速度矢量成像定量评价不同PTH水平尿毒症患者左心功能的研究
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摘要
研究背景:在临床上尿毒症患者多死于尿毒症心肌病。近几年来发现,甲状旁腺素(PTH)功能亢进在其中起着重要作用。国内外研究都表明PTH＞正常值上限3倍的患者有明显的心肌损害加重趋势,但常规二维超声心动图只能估测整体心脏运动,不能显示不同节段早期心肌功能不全。新近发展起来的速度矢量成像(VelocityVector Imaging,VVI)技术克服了周围心肌牵拉和心脏整体运动的干扰及角度依赖性,能准确有效地评价局部心肌功能。目前国内外尚无用VVI评价不同PTH水平的尿毒症患者左心局部心肌功能的研究报道。
目的:利用VVI技术定量评价PTH＜正常值上限3倍患者、PTH＞正常值上限3倍患者左心长轴各节段的心肌功能,与正常人比较,观察其变化特点;观察PTH＜正常值上限3倍患者、PTH＞正常值上限3倍患者左心室各节段收缩功能与舒张功能的改变先后;探讨VVI技术在评价不同PTH水平的尿毒症患者左心长轴功能无创估测中的价值。
对象及方法:2007年6月～2008年2月在我院血液净化中心进行维持性血液透析(MHD)、完全符合尿毒症标准的患者60例,根据超声心动图检查前一周内抽血清测得PTH值大小,将实验组对象分成A、B两组,A组<正常值上限3倍,B组>正常值上限3倍(我院PTH正常值为1.48～7.63pmol/L),每组各30例。按性别、年龄与A、B组患者匹配的正常人30例。凡既往有高血压、瓣膜性心脏病、先天性心脏病史,经检查有糖尿病、甲状腺疾病、代谢性疾病、结缔组织疾病、营养不良、有严重的肝功能损害者,有酗酒和毒物接触史者,处于围生期者均排除在外。用VVI技术分别测量16节段心肌长轴上三组指标:Ⅰ—收缩期峰值应变率(SSRmax);Ⅱ—舒张期峰值应变率(DSRmax);Ⅲ—应变率达峰时间(PTSR);每一指标均取一个心动周期。
结果:正常组收缩期应变率、舒张期应变率在基底段、中间段、心尖段无明显差异,应变率达峰时间在16个节段的一致性较好。与正常组比较,A组患者左室心肌长轴方向下壁及后间壁的基底段、中间段、心尖段,前间壁的基底段、中间段,侧壁及前壁的心尖段,后壁的中间段的SSRmax减低,差异有显著性意义(p＜0.05);B组各节段SSR均减低,差异有显著性或极显著性意义(P＜0.05或P＜0.01)。A、B两组所有节段的DSRmax测值均减低,PTSR测值均延长,差异均具有显著性意义(A组p＜0.05,B组p＜0.01)。与A组患者比较,B组患者前壁的基底段、中间段、心尖段,后间隔、下壁的中间段、心尖段,前间壁、后壁的中间段,侧壁的心尖段的SSRmax测值减低,差异有显著性意义(p＜0.05);B组患者所有节段的DSRmax测值均减低,PTSR测值均延长,差异均具有显著性意义(p＜0.05)。
结论:与正常对照组相比,两组患者的所有节段心肌的舒张功能减退,不同节段心肌的收缩功能发生不同程度的减退,说明心肌的舒张功能障碍发生在收缩功能障碍之前,且PTH不但对心肌整体结构功能产生损害,还对不同节段心肌产生不同程度损伤;另外B组的损伤程度较A组严重,说明了PTH水平越高,对心肌结构功能的损害程度越严重。VVI技术的应用能够早期、客观、准确的发现患者长轴方向心肌舒缩功能的微小变化,为PTH对心肌的损害提供了客观、定量的理论依据。相信随着对VVI技术进一步深入的研究,以及对应变率这一参数特性的掌握,将使这项技术在不久后广泛运用于临床工作中。
Backgroud:Most of uremic patients died of uremic cardiomyopathy. Recently we found secondary hyperparathyroidism is a important role. Scholars at home and abroad have found there were much more injury on myocardium of uremic patients with PTH more than 3 times of upper normal limnit.But the routine technique of ECHO could only estimate the global heart movement and could not evaluate effectively local myocardium movement damaged by different quantity of PTH.Recently developed new technique-Velocity Vector Imaging(VVI)can conquer the angle-dependency,the drag of surrounding myocardial and interference of the global heart movement and can estimate exactly regional myocardium function.No scholars at home and abroad had studied the the left ventricular longitudinal function in uremic patients with differnent quantity of PTH.
