慢性肾脏疾病患者左室结构及功能改变的超声评价

目的：应用超声心动图评价慢性肾脏疾病（CKD）患者左室结构及功能改变，探讨不同程度CKD患者左室改变情况。方法：对CKD非透析患者39例（CKD2～3期组19例，CKD4～5期组20例）及对照组40例进行常规肾脏扫查及超声心动图检查，通过二维超声观察CKD患者肾脏形态结构、实质回声、皮髓质分界、血流信号改变；通过超声心动图获得左室结构参数：左房内径（LAD）、左室舒张末期内径（I。VID），左室质量指数（LV—MI）、左室相对室壁厚度（RWT）；左室功能参数：左室射血分数（EF）、二尖瓣口舒张早期血流速度E峰、晚期A峰、E／A、舒张早期二尖瓣环运动速度Em，E／Era。结果：①CKD2～3期组19例患者中6例患者肾脏声像图有明显改变，CKD4～5期组中18例患者肾脏声像图有显著改变；②与正常组比较，cKD2～3期组LVM、RWT、LAD均显著增高，CKD4～5期组LVID、LVMI、E、A、E／Em增高，DTE、E／A、Em减低，与CKD2～3期组比较，CKD4～5期组LVM、RWT、LAD、LVID、LVMI、E、A、EjEm显著增加，DTE显著减低，E／A、Em无明显差异；③CKD2～3期组中有5例左室重构（26．3％），CKD4～5期组患者中有17例左室壁重构（85％）。结论：早中期CKD患者其肾脏结构二维超声改变不明显，而超声心动图能早期检测到CKD患者左室构型及左室舒张功的改变，为临床上该病治疗及心血管并发症的预防提供有价值的参考信息。

Ultrasonographic evaluation of left ventricular alterations in patients with chronic kidney disease

Objective： To evaluate the structural and functional changes of the left ventricle in patients with chronic kidney disease （CKD）. Method： Thirty-nine non-dialysis CKD patients divided into stage 2 3 group （n= 19） and stage 4-5 group （n=20） were enrolled in the study. Another forty healthy volunteers were selected as the control group. Renal structure of these CKD patients were observed by two-dimensional ultrasound. According to the ASE guidelines, left atrial diameter （LAD）, left ventricular end-diastolic internal diameter （LVID）, LV mass （LVM）, LV mass index （LVMI）, relative wall thickness （RWT） were detected. Also, the parameter of the LV systolic and diastolic function such as eject fraction （EF）, transmitral diastolic velocities （E, A）, deceleration time of E peak, peak early diastolic annular veloctiy （Em）, peak ate diastolic annular velocity （Am） and E/Em were measured. These indexes were compared between stage 2-3 group, stage 4-5 group and the control group. Result： The renal sonogram of six patients in CKD stage 2-3 group have changed significantly, while 18 patients have changed greatly in CKD stage 4-5. Compare with the control group LVM, RWT, LAD were significantly in- creased in CKD stage 2-3 group, and LVID, LVMI, E, A, E/Era were increased in CKD stage 4-5 group, while DTE, E/A and Em were decreased. Compare with CKD stage 2-3 group, LVM, RWT, LAD, LVID, LVMI, E, A, E/Em of CKD stage 4-5 were increased significantly, while DTE was significantly decreased and E/A and Em didn＇t alter evidently. Among the patients of CKD stage 4-5 group, 85 ~ （n= 17） had alteration of left ventricular configuration, while among CKD stage 2-3 group, 26.30/oo （n=5） had LV remodeling. Conclusion： Renal struc- tural changes can not be detected by ultrasound in most CKD patients of early stage. Compared with two--dimen- sional ultrasonography echocardiography can clearly detect the structural and functional changes of the left ventri- cle in patients with CKD in the early stage and provide valuable information for clinical management.