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| 四维自动左房定量技术评价不同透析方式对尿毒症患者左房结构和功能的影响 |
| 练菲菲,刘表虎,纪文艳,闫娜,杨优,吴书甜,钟玉心 |
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| (皖南医学院弋矶山医院超声科) |
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| 摘要: |
| 目的 应用四维自动左房定量技术(four-dimensional automatic left atrial quantification,4D Auto LAQ)分别从容积和应变角度评估不同透析方式对尿毒症患者左房结构和功能的影响。方法 选取在我院肾内科确诊尿毒症患者80例,并根据透析方式分为血液透析组41例(血透组)和腹膜透析组39例(腹透组),另选取与其性别、年龄相匹配的健康体检者35例(正常对照组)。应用二维超声心动图检查获取常规参数：左房内径(LAD)、左室舒张末期内径(LVEDD)、室间隔厚度(IVS)、左室后壁厚度(LVPW)、左室射血分数(LVEF)；应用4D Auto LAQ获取左房应变和容积参数：左房储备期纵向应变(LASr)、左房管道期纵向应变(LAScd)、左房收缩期纵向应变(LASct)；左房储备期环形应变(LASr-c)、左房管道期环形应变(LAScd-c)、左房收缩期环形应变(LASct-c)；左房最大容积(LAVmax)、左房最小容积(LAmin)、左房收缩前容积(LAVpreA),左房射血分数(LAEF),比较上述组间参数有无差异,分析4D Auto LAQ应变和容积参数间有无相关性。结果 ①常规参数：腹透组和血透组LAD、LVEDD、IVS、LVPW较正常对照组增大,差异有统计学意义(P<0.05),各组间LVEF差异无统计学意义(P>0.05)；血透组和腹透组LAD、LVEDD、IVS、LVPW差异无统计学意义(P>0.05)；②应变参数：腹透组LASr、LAScd、LASr-c、LAScd-c较正常对照组减小,LASct、LASct-c较正常对照组增大,血透组LASr、LAScd、LASct、LASr-c、LAScd-c、LASct-c较正常对照组减小,差异有统计学意义(P<0.05)；血透组LASr、LASct、LASr-c、LAScd-c、LASct-c较腹透组减小,差异有统计学意义(P<0.05),两组间LAScd差异无统计学意义(P>0.05)；③容积参数：腹透组和血透组LAVmax、LAmin、LAVpreA较正常对照组增大,LAEF较正常对照组减小,差异有统计学意义(P<0.05)；血透组LAVmax、LAmin、LAVpreA较腹透组增大,LAEF较腹透组减小,差异有统计学意义(P<0.05)。在相关性分析中,LAEF与LASr、LAScd、LASr-c、LAScd-c的绝对值呈正相关,相关性系数分别为0.531、0.522、0.705、0.686。结论 4D Auto LAQ可以评价不同透析方式对左房结构和功能的改变,血透较腹透对左房结构和功能影响更为显著。 |
| 关键词: 左房四维定量分析 透析 尿毒症 应变 容积 左房功能 |
| DOI： |
| 投稿时间：2023-06-08修订日期：2023-08-07 |
| 基金项目:安徽省高等学校省级质量工程项目(2020xskt525);安徽省高等学校省级质量工程项目(2020xsxxkc458)；皖南医学院校级科研项目(WK2022F24)第一作者：练菲菲,安徽省芜湖市,皖南医学院弋矶山医院。E-mail:1066539821@qq.com 通信作者：刘表虎,安徽省芜湖市,皖南医学院弋矶山医院。E-mail:lbhwuhu@163.com |
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| Evaluation of the effects of different dialysis methods on left atrial structure and function in uremic patients using four-dimensional automatic left atrial quantification technology |
| LIAN Feifei,LIU Biaohu,JI Wenyan,Yan na,YANG you,Wu shutian,Zhong yuxin |
| (Department of ultrasound,Yijishan Hospital,Wannan Medical College,Anhui,241000;China) |
| Abstract: |
| Objective Four dimensional automatic left atrial quantification (4D Auto LAQ) was applied to evaluate the effects of different dialysis methods on left atrial structure and function in uremic patients from the perspectives of volume and strain, respectively.Methods 80 patients with confirmed uremia in the nephrology department of our hospital were selected and divided into a hemodialysis group of 41 cases (hemodialysis group) and a peritoneal dialysis group of 39 cases (peritoneal dialysis group) based on the dialysis method. Additionally, 35 healthy individuals who matched their gender and age were selected (normal control group).SConventional parameters were obtained by two-dimensional echocardiography: left atrial diameter (LAD), left ventricular end diastolic diameter (LVEDD), interventricular septum thickness (IVS), left ventricular posterior wall thickness (LVPW), left ventricular ejection fraction (LVEF);SUsing 4D Auto LAQ to obtain left atrial strain and volume parameters: left atrial reserve longitudinal strain (LASr), left atrial ductal longitudinal strain (LAScd), and left atrial systolic longitudinal strain (LASct);SLeft atrial reserve phase circumferential strain (LASr-c), left atrial ductal phase circumferential strain (LAScd-c), and left atrial systolic phase circumferential strain (LASct-c);SLeft atrial maximum volume (LAVmax), left atrial minimum volume (LAmin), left atrial pre-systolic volume (LAVpreA), and left atrial ejection fraction (LAEF) were compared for differences in the above group parameters, and the correlation between 4D Auto LAQ strain and volume parameters was analyzed.Results ① Routine parameters: LAD, LVEDD, IVS, and LVPW in the peritoneal dialysis group and hemodialysis group increased compared to the normal control group, with a statistically significant difference (P<0.05). There was no statistically significant difference in LVEF between the groups (P>0.05);SThere was no statistically significant difference in LAD, LVEDD, IVS, and LVPW between the hemodialysis group and the peritoneal dialysis group (P>0.05)SStrain parameters: LASr, LAScd, LASr-c, and LAScd-c in the peritoneal dialysis group decreased compared to the normal control group, while LASct and LASct-c increased compared to the normal control group. LASr, LAScd, LASct, LASr-c, LAScd-c, and LASct-c in the hemodialysis group decreased compared to the normal control group, with a statistically significant difference (P<0.05);SThe LASr, LASct, LASr-c, LAScd-c, and LASct-c in the hemodialysis group were significantly reduced compared to the peritoneal dialysis group (P<0.05), and the difference was statistically significant (P<0.05). There was no statistically significant difference in LAScd between the two groups (P>0.05)SVolume parameters: LAVmax, LAmin, and LAVpreA in the peritoneal dialysis group and hemodialysis group increased compared to the normal control group, while LAEF decreased compared to the normal control group, with a statistically significant difference (P<0.05);SThe LAVmax, LAmin, and LAVpreA in the hemodialysis group increased compared to the peritoneal dialysis group, while LAEF decreased compared to the peritoneal dialysis group, with a statistically significant difference (P<0.05).SIn correlation analysis, LAEF is positively correlated with the absolute values of LASr, LAScd, LASr-c, and LAScd-c, with correlation coefficients of 0.531, 0.522, 0.705, and 0.686, respectively.Conclusion 4D Auto LAQ can evaluate the changes in left atrial structure and function caused by different dialysis methods, and hemodialysis has a more significant impact on left atrial structure and function than peritoneal dialysis. |
| Key words: Four dimensional quantitative analysis of the left atrium Dialysis Uremia Strain Volume Left atrial function |
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