Objective:To investigate the regional longitudinal contraction and relaxation of left ventricle in patients with differnent quantity of PTH,compared with normal persons,characterize the regularity of left ventricular longitudinal function;To characterize change sequence of systolic function and diastolic function in uremic patients with different quantity of PTH.To discuss the important clinical value of velocity vector imaging in quantitatively evaluating regional longitudinal function of left ventricle.
Methods:60 patients diagnosed uremia were divided into 2 groups according to the value of PTH(1.48～7.63pmol/L):Group A is 30 patients with PTH less than 3 times of upper normal limit,Group B is 30 patients with PTH more than 3 times of upper normal limnit.Normal control group is 30 healthy people.They were matched with for sex and age.Exclusion criteria for all subjects were HBP,cardiac valve disease, congenital heart disease,Diabetes mellitus,thyroid disease,metabolic disease,connective tissue disease,dystrophy,severe dysfunction of liver and kidney,contact of toxic,alcohol abuse,pregnant woman in perinatal period.All people were evaluated by Velocity Vector Imaging. Get indexs below in 16 segments from 1 heart beat respectively to assess left ventricular longitudinal contraction and relaxation:Ⅰ-systolic max strain rate(SSRmax);Ⅱ-diastolic max strain rate(DSRmax);Ⅲ-peak time of strain rate(PTSR).
Results:The SSRmax and DSRmax were not obvious different from the base to apex in normal group.PTSR had good coherence among 16 myocardium segments in normal group.Compared with normal group,in group A,SSRmax in base、medium and apex of posterior septum wall and superior wall,base and medium of anterior septum wall,apex of laternal and anterior wall,medium of posterior wall wall were significantly lower(P＜0.05);SSRmax in group B were significantly lower(P＜0.05 or 0.01).In all patients,all segments' DSRmax were significantly lower,PTSR were significantly longer(Group A p＜0.05, Group B p＜0.01).Compared with Group A,SSRmax in group B,apex of laternal wall,medium of anterior septum wall、posterior wall,medium and apex of posterior septum wall and superior wall,base、medium and apex of anterior wall were significantly lower(P＜0.05);In group B all segments' DSRmax were significantly lower,PTSR were significantly longer(P＜0.05).
Conclusion:All segments' relaxation and coherence were obvious decrease,different segments' contraction were decrease in varing degree,proving the dysfunction of relaxation happen before contraction,and PTH injury not only the global heart movement,but aslo local myocardium movement.In addition,the higher the PTH,the much worse the local cardiomyopathy function.VVI is another viable objective tool to quantitatively assess LV segmental function damaged by different quantity of PTH.It proved that myocardium is damaged by PTH with varing degree.
