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目的:采用超声及速度向量成像技术(VVI)分析不同分期慢性肾脏疾病(CKD)患者左室结构与功能、左房功能及同步性改变。方法:选取2013年1月至2016年8月福建中医药大学附属第二人民医院收治的CKD患者,根据肾小球滤过率(GFR)将其分为CKD 2~3期组(A组,n=52)和CKD 4~5期组(B组,n=51),另选取年龄和性别相匹配的健康志愿者50例作为对照组(C组)。采用常规超声心动图测量左室壁厚度及左心功能,VVI技术分析左心房收缩期峰值应变率(SR-s)、舒张早期应变率(SR-e)、舒张晚期峰值应变率(SR-a)、左房肌6节段纵向应变率达峰时间标准差(Tsr-SD)和左房肌6节段任意二个节段应变率达峰时间最大差值(Tsr-Max)。结果:与C组相比,A组和B组SR-s和SR-e显著降低(P<0.05),左心室质量指数(LVMI)及二尖瓣口舒张早期血流速度/瓣环运动速度(E/e’)比值显著增加(P<0.05);且B组SR-s和SR-e均低于A组,而E/e’比值高于A组(均P<0.05)。SR-a在A组升高,在B组中降低(均P<0.05)。CKD患者Tsr-SD、Tsr-Max均显著升高(均P<0.05),而A组升高程度更明显(P<0.05)。结论:CKD患者出现左室结构与功能、左房功能及同步性异常,VVI技术可用于早期评估CKD患者左房功能及同步性改变。
OBJECTIVE: To analyze left ventricular function and left ventricular function and synchrony changes in patients with different stages of chronic kidney disease (CKD) by using ultrasound and velocity vector imaging (VVI). Methods: CKD patients who were admitted to the Second People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine from January 2013 to August 2016 were divided into two groups according to glomerular filtration rate (GFR) n = 52) and CKD group 4 ~ 5 (group B, n = 51). Another 50 healthy volunteers were selected as control group (age, sex). The left ventricular wall thickness and left ventricular function were measured by conventional echocardiography. The peak systolic strain (SR-s), SR-e, SR-a ), Tsr-SD of peak longitudinal strain rate in 6 segments of left atrium, and Tsr-Max of strain rate of any two segments in 6 segments of left atrium. Results: Compared with group C, SR-s and SR-e in group A and group B were significantly decreased (P <0.05), left ventricular mass index (LVMI) and mitral early diastolic flow velocity / (P <0.05). The SR-s and SR-e of group B were lower than that of group A, while the ratio of E / e ’was higher than that of group A (all P <0.05). SR-a increased in group A and decreased in group B (all P <0.05). Tsr-SD and Tsr-Max in patients with CKD were significantly increased (all P <0.05), while those in group A were more obvious (P <0.05). Conclusion: Left ventricular structure and function, left atrial function and synchronicity are abnormal in patients with CKD. VVI can be used to evaluate left atrial function and synchronicity in CKD patients.