-STI能够定量、客观评价尿毒症患者透析前后左心室心肌收缩功能变化.
Objective To evaluate the left ventricular systolic function of uremic patients after peritoneal dialysis measured by two-dimensional speckle tracking imaging. Methods Thirty uremic patients with their left ventricular ejection fraction (LVEF) > 50% who had not been underwent dialysis were enrolled in this study. Thirty healthy volunteers were involved as controls. For both groups, the basic data and routine cardiac ultrasound parameters were measured, and the images were collected to be analyzed by QLab software. The left ventricular 16-segment time-strain curves were obtained, and the peak strain of the systolic phase of each segment was measured. The data of 2 groups were analyzed by two independent samples t-test. After 6 months of peritoneal dialysis, the uremic patients were checked again. By using paired t-test, we analyzed the difference in left ventricular systolic dysfunction of uremic patients before and after peritoneal dialysis. Results (1) Comparison between uremia group (nondialysis patients) and control group: systolic arterial pressure, diastolic arterial pressure and pulse pressure of uremic patients increased (t=-4.445,-4.531 and-2.203, P<0.05); left atrial anterior and posterior diameter (LAAPD), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV) and left ventricular mass index (LVMI) of uremic patients were larger. Interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT) and relative wall thickness (RWT) were thicker (t=-6.461,-5.168,-4.660,-3.578,-2.872,-6.819,-6.251,-7.108 and-2.659, P < 0.05); the longitudinal, radial and circumferential directions peak systolic strain of 16 segment myocardial of uremic patients decreased (the longitudinal strain:t=-7.063,-5.391,-3.351,-5.323,-5.586,-7.842,-5.265,-5.587,-5.037,-3.051,-4.584,-3.936,-4.168,-9.783,-9.175 and-3.805; the radial strain: t=3.659, 3.58, 5.368, 2.649, 2.928, 4.344, 2.754, 5.031, 5.025, 2.277, 2.691, 2.731, 3.187, 4.179, 5.292 and 4.429; the circumferential strain: t=-5.158,-3.959,-2.164,-3.592,-2.324,-5.672,-4.946,-7.184,-7.748,-5.014,-2.439,-6.299,-8.072,-8.410,-7.884 and-8.854, P < 0.05).(2)Comparison between uremic patients before and after dialysis:the systolic arterial pressure of uremic patients decreased after dialysis (t=2.833, P < 0.05); LAAPD and LVMI of uremic patients decreased after dialysis (t=4.805, 2.631, P < 0.05); BAS, BA, BIL, BI, BIS, MAS, MAL, MIL, APA and APL longitudinal systolic peak strain and the BAL, MAL, MIS, APS, APL and API radial systolic peak strain of uremic patients increased after dialysis (t=5.199, 4.127, 3.781, 3.380, 4.114, 3.116, 2.840, 3.243, 4.003 and 5.605, P < 0.05; t=-3.343,-3.687,-2.488,-2.921,-3.826 and-3.339, all P < 0.05). There were no statistical differences in circumferential peak systolic strain (P>0.05). Conclusions In uremic patients, the structure of the left ventricle changed, the function of myocardial contraction decreased, and the function of myocardial contraction improved after peritoneal dialysis. 2D-STI was able to quantitatively and objectively evaluate the function of the left ventricular myocardial constriction before and after dialysis.
Objective To evaluate the left ventricular systolic function of uremic patients after peritoneal dialysis measured by two-dimensional speckle tracking imaging. Methods Thirty uremic patients with their left ventricular ejection fraction (LVEF) > 50% who had not been underwent dialysis were enrolled in this study. Thirty healthy volunteers were involved as controls. For both groups, the basic data and routine cardiac ultrasound parameters were measured, and the images were collected to be analyzed by QLab software. The left ventricular 16-segment time-strain curves were obtained, and the peak strain of the systolic phase of each segment was measured. The data of 2 groups were analyzed by two independent samples t-test. After 6 months of peritoneal dialysis, the uremic patients were checked again. By using paired t-test, we analyzed the difference in left ventricular systolic dysfunction of uremic patients before and after peritoneal dialysis. Results (1) Comparison between uremia group (nondialysis patients) and control group: systolic arterial pressure, diastolic arterial pressure and pulse pressure of uremic patients increased (t=-4.445,-4.531 and-2.203, P<0.05); left atrial anterior and posterior diameter (LAAPD), left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV) and left ventricular mass index (LVMI) of uremic patients were larger. Interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT) and relative wall thickness (RWT) were thicker (t=-6.461,-5.168,-4.660,-3.578,-2.872,-6.819,-6.251,-7.108 and-2.659, P < 0.05); the longitudinal, radial and circumferential directions peak systolic strain of 16 segment myocardial of uremic patients decreased (the longitudinal strain:t=-7.063,-5.391,-3.351,-5.323,-5.586,-7.842,-5.265,-5.587,-5.037,-3.051,-4.584,-3.936,-4.168,-9.783,-9.175 and-3.805; the radial strain: t=3.659, 3.58, 5.368, 2.649, 2.928, 4.344, 2.754, 5.031, 5.025, 2.277, 2.691, 2.731, 3.187, 4.179, 5.292 and 4.429; the circumferential strain: t=-5.158,-3.959,-2.164,-3.592,-2.324,-5.672,-4.946,-7.184,-7.748,-5.014,-2.439,-6.299,-8.072,-8.410,-7.884 and-8.854, P < 0.05).(2)Comparison between uremic patients before and after dialysis:the systolic arterial pressure of uremic patients decreased after dialysis (t=2.833, P < 0.05); LAAPD and LVMI of uremic patients decreased after dialysis (t=4.805, 2.631, P < 0.05); BAS, BA, BIL, BI, BIS, MAS, MAL, MIL, APA and APL longitudinal systolic peak strain and the BAL, MAL, MIS, APS, APL and API radial systolic peak strain of uremic patients increased after dialysis (t=5.199, 4.127, 3.781, 3.380, 4.114, 3.116, 2.840, 3.243, 4.003 and 5.605, P < 0.05; t=-3.343,-3.687,-2.488,-2.921,-3.826 and-3.339, all P < 0.05). There were no statistical differences in circumferential peak systolic strain (P>0.05). Conclusions In uremic patients, the structure of the left ventricle changed, the function of myocardial contraction decreased, and the function of myocardial contraction improved after peritoneal dialysis. 2D-STI was able to quantitatively and objectively evaluate the function of the left ventricular myocardial constriction before and after dialysis.