目的:利用VVI技术定量评价PTH＜正常值上限3倍患者、PTH＞正常值上限3倍患者左心长轴各节段的心肌功能,与正常人比较,观察其变化特点;观察PTH＜正常值上限3倍患者、PTH＞正常值上限3倍患者左心室各节段收缩功能与舒张功能的改变先后;探讨VVI技术在评价不同PTH水平的尿毒症患者左心长轴功能无创估测中的价值。
对象及方法:2007年6月～2008年2月在我院血液净化中心进行维持性血液透析(MHD)、完全符合尿毒症标准的患者60例,根据超声心动图检查前一周内抽血清测得PTH值大小,将实验组对象分成A、B两组,A组<正常值上限3倍,B组>正常值上限3倍(我院PTH正常值为1.48～7.63pmol/L),每组各30例。按性别、年龄与A、B组患者匹配的正常人30例。凡既往有高血压、瓣膜性心脏病、先天性心脏病史,经检查有糖尿病、甲状腺疾病、代谢性疾病、结缔组织疾病、营养不良、有严重的肝功能损害者,有酗酒和毒物接触史者,处于围生期者均排除在外。用VVI技术分别测量16节段心肌长轴上三组指标:Ⅰ—收缩期峰值应变率(SSRmax);Ⅱ—舒张期峰值应变率(DSRmax);Ⅲ—应变率达峰时间(PTSR);每一指标均取一个心动周期。
结果:正常组收缩期应变率、舒张期应变率在基底段、中间段、心尖段无明显差异,应变率达峰时间在16个节段的一致性较好。与正常组比较,A组患者左室心肌长轴方向下壁及后间壁的基底段、中间段、心尖段,前间壁的基底段、中间段,侧壁及前壁的心尖段,后壁的中间段的SSRmax减低,差异有显著性意义(p＜0.05);B组各节段SSR均减低,差异有显著性或极显著性意义(P＜0.05或P＜0.01)。A、B两组所有节段的DSRmax测值均减低,PTSR测值均延长,差异均具有显著性意义(A组p＜0.05,B组p＜0.01)。与A组患者比较,B组患者前壁的基底段、中间段、心尖段,后间隔、下壁的中间段、心尖段,前间壁、后壁的中间段,侧壁的心尖段的SSRmax测值减低,差异有显著性意义(p＜0.05);B组患者所有节段的DSRmax测值均减低,PTSR测值均延长,差异均具有显著性意义(p＜0.05)。
结论:与正常对照组相比,两组患者的所有节段心肌的舒张功能减退,不同节段心肌的收缩功能发生不同程度的减退,说明心肌的舒张功能障碍发生在收缩功能障碍之前,且PTH不但对心肌整体结构功能产生损害,还对不同节段心肌产生不同程度损伤;另外B组的损伤程度较A组严重,说明了PTH水平越高,对心肌结构功能的损害程度越严重。VVI技术的应用能够早期、客观、准确的发现患者长轴方向心肌舒缩功能的微小变化,为PTH对心肌的损害提供了客观、定量的理论依据。相信随着对VVI技术进一步深入的研究,以及对应变率这一参数特性的掌握,将使这项技术在不久后广泛运用于临床工作中。
Backgroud:Most of uremic patients died of uremic cardiomyopathy. Recently we found secondary hyperparathyroidism is a important role. Scholars at home and abroad have found there were much more injury on myocardium of uremic patients with PTH more than 3 times of upper normal limnit.But the routine technique of ECHO could only estimate the global heart movement and could not evaluate effectively local myocardium movement damaged by different quantity of PTH.Recently developed new technique-Velocity Vector Imaging(VVI)can conquer the angle-dependency,the drag of surrounding myocardial and interference of the global heart movement and can estimate exactly regional myocardium function.No scholars at home and abroad had studied the the left ventricular longitudinal function in uremic patients with differnent quantity of PTH.
Objective:To investigate the regional longitudinal contraction and relaxation of left ventricle in patients with differnent quantity of PTH,compared with normal persons,characterize the regularity of left ventricular longitudinal function;To characterize change sequence of systolic function and diastolic function in uremic patients with different quantity of PTH.To discuss the important clinical value of velocity vector imaging in quantitatively evaluating regional longitudinal function of left ventricle.
Methods:60 patients diagnosed uremia were divided into 2 groups according to the value of PTH(1.48～7.63pmol/L):Group A is 30 patients with PTH less than 3 times of upper normal limit,Group B is 30 patients with PTH more than 3 times of upper normal limnit.Normal control group is 30 healthy people.They were matched with for sex and age.Exclusion criteria for all subjects were HBP,cardiac valve disease, congenital heart disease,Diabetes mellitus,thyroid disease,metabolic disease,connective tissue disease,dystrophy,severe dysfunction of liver and kidney,contact of toxic,alcohol abuse,pregnant woman in perinatal period.All people were evaluated by Velocity Vector Imaging. Get indexs below in 16 segments from 1 heart beat respectively to assess left ventricular longitudinal contraction and relaxation:Ⅰ-systolic max strain rate(SSRmax);Ⅱ-diastolic max strain rate(DSRmax);Ⅲ-peak time of strain rate(PTSR).
