| 摘要: |
| 目的 采用实时三维超声及三维斑点追踪技术（3D-STI）对左室射血分数保留的终末期慢性肾疾病（ESRD）患者的右心室收缩功能进行评价。方法 纳入规律血液透析的左室射血分数保留的ESRD患者43例，诊断标准GFR＜15mL/(min·1.73m2)，根据是否合并肺动脉高压分为ESRD组(n=23)、ESRD合并肺动脉高压组(n=20)，对照组选择25例健康志愿者。测量各心腔大小、LVEF及右室做功指数（RIMP）；应用实时三维超声测量右室容积（EDV、ESV）、右室每分输出量（RVCO）、射血分数（3DRVEF）、面积变化分数（FAC）及三尖瓣环收缩期位移（TAPSE）。通过3D-STI获取游离壁整体纵向应变（3DGLS）。结果 ①与对照组比较，ESRD组及ESRD合并肺动脉高压组EDV、ESV、RVCO、RIMP显著增大，3DRVEF、TAPSE、FAC显著减低（P＜0.01）；ESRD组RVD1、RVD2、RVD3差异均无统计学意义（P＞0.05）；ESRD合并肺动脉高压组SV、PA、RAD、RVD1、RVD2均增大（P＜0.05）。与ESRD组比较，ESRD合并肺动脉高压组EDV、ESV、RVCO增大，3DRVEF、TAPSE、FAC减低（P＜0.05）。②3DGLS在对照组、ESRD组、ESRD合并肺动脉高压组依次显著减小（P＜0.01）。③相关性分析显示：3DGLS的绝对值与3DRVEF、TAPSE、FAC、RIMP均呈强相关（r=0.7701、0.6206、0.5922、-0.5475，P均＜0.01）。结论 实时三维超声及三维斑点追踪技术可以早期、敏感的定量评估LVEF保留的血液透析ESRD患者右心室收缩功能 |
| 关键词: 超声心动描记术 斑点追踪 终末期肾病 肺动脉高压 心室功能，右 |
| DOI： |
| 投稿时间：2020-04-28修订日期：2020-05-09 |
| 基金项目: |
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| Evaluation of right ventricular systolic function by Real-time three-dimensional echocardiography and three-dimensional speckle tracking imaging in end-stage renal dysfunction (ESRD) patients |
| du rui,tang xiao yan,qian sheng li,yang li,ma zhou,huang wei |
| (Chinese PLA Central War Command General Hospital) |
| Abstract: |
| Objective To evaluate the impairment of the right ventricular systolic function of patients with end-stage chronic renal disease (ESRD) with normal left ventricular ejection fraction (LVEF). Methods Real-time three-dimensional echocardiography and three-dimensional speckle tracking imaging(3D-STI) were employed in the right ventricular systolic function measurement. 25 healthy volunteers were enrolled as the control group. 43 ESRD patients were enrolled according to the Kidney Disease Improving Global Outcomes (KDIGO) guidelines who were undergoing regular hemodialysis therapy with preserved LVEF. Patients were divided in to ESRD group and ESRD complicated with pulmonary hypertension group according to whether he/she complicated with pulmonary hypertension. The diameter of the right ventricular index of myocardial performance (RIMP) were measured. The global longitudinal strain of free wall (3DGLS) was obtained by using 3D-STI. Real-time three-dimensional echocardiography was performed to measure right ventricular volume (EDV, ESV), ejection fraction (3DRVEF), calculate right ventricular output per minute (RVCO). Record fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE). Results ①Compared with the control group, EDV, ESV, RVCO, RIMP increased in ESRD group and ESRD complicated with pulmonary hypertension group, 3DRVEF, TAPSE, FAC decreased (P <0.01); RVD1, RVD2, RVD3 in ESRD group were not statistically significant (P> 0.05); RAD, RVD1, RVD2, PA, SV were increased in the ESRD combined with pulmonary hypertension group (P <0.05). Compared with the ESRD group, EDV, ESV, and RVCO in the ESRD complicated pulmonary hypertension group were increased, while the 3DRVEF, TAPSE, FAC were decreased (P <0.05). ②The absolute value of 3DGLS decreased significantly in both the two groups compared to the control (P <0.01). ③Correlation analysis shows that the absolute value of 3DGLS is strongly correlated with 3DRVEF, TAPSE, FAC, RIMP (r =0.7701, 0.6206, 0.5922, -0.5475, P <0.01). Conclusion Real-time three-dimensional echocardiography and three-dimensional speckle tracking imaging can be applied to evaluate the right ventricular systolic function of LVEF-preserved ESRD patients undergoing hemodialysis in the early stage of the disease and more sensitive than 2D echocardiography. |
| Key words: Echocardiography Speckle tracking End-stage renal disease Pulmonary hypertension Ventricular function, right |
