超声心动图检测慢性肾脏病患者心脏改变的价值分析
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摘要
目的研究超声心动图在慢性肾病患者心脏改变中的应用价值。方法慢性肾病患者120例作为慢性肾病组,正常体检者55例作为对照组。分别测量各腔室大小、血流及心功能参数,主要观察指标包括室间隔厚度(IVS)、左心室后壁厚度(LVPW)、左心房内径(LA)、左心室舒张期末内径(LV)、升主动脉内径(AAO)、二尖瓣舒张早期/晚期峰值流速比值(E/A)、二尖瓣舒张早期血流峰值与瓣环运动速度比值(E/Em)、左心室射血分数(EF)、室壁运动积分指数(WMSI)等。1年后再次测量上述指标并保存。先进行横向观察,正常对照组与慢性肾病各组比较。再进行纵向观察,比较慢性肾病组各指标1年后与1年前相比有哪些变化。结果 1、2、3期组E/A、E/Em与对照组比较,差异有统计学意义(P<0.05),且2期组IVS、LA,3期组IVS、LVPW、LA与对照组比较,差异均有统计学意义(P<0.05),4、5期组IVS、LVPW、LA、LV、AAO、E/A、E/Em、EF、WMSI与对照组比较,差异均有统计学意义(P<0.05)。120例慢性肾病患者,通过1年的随访,所测各指标均有不同程度的进展,其中以IVS、LA、E/A、E/Em,改变最明显,其次是LVPW、LV、EF、WMSI,差异均有统计学意义(P<0.05),AAO无明显变化(P>0.05)。各指标检出异常的百分比也是不同程度的上升,以IVS、LVPW、LA、E/A、E/Em增幅较大(P<0.05)。在120例慢性肾病患者中,Ⅰ级舒张功能减低1期患者至3期患者百分比逐渐增高,从33.33%上升到50.00%,然后逐渐下降,4期为10.00%,5期为0,Ⅲ级舒张功能减低患者从1期到5期百分比逐级增高。从1期的3.57%到5期的87.50%。1期到3期患者,舒张功能减低Ⅰ级到Ⅲ级逐渐下降,4期到5期患者,舒张功能减低Ⅰ级到Ⅲ级逐渐上升,均为100%。1年前、1年后,糖肾组的各项指标都要劣于非糖肾组,尤其是IVS、LVPW、LA、E/M、E/Em、WMSI,差异有统计学意义(P<0.05)。结论超声心动图在慢性肾病患者心血管并发症的研究中起到了重要作用。能够早期监测心脏异常改变,为临床医师提供重要依据,及时指导治疗方案,改善患者预后。
Objective To investigate the application value of echocardiography in detecting cardiac changes in patients with chronic kidney disease. Methods A total of 120 patients with chronic kidney disease were enrolled as chronic kidney disease group, and the other 55 healthy subjects were enrolled as control group. The size, blood flow and cardiac function parameters of each chamber were measured. The main observation indexes included ventricular septal thickness(IVS), left ventricular posterior wall thickness(LVPW), left atrial diameter(LA), left ventricular end diastolic diameter(LV), ascending aortic diameter(AAO), mitral valve early/late peak flow ratio(E/A), the ratio of blood flow peak to annulus velocity(E/Em), left ventricular ejection fraction(EF), wall motion index(WMSI).After 1 year,these indexes mentioned above were detected again to observe the changes of these indexes.Results There was significant difference in the E/Em at phase 1,phase 2,phase 3 between the two groups(P<0.05),there were significant differences in IVS, LLA, and LA at phase 2 and in IVS, LVPW, LA at phase 3 as well as in IVS,LVPW,LA,LV,AAO,E/A,E/Em,EF,WMSI at phase 4,phase 5 between the two groups(P<0.05). After 1 year of follow-up,all the indexes mentioned above were improved in the 120 patients with chronic kidney disease,in which,the changes of IVS, LA, E/A, E/Em were the most obvious, followed by LVPW, LV, EF, WMSI, the differences were statistically significant.(P<0.05),but there was no significant change in AAO(P>0.05). The percentage of abnormality of each index was increased at different extents,in which the increase extents of IVS, LVPW, LA, E/A and E/Em were greater(P<0.05). In 120 patients with chronic kidney disease, the percentage of patients with stage I diastolic function was increased gradually from stage 1 to stage 3(from 33.33% to 50.00%), then was gradually decreased,which at stage 4 was 10.00%,and 0 at stage 5.Moreover the percentage of patients with grade Ⅲ diastolic function were increased stage 1 to stage 5(from 3.57% to 87.50%).The indexes mentioned above before and after 1 year in chronic kidney disease group were inferior to those in control group,especially in IVS,LVPW,LA,E/M,E/Em,WMSI,there were sign ificant differences between the two groups( P < 0. 05).Conclusion Echoc ardiography plays an importanmt role in detcting chronic kidney disease complicated by cardiovascular complications,which can monitor the abnormal cardiac changes early,providing an important basis for clinicians to timely make treatment programs and improve patient's outcomes.
