三维斑点追踪成像评价慢性肾功能不全患者左心室收缩功能

发布时间：2018-02-23 03:43

本文关键词： 肾功能不全慢性心室功能左超声心动描记术三维斑点追踪成像　出处：《中国医学影像学杂志》2017年09期 　论文类型：期刊论文

【摘要】：目的应用三维斑点追踪成像(3D-STI)评价不同阶段慢性肾功能不全患者左心室心肌收缩功能变化。资料与方法选取2015年6月-2016年6月于青岛大学附属医院西海岸医疗中心就诊的26例轻度慢性肾功能不全患者(CKD2~3期组)、20例中-重度慢性肾功能不全患者(CKD4~5期组)及20例健康志愿者(对照组)。行常规二维超声心动图测量并比较常规超声心动图指标,包括室间隔舒张末期厚度(IVSTd)和左心室舒张末期厚度(LVPWTd),同时行3D-STI分析并比较舒张末期左心室容积(LVEDV)、收缩末期左心室容积(LVESV)、左心室三维射血分数(3D-LVEF)、左心室整体纵向应变(GLS)、径向应变(GRS)、圆周应变(GCS)等指标;通过ROC曲线分析比较GLS、GCS、GRS诊断慢性肾功能不全患者左心室收缩功能异常的检验效能。结果与对照组相比,CKD2~3期组血肌酐、三酰甘油增高(t=22.152、2.655),肾小球滤过率(GFR)、血红蛋白含量降低(t=-36.527、-19.610),IVSTd增大(t=6.035),3D-LVEF、GLS、GRS、GCS减小(t=-2.958、-5.336、-9.552、-4.384);与对照组相比,CKD4~5期组收缩压、血肌酐、总胆固醇、三酰甘油增高(t=15.060、29.461、8.210、6.512),GFR、血红蛋白含量降低(t=-67.557、-28.071),IVSTd增大(t=10.959),3D-LVEF、GLS、GRS、GCS减小(t=-7.315、-7.460、-17.99、-6.052);与CKD2~3期组相比,CKD4~5期组收缩压、血肌酐、总胆固醇升高(t=14.551、28.902、8.555),GFR、血红蛋白降低(t=-18.455、-16.832),IVSTd增大(t=7.331),3D-LVEF、GRS、GCS、GLS减小(t=-4.977、-3.847、-4.929、-2.553);以上组间比较差异均有统计学意义(P0.05)。ROC曲线显示,分别采用GLS、GCS、GRS判定慢性肾功能不全患者左心室收缩功能异常时,当GLS以17.80%为截断值时,其灵敏度最高(88.89%),约登指数为0.673;当GCS以14.70%为截断值时,其特异度最高(89.47%),约登指数为0.561。结论慢性肾功能不全患者左心室收缩功能减低,且随着病情进展,心功能逐渐减低3D-STI能准确评价不同阶段慢性肾功能不全患者左心室心肌收缩功能变化。
[Abstract]:Objective to evaluate the changes of left ventricular systolic function in patients with chronic renal insufficiency at different stages by 3D speckle tracking imaging (3D-STI). Data and methods selected from June 2015 to June 2016 in the West Coast Medical Center affiliated Hospital of Qingdao University. Twenty patients with moderate to severe chronic renal insufficiency (CKD4 stage 5) and 20 healthy volunteers (control group) were measured by routine two-dimensional echocardiography and compared with conventional echocardiography. IVSTD) and left ventricular end-diastolic thickness (LVPWTdN). At the same time, 3D-STI analysis and comparison of end-diastolic left ventricular volume (LVEDVV), end-systolic left ventricular volume (LVESVV), left ventricular three-dimensional ejection fraction (3D-LVEFV), left ventricular whole longitudinal response were performed. Variable GLS, radial strain GRSs, circumferential strain GCSs, etc. The ROC curve analysis was used to compare the efficacy of GRS in the diagnosis of left ventricular systolic dysfunction in patients with chronic renal insufficiency. Elevated triacylglycerol 22.152U 2.655g, glomerular filtration rate (GFRN), decreased hemoglobin content (36.527m) -19.61010 (IVSTd) increased T6.035 GRS GCS decreased t-2.958-5.336U -9.552U -4.384m; compared with control group, CKD45 group had systolic blood pressure, serum creatinine, total cholesterol, and cholesterol. The increase of triacylglycerol was 8.2106.512g / g, and the decrease of hemoglobin content was found in CKD2~3 phase 5 group, the systolic blood pressure, serum creatinine, serum creatinine, blood creatinine, blood creatinine, blood creatinine, blood creatinine, blood creatinine, blood creatinine, blood creatinine, blood creatinine, blood creatinine, blood creatinine, blood creatinine, blood creatinine, blood creatinine. The increase of total cholesterol was 14.551U 28.902 / 8.555GR, and the decrease of hemoglobin was found in IVSTd of 7.331D LVEFRS GLS. The difference between the two groups was statistically significant (P0.05. ROC curve showed that GLS- GCSGRS was used to judge the abnormal left ventricular systolic function in patients with chronic renal insufficiency, respectively), and the difference between the two groups was significant (P 0.05. ROC curve), which showed that GCSGRS was used to judge the abnormal left ventricular systolic function in patients with chronic renal insufficiency, and the difference between the above groups was statistically significant (P 0.05), and the difference between the two groups was significant (P < 0.05), and the difference between the two groups was significant (P < 0.05), and the difference between the two groups was significant (P < 0.05), and the difference between the two groups was significant (P < 0.05). When the truncation value of GLS is 17.80%, its sensitivity is the highest (88.89g), the Yorden index is 0.673, when GCS is 14.70%, the specificity is the highest (89.4747) and the Joden's index is 0.561. Conclusion the systolic function of left ventricle is decreased in patients with chronic renal insufficiency, and the left ventricular systolic function decreases with the progress of the disease. Decreased cardiac function 3D-STI can accurately evaluate the left ventricular systolic function in patients with chronic renal insufficiency at different stages.
【作者单位】：青岛大学附属医院心脏超声科;青岛大学附属医院腹部超声科;
【分类号】：R540.45;R692

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