慢性肾脏病进展对左心房功能的影响

目的探索在慢性肾脏病（CKD）进展过程中左心房功能和容积的改变情况。 方法选取CKD患者103例，根据CKD分期将其分为3组：A组50例（CKD1、2期），B组29例（CKD3、4期），C组24例（腹膜透析患者）。对以上患者行传统超声心动学检查，使用左心房斑点追踪技术测量左心房峰值应变、峰值应变率、舒张早期左心房应变、左心房收缩应变，并获得左心房时间-容积曲线计算总排空率、被动排空率及主动排空率，使用方差分析及卡方检验比较各组间的指标差异。 结果与A组患者相比，B组的左心房峰值应变、峰值应变率及舒张早期左心房应变减低，差异有统计学意义［（35.1±6.0）% vs（30.9±7.7）%，（2.11±0.55）s^-1 vs（1.83±0.45）s^-1，（25.4±6.1）% vs（18.1±5.7）%，q=3.70、3.28、7.77，P均<0.05］；高血压患病率、室间隔厚度、左心房收缩应变增加，差异有统计学意义［56.0% vs 86.2%，χ²=7.59，P=0.006；（9.8±1.4）mm vs（11.1±2.1）mm，（9.6±3.9）% vs（12.8±5.7）%，q=4.09、4.22，P均<0.05］；C组的左心房峰值应变、舒张早期应变低于A组，差异有统计学意义［（29.5±7.5）% vs（35.1±6.0）%，（19.7±4.7）% vs（25.4±6.1）%，q=4.68、5.70，P均<0.05］；C组的高血压患病率、左心室舒张功能障碍率、左心室质量、左心房容积指数、左心房最大容积、左心房最小容积、左心房收缩前容积均高于A组，差异有统计学意义［95.8% vs 56.0%，54.2% vs16.0%，χ²=12.01、11.61，P均=0.001；（201.7±66.0）g vs（159.5±45.2）g，（35.2±9.0）ml vs （28.1±8.0）ml，（57.0±21.1）ml vs （42.1±15.7）ml，（22.9±19.8）ml vs（13.1±6.7）ml，（38.2±14.6）ml vs（27.1±11.3）ml，q=4.46、3.37、4.84、4.78、4.95，P均<0.05］。与B组相比，C组的糖尿病患病率、左心房收缩应变减低，差异有统计学意义［41.4% vs 8.3%，χ²=7.4，P=0.007；（12.8±5.7）% vs （9.7±4.5）%，q=13.45，P<0.05］；左心室舒张功能障碍率、左心房容积指数、左心房最大容积、左心房最小容积、左心房收缩前容积增加，差异有统计学意义［13.8% vs 54.2%，χ²=9.82，P=0.002；（28.6±8.7）ml vs （35.2±9.0）ml，（41.3±17.5）ml vs（57.0±21.1）ml，（14.1±9.2）ml vs （22.9±19.8）ml，（28.2±13.8）ml vs（38.2±14.6）ml，q=2.81、4.58、3.85、4.00，P均<0.05］。 结论左心房贮存和通道功能随着CKD的进展而减低，CKD3、4期患者的左心房收缩功能强于CKD1、2期患者及腹膜透析患者。左心房应变参数比左心房容积参数更敏感，能在左心房容积改变之前发现左心房功能的改变。

Effect of the progression of chronic kidney disease on left atrial function

ObjectiveTo explore the changes of left atrial function and volume in the progression of chronic kidney disease using two-dimensional spot tracking. MethodA total of 103 patients with CKD were selected and divided into 3 groups according to CKD stage: 50 patients in group A (stage 1 and 2), 29 patients in group B (stage 3 and 4), and 24 patients in group C (peritoneal dialysis patients). The traditional echocardiography and left atrial speckle tracking technology was used to measure left atrial peak strain, early diastolic left atrial strain, and left atrial contraction strain in all patients, and the left atrial time-volume curve was obtained to calculate the total emptying rate, passive emptying rate and active emptying rate. SNK test was used to compare the differences among groups. ResultsCompared with stage 1 and stage 2 patients, the left atrial peak strain and peak strain rate and the early diastolic left atrial strain were reduced in the group of stage 3 and stage 4 patients, and the differences were statistically significant (35.1±6.0)% vs (30.9±7.7)%, (2.11±0.55)s^-1 vs (1.83±0.45)s^-1, (25.4±6.1)% vs (18.1±5.7)%, q=3.70, 3.28 and 7.77, both P<0.05]. The prevalence rate of hypertension, IVS and left atrial contraction strain increased (56% vs 86.2%), (9.8±1.4) mm vs (11.1±2.1) mm, (9.6±3.9)% vs (12.8±5.7)%, χ²=7.59, P=0.006; q=4.09 and 4.22, both P<0.05]. The peak strain and early diastolic strain of peritoneal dialysis patients reduced (35.1±6.0)% vs (29.5±7.5)%, (25.4±6.1)% vs (19.7±4.7)%; q=4.68 and 5.70, both P<0.05]. The prevalence rate of hypertension, LVM, LVDD, LAVI, LAVmax, LAVmin and LAV pre-A and the prevalence of left atrial enlargement increased (56.0% vs 95.8%), (159.5±45.2) g vs (201.7±66.0)g, (16.0% vs 54.2%), (28.1±8.0) ml vs (35.2±9.0) ml, (42.1±15.7) ml vs (57.0±21.1) ml, (13.1±6.7)ml vs 22.9±19.8) ml, (13.1±6.7) ml vs (22.9±19.8) ml, (27.1±11.3) ml vs (38.2±14.6) ml, χ²=12.01 and 11.61, both P=0.001; q=4.46, 3.37, 4.84, 4.78 and 4.95, both P<0.05]. Compared with stage 3 and 4 patients, the incidence of diabetes and left atrial contraction strain in peritoneal dialysis patients reduced (41.4% vs 8.3%), (12.8±5.7% vs (9.7±4.5), χ²=7.4, P=0.007; q=13.45, P<0.05], the rate of left ventricular diastolic dysfunction, LAVI, LAVmax and LAV pre-A increased (13.8% vs 54.2%), (28.6±8.7ml vs (35.2±9.0) ml, (41.3±17.5) ml vs (57.0±21.1) ml, (14.1±9.2) ml vs (22.9±19.8) ml, (28.2±13.8) ml vs (38.2±14.6) ml, χ²=9.82, P=0.002, q=2.81, 4.58, 3.85 and 4.00, both P<0.05]. Compared with group A, the left atrial reservoir and conduit function of group B decreased, but left atrial volume parameters (including LAVI, left atrial maximum volume, minimum volume and volume before left atrial contraction obtained by speckle tracking) had no significant difference. Left atrial total emptying rate, rate of passive and active emptying can be calculated through left atrial time-volume curve. However, the above three parameters had no significant difference among three groups. ConclusionThe reservoir and conduit function of left atrium decreased with the aggravation of chronic renal disease, but compared with CKD1, 2 and peritoneal dialysis patients, the left atrial contraction function of CKD3, 4 stage patients increased. In addition, the left atrial strain parameters is more sensitive than the left atrial volume parameters, and we can find the changes of left atrial function before the left atrial volume changes.