超声心动图自动心肌运动定量技术对尿毒症透析患者早期左心室收缩功能的评估

目的探讨超声心动图自动心肌运动定量技术（aCMQ）评估不同透析时间段的尿毒症患者左心室收缩功能的价值。 方法选择2018年5月至2019年2月在浙江省杭州市萧山区第一人民医院血液透析室接受透析治疗的尿毒症患者52例。根据其接受血透时间的不同分为3组，A组为透析时间≤3年的患者，共27例；B组为透析时间＞3年且≤7年的患者，共16例；C组为透析时间＞7年的患者，共9例；正常对照组共60例，既往均无心脏及肾疾病病史，常规心电图及超声心动图检查均未见明显异常。首先运用M型超声心动图，通过Teichholz法获得病例组及对照组左心室射血分数（LVEF），然后启动X-Plane技术采集4个心动周期的四腔心及两腔心，根据心电图指示分别描记左心室舒张末期及左心室收缩末期，运用双平面Simpson法分别计算出病例组及对照组LVEF，最后运用aCMQ分别获取病例组及对照组研究对象的左心室整体长轴应变（LVGLS）、心尖两腔心长轴应变（LVAP2LS）、心尖四腔心长轴应变（LVAP4LS）及心尖三腔心长轴应变（LVAP3LS），分析不同透析年限组尿毒症患者左心室长轴应变变化。多组间比较采用方差分析，组间两两比较采用LSD-t检验。 结果Teichholz法测得病例组与对照组LVEF分别为：A组（67.21±6.63）%；B组（64.73±6.47）%；C组（64.58±8.38）%；对照组（67.02±3.62）%。Simpson法测得病例组与对照组LVEF分别为：A组（64.71±4.93）%；B组（64.08±6.02）%；C组（63.91±7.49）%；对照组（66.17±3.14）%。病例组与对照组LVEF比较以及病例组间LVEF比较，差异均无统计学意义（P均＞0.05）。运用aCMQ得到病例组与对照组LVGLS分别为：A组（-20.79±2.70）%、B组（-20.03±3.58）%、C组（-18.32±3.71）%、对照组（-24.39±2.05）%；LVAP4LS分别为：A组（-22.09±2.76）%、B组（-20.11±3.94）%、C组（-19.49±3.73）%、对照组（-24.61±2.37）%；LVAP3LS分别为：A组（-19.32±3.85）%、B组（-19.28±4.37）%、C组（-16.61±4.40）%、对照组（-23.53±6.18）%；LVAP2LS分别为：A组（-20.09±2.53）%、B组（-19.57±2.65）%、C组（-18.09±4.01）%、对照组（-23.51±7.52）%。病例组LVGLS、LVAP2LS、LVAP4LS及LVAP3LS的测值均较对照组减低，差异具有统计学意义（A组 vs 对照组：t=-5.949、-3.844、-6.117、-4.863，P均＜0.001；B组 vs 对照组：t=-5.883、-5.619、-5.036、-4.650，P均＜0.001；C组 vs 对照组：t=-6.541、-5.081、-6.130、-4.854，P均＜0.001），其中A组LVGLS、LVAP4LS和LVAP3LS测值比C组减低，差异具有统计学意义（t=-2.493、-2.405、-2.012，P=0.014、=0.018、=0.047），A组与C组LVAP2LS测值比较，差异无统计学意义（P＞0.05），A组与B组间以及B组与C组间在LVGLS、LVAP2LS、LVAP3LS、LVAP4LS测值比较，差异也均无统计学意义（P均＞0.05）。 结论aCMQ能早期发现尿毒症透析患者左心室收缩功能的异常，为临床早期预防及治疗心功能衰竭提供了新的途径。

Evaluation of early left ventricular systolic function in uremia patients on dialysis by automated cardiac motion quantification

Objective To explore the value of automated cardiac motion quantification(aCMQ)in evaluating left ventricular systolic function in uremia patients with different durations of dialysis.Methods Fifty-two cases of uremia were selected at First People's Hospital of Xiaoshan District from May 2018 to February 2019.They were divided into three groups according to the duration of hemodialysis.Group A consisted of 27 patients receiving dialysis for≤3 years,group B consisted of 16 patients receiving dialysis for>3 years to less than 7 years,and group C consisted of 9 patients receiving dialysis for>7 years.A normal control group consisting of 60 subjects with no past history of heart and kidney disease was also included.M echocardiography was performed to estimate the left ventricular ejection fraction(LVEF)using the Teichholz method,and the X-Plane technique was used to collect four-and two-chamber view images of the heart for four cardiac cycles.Left ventricular end-diastole and left ventricular end-systole were recorded according to electrocardiogram,and the LVEF of the case group and control group was calculated by double plane Simpson method.The aCMQ was used to obtain left ventricular global longitudinal strain(LVGLS).Longitudinal strain of the left ventricle in apical four-chamber view,two-chamber view,and threechamber view(LVAP4LS,LVAP2LS,and LVAP3LS)was obtained by aCMQ to analyze the changes of left ventricular long axis strain in uremia patients with different durations of dialysis.Analysis of variance was used for comparison among groups,and LSD-t test was used for pairwise comparison between groups.Results The mean LVEF measured by the Teichholz method was(67.21±6.63)%in group A,(64.73±6.47)%in group B,(64.58±8.38)%in group C,and(67.02±3.62)%in control group.The mean LVEF measured by Simpson method was(64.71±4.93)%in group A,(64.08±6.02)%in group B,(63.91±7.49)%in group C,and(66.17±3.14)%in control group.There was no significant difference in LVEF between the case groups or between the case group and control group(P>0.05 for all).The mean values of LVGLS measured by aCMQ were(-20.79±2.70)%,(-20.03±3.58)%,(-18.32±3.71)%,and(-24.39±2.05)%in groups A,B,C,and control group,respectively.The mean values of LVAP4LS during the systolic period were as follows:group A(-22.09±2.76)%,group B(-20.11±3.94)%,group C(-19.49±3.73)%,and control group(-24.61±2.37)%.The mean values of LVAP3LS during the systolic period were as follows:group A(-19.32±3.85)%,group B(-19.28±4.37)%,group C(-16.61±4.40)%,and control group(-23.53±6.18)%.The mean values of LVAP2LS during the systolic period were as follows:group A(-20.09±2.53)%,group B(-19.57±2.65)%,group C(-18.09±4.01%),and control group(-23.51±7.52)%.LVGLS,LVAP4LS,LVAP2LS,and LVAP3LS were significantly reduced in the case groups compared to the control group(group A vs control group:t=-5.949,-3.844,-6.117,and-4.863,P<0.001 for all;group B vs control group:t=-5.883,-5.619,-5.036,and-4.650,P<0.001 for all;group C vs control group:t=-6.541,-5.081,-6.130,and-4.854,P<0.001 for all).The LVGLS,LVAP4LS,and LVAP3LS values of group A were significantly lower than those of group C(t=-2.493,-2.405,and-2.012;P=0.014,0.018,and 0.047,respectively).The LVAP2LS value did not differ significantly between group A and group B or group C(P>0.05),and between group B and group C(P>0.05).Conclusion aCMQ can evaluate the abnormality of left ventricular systolic function in uremia patients with different durations of dialysis,which provides a new way for early prevention and treatment of heart failure.