左房僵硬度指数评价慢性肾脏病患者左房功能的临床价值

目的：探讨左房僵硬度指数（LASI）评估不同程度慢性肾脏病（CKD）患者左房功能的临床价值。方法：选取我院收治的CKD患者104例，根据估算肾小球滤过率（eGFR）分为CKD1组（eGFR 30~89 ml·min-1）52例和CKD2组（eGFR＜30 ml·min-1）52例，另选同期体检正常成人52例为对照组，比较各组一般资料、实验室指标、常规超声心动图参数及左房应变参数的差异，并分析LASI与心肌标志物[肌钙蛋白T（cTnT）、肌红蛋白（Myo）、N末端脑钠肽前体（NT-proBNP）]及肾功能指标[血肌酐（Scr）、尿素（Urea）、胱抑素（Cys-C）、eGFR]的相关性；多重线性回归分析LASI的影响因素；采用组内相关系数（ICCs）分析观察者内及观察者间超声指标（LASr、LAScd、LASct、LAD）的重复性。结果：对照组、CKD1组、CKD2组cTnT、Myo、NT-proBNP、Scr、Urea、Cys-C、LASI依次增大，eGFR依次减小，各组两两比较差异均有统计学意义（均P＜0.05）。LASI与NT-proBNP（r=0.601，P＜0.001）及eGFR（r=-0.577，P＜0.001）呈良好的相关性；多重线性回归分析表明CKD患者NT-proBNP是LASI的独立影响因子。重复性检验分析显示，左房超声参数在观察者内和观察者间均有良好的重复性（观察者内LASr=0.992、LAScd=0.98、LASct=0.984、LAD=0.982，观察者间LASr=0.995、LAScd=0.996、LASct=0.989、LAD=0.99）。结论 ：LASI可作为评价不同程度CKD左房功能的有效指标，其值随CKD病情进展而增大。

The value of left atrial stiffness index in evaluating left atrial function in patients with chronic kidney disease

Objective: This study aimed to investigate the clinical value of the left atrial stiffness index (LASI) in evaluating left atrial function in patients with different stages of chronic kidney disease (CKD).Methods: A total of 104 CKD patients admitted to our hospital were included in this study. They were divided into two groups based on estimated glomerular filtration rate (eGFR): CKD1 group (eGFR 30-89 ml·min-1, n=52) and CKD2 group (eGFR <30 ml·min-1, n=52). Additionally, 52 healthy adults undergoing regular physical examinations during the same period were selected as the control group. The differences in general characteristics, laboratory parameters, conventional echocardiographic parameters, and left atrial strain parameters were compared among the groups. The correlation between LASI and cardiac biomarkers (cardiac troponin T [cTnT], myoglobin [Myo], N-terminal pro-brain natriuretic peptide [NT-proBNP]), as well as renal function parameters (serum creatinine [Scr], Urea, cystatin C [Cys-C], eGFR), were analyzed. Multiple linear regression analysis was performed to identify the influencing factors of LASI. Intra-observer and inter-observer reproducibility of ultrasound parameters (LASr, LAScd, LASct, LAD) were assessed using the intraclass correlation coefficient (ICC).Results: The levels of cTnT, Myo, NT-proBNP, Scr, Urea, Cys-C, and LASI increased gradually, while eGFR decreased gradually in the control group, CKD1 group, and CKD2 group, with statistically significant differences observed among all groups (all P<0.05). LASI showed a good correlation with NT-proBNP (r=0.601, P<0.001) and eGFR (r=-0.577, P<0.001). Multiple linear regression analysis indicated that NT-proBNP was an independent influencing factor for LASI in CKD patients. The reproducibility analysis demonstrated good intra-observer and inter-observer reliability of left atrial ultrasound parameters (intra-observer ICC: LASr=0.992, LAScd=0.98, LASct=0.984, LAD=0.982; inter-observer ICC: LASr=0.995, LAScd=0.996, LASct=0.989, LAD=0.99).Conclusion: LASI can serve as an effective index for evaluating left atrial function in patients with different stages of CKD, with its value increasing as CKD progresses.