三维斑点追踪成像早期检测慢性肾脏病患者心肌功能的价值

目的:探讨三维斑点追踪成像技术(3D-STI)早期评价慢性肾脏病(CKD)患者心肌功能的价值。方法:90例CKD按肾小球滤过率(GFR)分为GFR轻度降低组(Ⅰ组)、中度降低组(Ⅱ组)、重度降低组(Ⅲ组)各30例;40例健康志愿者作为对照组。测量并比较4组的常规超声心动图参数,以及3D-STI应变参数,即左心室整体径向应变(GRS)、整体纵向应变(GLS)、整体圆周应变(GCS)及左心室旋转。结果:与对照组比较,Ⅰ组左心室射血分数(LVEF)降低,左心室质量指数(LVMI)增加,差异均有统计学意义(均P<0.01),其他常规超声心动图参数差异均无统计学意义(均P>0.05)。与对照组比较,Ⅱ组和Ⅲ组左心室舒张末期内径(LVEDd)、室间隔厚度(IVST)、左心室后壁厚度(LVPWT)及LVMI均增加,LVEF均减低,差异均有统计学意义(均P<0.01或P<0.05)。与对照组比较,Ⅲ组左心室收缩末期内径(LVESD)增加,差异有统计学意义(P<0.01)。与Ⅰ组比较,Ⅱ组LVPWT、LVMI增加,LVEF降低,差异均有统计学意义(均P<0.01或P<0.05);Ⅲ组LVEDd、LVESD、IVST、LVPWT及LVMI均增加,LVEF降低,差异均有统计学意义(均P<0.01)。与Ⅱ组比较,Ⅲ组LVEDd、IVST、LVPWT及LVMI均增加,差异有统计学意义(均P<0.01或P<0.05),LVESD及LVEF差异无统计学意义(P>0.05)。与对照组比较,患者组GLS、GRS均降低(均P<0.05),左心室扭转增加(均P<0.05),而GCS差异无统计学意义(P>0.05)。与Ⅰ组比较,Ⅱ组GLS、GRS均显著降低(均P<0.01);Ⅲ组GLS、GCS及GRS均显著降低(均P<0.01)。与Ⅱ组比较,Ⅲ组GLS、GCS及GRS均显著降低(均P<0.01)。结论:CKD患者,病程早期由于圆周方向心肌功能的保持和心肌旋转代偿加强,LVEF可维持正常,但心肌纵向和径向功能降低;3D-STI可早期识别心肌损害,更加敏感地反映左心室收缩功能的改变,为临床决策和疗效评价提供依据。

3D speckle tracking imaging to detect the myocardial function in patients with chronic kidney disease

Objective:To evaluate the value of 3D speckle tracking imaging(3D-STI)in the early evaluation of myocardial function in patients with chronic kidney disease(CKD).Methods:According to glomerular filtration rate(GFR),90 CKD patients were divided into three groups,30 cases in mild reduction group,30 cases in moderate reduction group,30 cases in severe reduction group,and 40 cases of healthy volunteers were enrolled as the control group.The left ventricular global radial strain(GRS),global longitudinal strain(GLS),global circumferential strain(GCS)and global left ventricular torsion(Ptw)were analyzed by 3D-STI.Results:Compared with the control group,LVEF decreased and LVMI increased in GroupⅠ,with statistically significant differences(both P<0.01),while other routine parameters showed no statistically significant differences(all P>0.05).Compared with the control group,LVEDd,IVST,LVPWT and LVMI in GroupⅡandⅢincreased,while LVEF decreased,with statistical significances(all P<0.05).Compared with the control group,LVESD in GroupⅢincreased,and the difference was statistically significant(P<0.01).Compared with GroupⅠ,LVPWT and LVMI in GroupⅡincreased,while LVEF decreased,with statistical significances(all P<0.05).In GroupⅢ,LVEDd,LVESD,IVST,LVPWT and LVMI increased,LVEF decreased,with statistical significances compared with GroupⅠ(all P<0.01).Compared with GroupⅡ,LVEDd,IVST,LVPWT and LVMI in GroupⅢincreased,and the differences were statistically significant(all P<0.05),while there were no statistically significant differences in LVEF and LVESD.Compared with the control group,all patients’GLS and GRS decreased(all P<0.05),Ptw increased(all P<0.05),while there were no differences of GCS(all P>0.05).Compared with GroupⅠ,GLS and GRS in GroupⅡdecreased(both P<0.01),GLS,GCS and GRS in GroupⅢdecreased(all P<0.01).Compared with GroupⅡ,GLS,GCS and GRS in GroupⅢdecreased(all P<0.01).Conclusions:LVEF can maintain normal for CKD patients at early stage due to the compensatory of circumferential myocardial function,but the longitudinal and radial myocardial function reduce.3D-STI can identify CKD patients’early myocardial damage sensitively,providing the basis for clinical decision and effect evaluation.