应变率成像技术评价不同分期慢性肾脏病患者左心房功能

发布时间：2018-04-09 03:42

本文选题：应变率成像技术　切入点：慢性肾脏病　出处：《山西医科大学》2017年硕士论文

【摘要】：目的:1.应用应变率成像技术(Strain Rate Imaging,SRI)评价慢性肾脏病(Chronic Kidney Disease,CKD)各期左房功能的受损情况。2.了解慢性肾脏病各期进展过程中,左房功能受损程度的变化情况。3.探讨应变率成像技术对不同分期CKD患者左房功能评价的应用价值。方法:选取我院2016年4月~2016年10月肾内科CKD患者58例,依据2012年全球肾脏病组织KDIGO所定义的标准纳入,根据肾小球滤过率(GFR)水平将CKD患者分为3组,A组(19例,GFR≥60 ml/min/1.73m2,CKD 1~2期),B组(22例,GFR:30~59 ml/min/1.73m2,CKD 3期),C组(17例,GFR:15~29ml/min/1.73m2,CKD 4期),三组LVEF均大于55%,未进行过透析治疗;同时选取健康对照组(N组)19例,四组间性别、年龄无统计学差异。所有的受检者采用Philips i E33彩色超声诊断仪进行检查,分别采集连续3个心动周期常规条件下及组织多普勒条件下心尖二腔切面及心尖四腔切面图像,动态储存后进行脱机分析。用simpson双平面法测量左心房最大容积LAVmax、最小容积LAVmin、主动收缩前容积LAVp,通过这几个参数值计算左心房的被动射血容积LAPEV=LAVmax-LAVp、左心房的主动射血容积LAAEV=LAVp-LAVmin、左心房的被动射血分数LAPEF=LAPEV/LAVmax、左心房的主动射血分数LAAEF=LAAEV/LAVp,左心房的总射血分数LATEF=(LAVmax-LAVmin)/LAVmax。运用QLAB-SQ软件得出左心房前壁、下壁、侧壁及房间隔共4个节段心肌应变率曲线,分别测量各个壁收缩期、舒张早期及舒张晚期平均应变率峰值SRs、SRe及SRa。上述测值均连续测量3次,取平均值。结果:1.常规二维参数比较B组、C组LAVmax、LAVmin、LAVp较N组、A组增大(P0.05),即CKD 3期、4期患者左心房容积增大;B组、C组LATEF、LAPEF较N组、A组减少(P0.05),即CKD 3期、4期患者左心房储存功能及管道功能减低;2.应变率参数比较SRs、SRe:B组、C组前壁、下壁、侧壁及房间隔较N组、A组均降低(P0.05),结果同上,CKD3期、4期时左心房储存功能及管道功能受损,其中B组与C组无明显统计学差异(P0.05),说明CKD患者病情从3期进展到4期时,左房的储存功能及管道功能未明显进一步受损;SRa:四组间前壁、下壁、侧壁及房间隔无显著性差异(P0.05),表明慢性肾脏病前4期患者左房的助力泵功能未受损。3.应变率SRe/a比较SRe/a可定位反应左心房的舒张功能,整体B组、C组SRe/a较正常组及A组减低,且有统计学差异(P0.05);且C组前壁及下壁SRe/a较B组进一步较低(P0.05),说明CKD3、4期患者左房舒张功能减低,受损心肌以前壁和下壁为著。结论:本次研究,SRI测量结果同常规参数测量结果提示一致,但SRI测量更为简便、准确,能评价不同分期慢性肾脏病患者左房的功能,并可以评估左房功能的受损程度,从而可以为临床早期干预提供依据。
[Abstract]:Purpose 1.Strain Rate imaging (SRI) was used to evaluate the impairment of left atrial function in patients with chronic kidney disease (Chronic Kidney diseaseCKD).To understand the changes of left atrial function damage in each stage of chronic kidney disease.To evaluate the value of strain rate imaging in evaluating left atrial function in patients with CKD at different stages.Methods: 58 patients with CKD from April 2016 to October 2016 in our hospital were selected and included according to the criteria defined by the global kidney disease tissue KDIGO in 2012.There was no statistical difference in sex and age among the four groups.All the subjects were examined by Philips I E33 color ultrasound diagnostic instrument. The images of apical two-chamber section and apical four-chamber section were collected under the conventional condition of 3 consecutive cardiac cycles and under the condition of tissue Doppler respectively, and then the off-line analysis was performed after dynamic storage.The active ejection fraction of left atrium was LAAEFV / LAAEV / LAVp, and the total ejection fraction of left atrium was LAVmax-LAVminn / LAVmax.The strain rate curves of left atrial anterior wall, inferior wall, lateral wall and atrial septum were obtained by QLAB-SQ software.The above measured values were measured continuously for 3 times, and the average values were taken.The result is 1: 1.Comparison of two dimensional parameters between group B and group C the left atrial volume of patients with stage 3 and stage 4 of CKD was increased, and the left atrial volume in group B was lower than that in group N (P 0.05), that is, the storage function and conduit function of left atrium in patients with stage 3 and stage 4 of CKD were decreased by 2. 05%.The strain rate parameters of group C were compared with those of group C. The anterior wall, inferior wall, lateral wall and atrial septum of group C were lower than those of group N (P 0.05). The results showed that the left atrium storage function and conduit function were impaired in stage 4 of CKD3.There was no significant difference between group B and group C (P 0.05), which indicated that the storage function and conduit function of left atrium were not further damaged in patients with CKD from stage 3 to stage 4.There was no significant difference in lateral wall and atrial septum (P 0.05), indicating that the left atrial pump function was not impaired in the first four stages of chronic kidney disease.Strain rate SRe/a compared with SRe/a could localize the diastolic function of left atrium. SRe/a in group B and C was lower than that in group A and normal group.The SRe/a of anterior wall and inferior wall in group C was lower than that in group B, indicating that left atrial diastolic function was decreased in patients with CKD3 stage 4, and the anterior wall and inferior wall of myocardium were damaged.Conclusion: the results of Sri measurement in this study are consistent with those of conventional parameter measurement, but SRI measurement is more convenient and accurate. It can evaluate the left atrial function of patients with chronic kidney disease at different stages, and can evaluate the degree of damage to left atrial function.Therefore, it can provide basis for early clinical intervention.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692;R540.4

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