Objective To investigate the application value of echocardiography in detecting cardiac changes in patients with chronic kidney disease. Methods A total of 120 patients with chronic kidney disease were enrolled as chronic kidney disease group, and the other 55 healthy subjects were enrolled as control group. The size, blood flow and cardiac function parameters of each chamber were measured. The main observation indexes included ventricular septal thickness(IVS), left ventricular posterior wall thickness(LVPW), left atrial diameter(LA), left ventricular end diastolic diameter(LV), ascending aortic diameter(AAO), mitral valve early/late peak flow ratio(E/A), the ratio of blood flow peak to annulus velocity(E/Em), left ventricular ejection fraction(EF), wall motion index(WMSI).After 1 year,these indexes mentioned above were detected again to observe the changes of these indexes.Results There was significant difference in the E/Em at phase 1,phase 2,phase 3 between the two groups(P<0.05),there were significant differences in IVS, LLA, and LA at phase 2 and in IVS, LVPW, LA at phase 3 as well as in IVS,LVPW,LA,LV,AAO,E/A,E/Em,EF,WMSI at phase 4,phase 5 between the two groups(P<0.05). After 1 year of follow-up,all the indexes mentioned above were improved in the 120 patients with chronic kidney disease,in which,the changes of IVS, LA, E/A, E/Em were the most obvious, followed by LVPW, LV, EF, WMSI, the differences were statistically significant.(P<0.05),but there was no significant change in AAO(P>0.05). The percentage of abnormality of each index was increased at different extents,in which the increase extents of IVS, LVPW, LA, E/A and E/Em were greater(P<0.05). In 120 patients with chronic kidney disease, the percentage of patients with stage I diastolic function was increased gradually from stage 1 to stage 3(from 33.33% to 50.00%), then was gradually decreased,which at stage 4 was 10.00%,and 0 at stage 5.Moreover the percentage of patients with grade Ⅲ diastolic function were increased stage 1 to stage 5(from 3.57% to 87.50%).The indexes mentioned above before and after 1 year in chronic kidney disease group were inferior to those in control group,especially in IVS,LVPW,LA,E/M,E/Em,WMSI,there were sign ificant differences between the two groups( P < 0. 05).Conclusion Echoc ardiography plays an importanmt role in detcting chronic kidney disease complicated by cardiovascular complications,which can monitor the abnormal cardiac changes early,providing an important basis for clinicians to timely make treatment programs and improve patient's outcomes.
引文
1 陆再英,终南山主编.内科学.第7版.北京:人民卫生出版社,2012.549-550.
2 Turin TC,Tonelli M,Manns BJ,et al.Chronic kidney disease and life expectancy.Nephrology,dialysis,transplantation official publication of the European Dialysis and Transplant Association- European Renal Association,2012,27:3182-3186.
3 Go AS,Chertow GM,Fan D,et al.Chronic kidney disease and the risks of death,cardiovascular events,and hospitalization.N Engl J Med,2004,351:1296-1305.
4 Cheung AK,Sarnak MJ,Yan G,et al.Cardiac disease in maintenance hemodialysis patients:Results of the HEMO study.Kindey Int,2014,65:2380-2389.
5 Toneli M,Wiebe N,Culleton B,et al.Chronic kidney disease and mortality risk.a systematic review.Journal of the American Society of Nephrology:JASN,2006,17:2034-2047.
6 Nagueh SF,Appleton CP,Gillebert TC,et al.Recommendations for the evaluation of left ventricular diastolic function by echocardiography.Journal of the American Society of Echocardiography:official publication of the American Society of Echocardiography,2009,22:107-133.
7 李治安主编.临床超声影像学.第1版.北京:人民卫生出版社,2003.189.
8 王今.慢性肾衰竭心脏功能超声数据模型的初步研究.皖南医学院,2015.
9 彭道有.慢性肾脏病心病变及其危险因素分析.新疆医科大学,2010.
10 蔡绮哲.超声心动图定量评价慢性肾病患者心脏结构与功能改变的研究.北京协和医学院,中国医学科学院,2015.
11 李毅,勤俭.左室舒张功能的临床评价现状.西部医学,2010,6:583-585.
12 胡绮雯,蔡琪,许敏玲,等.慢性肾功能衰竭维持性血透患者心功能变化临床观察.深圳中西医结合杂志,2015,25:7-9.
13 侯凡凡,马志刚,梅长林,等.中国五省市自治区慢性肾脏病患者心血管疾病的患病率调查.中华医学杂志,2005,85:458-463.
2 Turin TC,Tonelli M,Manns BJ,et al.Chronic kidney disease and life expectancy.Nephrology,dialysis,transplantation official publication of the European Dialysis and Transplant Association- European Renal Association,2012,27:3182-3186.
3 Go AS,Chertow GM,Fan D,et al.Chronic kidney disease and the risks of death,cardiovascular events,and hospitalization.N Engl J Med,2004,351:1296-1305.
4 Cheung AK,Sarnak MJ,Yan G,et al.Cardiac disease in maintenance hemodialysis patients:Results of the HEMO study.Kindey Int,2014,65:2380-2389.
5 Toneli M,Wiebe N,Culleton B,et al.Chronic kidney disease and mortality risk.a systematic review.Journal of the American Society of Nephrology:JASN,2006,17:2034-2047.
6 Nagueh SF,Appleton CP,Gillebert TC,et al.Recommendations for the evaluation of left ventricular diastolic function by echocardiography.Journal of the American Society of Echocardiography:official publication of the American Society of Echocardiography,2009,22:107-133.
7 李治安主编.临床超声影像学.第1版.北京:人民卫生出版社,2003.189.
8 王今.慢性肾衰竭心脏功能超声数据模型的初步研究.皖南医学院,2015.
9 彭道有.慢性肾脏病心病变及其危险因素分析.新疆医科大学,2010.
10 蔡绮哲.超声心动图定量评价慢性肾病患者心脏结构与功能改变的研究.北京协和医学院,中国医学科学院,2015.
11 李毅,勤俭.左室舒张功能的临床评价现状.西部医学,2010,6:583-585.
12 胡绮雯,蔡琪,许敏玲,等.慢性肾功能衰竭维持性血透患者心功能变化临床观察.深圳中西医结合杂志,2015,25:7-9.
13 侯凡凡,马志刚,梅长林,等.中国五省市自治区慢性肾脏病患者心血管疾病的患病率调查.中华医学杂志,2005,85:458-463.