超声联合Tei指数评价尿毒症心肌病左室肥厚及形变对心功能的影响

目的采用超声联合Tei指数评估尿毒症合并心肌病患者左室肥厚情况,探究其形变对心功能的影响。方法选取我院2016年6月~2018年6月收治的132例尿毒症患者和66例健康志愿者作为研究对象,健康志愿者作为正常组,尿毒症患者根据左心室不同构型分将左心室构型正常者作为对照组,左心室肥厚的尿毒症心肌病患者作为观察组。采用超声心动图常规测量左心室舒张末期内径(LVIDd)、左室收缩末期内径(LVIDs)、室间隔厚度(IVSd)、左心室后壁厚度(LVPWd),并计算左心室质量(LVM)、左心室质量指数(LVMI)、相对室壁厚度(RWT)、左心室射血分数(LVEF)及左室缩短率(LVFS);同时在组织多普勒成像TDI模式下,定量、定位测量二、三尖瓣环速度及时间等指标,计算Tei指数,评估尿毒症心肌病患者左心室构型变化及其对收缩/舒张功能的影响。结果M型超声心动图发现,观察组尿毒症心肌病患者因左心室肥厚,其LVIDd、LVIDs、IVSd、LVPWd、LVMI及RWT均大于左心室构型正常的对照组和健康人群(P<0.05);而左心室肥厚观察组患者LVEF和LVFS均显著低于其他2组,差异有统计学意义(P<0.05)。同时,观察组患者左室舒张功能降低,二尖瓣舒张早期血流峰值流速(E峰)降低,舒张晚期峰值流速(A峰)升高,E/A比值降低(P<0.05)。尿毒症心肌病患者因左心室肥厚,左室Tei指数显著高于其他2组,差异有统计学意义(P<0.05)。结论通过超声心动图联合组织多普勒超声模式下测得的Tei指数可以较好的评估尿毒症心肌病患者的左室肥厚及形变对心功能的影响,为临床治疗提供依据。

Echocardiography combined with Tei index to evaluate the effect of left ventricular hypertrophy and deformation on cardiac function in uremia cardiomyopathy

Objective To evaluate the left ventricular hypertrophy in patients with uremia combined with cardiomyopathy by ultrasonography combined with Tei index,and to analyze the effect of deformation on cardiac function.Methods 132 uremic patients and 66 healthy volunteers admitted to our hospital from June 2016 to June 2018 were selected as subjects.Healthy volunteers were used as normal group.Urinary patients were divided into left ventricle according to different configurations of left ventricle.Normal type was taken as a cintrol group,uremic cardiomyopathy with left ventricular hypertrophy as an observation group.Healthy volunteers were selected as the normal group.While,according to different left ventricular configurations,patients with uremia were selected as the control group and patients with uremia cardiomyopathy with left ventricular hypertrophy were divided into the observation group.Echocardiography was employed for the routine measurement of left ventricular end-diastolic diameter(LVIDd),left ventricular end systolic diameter(LVIDs),interventricular septum thickness(IVSd),left ventricular posterior wall thickness(LVPWd).We calculated the left ventricular mass(LVM),left ventricular mass index(LVMI),relative wall thickness(RWT),left ventricular ejection fraction(LVEF)and left ventricular shortening rate(LVFS).Meanwhile,in the TDI mode of tissue doppler imaging,the velocity and time of the second and tricuspid annulus were measured quantitatively and locatively.And then the Tei index was calculated to evaluate the left ventricular configuration change and its influence on the systolic/diastolic function in patients with uremia cardiomyopathy.Results The results of M mode echocardiography showed that the LVIDd,LVIDs,IVSd,LVPWd,LVMI and RWT in the observation group were all greater than those in the control group and healthy population(P<0.05)due to left ventricular hypertrophy.LVEF and LVFS in the left ventricular hypertrophy observation group were significantly lower than those in the other two groups,and the difference was statistically significant(P<0.05).In addition,left ventricular diastolic function of patients in the observation group decreased,mitral valve diastolic blood flow peak velocity(peak E)decreased in the early stage,peak flow velocity(peak A)increased in the late stage,and E/A ratio also decreased(P<0.05).Due to left ventricular hypertrophy,left ventricular Tei index of patients with uremia cardiomyopathy was significantly higher than that of the other two groups(P<0.05).Conclusion The Tei index measured under the mode of echocardiography combined with tissue doppler ultrasound can better evaluate the influence of left ventricular hypertrophy and deformation on cardiac function in patients with uremia cardiomyopathy,which could provide a reliable basis for early clinical detection and treatment.