Results:The SSRmax and DSRmax were not obvious different from the base to apex in normal group.PTSR had good coherence among 16 myocardium segments in normal group.Compared with normal group,in group A,SSRmax in base、medium and apex of posterior septum wall and superior wall,base and medium of anterior septum wall,apex of laternal and anterior wall,medium of posterior wall wall were significantly lower(P＜0.05);SSRmax in group B were significantly lower(P＜0.05 or 0.01).In all patients,all segments' DSRmax were significantly lower,PTSR were significantly longer(Group A p＜0.05, Group B p＜0.01).Compared with Group A,SSRmax in group B,apex of laternal wall,medium of anterior septum wall、posterior wall,medium and apex of posterior septum wall and superior wall,base、medium and apex of anterior wall were significantly lower(P＜0.05);In group B all segments' DSRmax were significantly lower,PTSR were significantly longer(P＜0.05).
Conclusion:All segments' relaxation and coherence were obvious decrease,different segments' contraction were decrease in varing degree,proving the dysfunction of relaxation happen before contraction,and PTH injury not only the global heart movement,but aslo local myocardium movement.In addition,the higher the PTH,the much worse the local cardiomyopathy function.VVI is another viable objective tool to quantitatively assess LV segmental function damaged by different quantity of PTH.It proved that myocardium is damaged by PTH with varing degree.
引文
[1]Hunsicker LG.The consequences and costs of chronic kidney disease before ESRD[J].J Am Soc Nephrol,2004,15(5):1363-1364.
[2]Foley RN,Parfrey PS,Harnett JD,et al.Impact of hypertension on cardiomyopathy morbidity and mortality in end-stage renal disease[J].Kidney Int,1999,47:186-192.
[3]Foley RN,Parfrey PS,Samak MJ,et al.Clinical epidniology of cardiovascular disease in chronic renal disease.Am JKidney Dis,1999,32(5 Suppl 3):112-119.
[4]Foley RN,Parfrey PS,Sarnak MJ.Epidemiology of cardiovascular disease in chronic renal disease.J Am Soc Nephrol,1998,9(12 Sup2 p1):s16-s23.
[5]陆慧勤,汪克定,陈强等.PTH对尿毒症患者心脏结构和功能的影响.苏州大学学报(医学版)2005;25(4):668-669.
[6]曹艳,石光清.慢性肾衰竭患者全段甲状旁腺素测定的临床价值.放射免疫学杂志.2007,20(2):122-123.
[7]D'Hooge J,Bijnens B,Jamal F,et al.High frame rate myocardial integrated backscatter:dose this change our understanding of this acoustic parameter ? Eur J Echocardiogr,2000,1:32241
[8]Mani AV,Gianni P,Peng Li,et al.Effect of Cardiac Resynchronization Therapy on Longitudinal and Circumferential Left Ventricular Mechanics by Velocity Vector Imaging:Description and Initial Clinical Application of a Novel Method Using High-Frame Rate B-Mode Echocardiographic Images.Echocardiography,2005,22:826-830.
[9]Foley RN,Parfrey PS,Harnett JD et al.Clinical and echocardiograph ic disease in patients starting end-stage renal disease therapy. Kidney Int, 1995; 47: 186
[10] Kuecherer HF, Kee L, Modin G, Cheitlin MD, Schiller NB. Echocardiography in serial evaluation of left ventricular systolic and diastolic function: importance of image acquisition, quantification, and physiologic variability in clinical and investigational applications. J Am Soc Echocardiogr, 1991, 4:203-214.
[11] Charlotte BI, Hans T, et al. Automated Analysis of Strain Rate and Strain:Feasibility and Clinical Implications. J Am Soc Echocardiogr 2005;18:411-8.)
[12] Mc Dicken ,Moran CM , Groudstroem KWE ,et al . Potential application of color Doppler imaging of the myocardium in assessing contractility and perfusion [J] .Am Heart J, 1993,359 - 374.
[13] Garcia - Fernamdez MA , Zamorano J , Azevedo J . Doppler TissueImaging Echocardiography. Madrid, McGRAW- HILL, 1998 :7
[14] Galiuto L, Ignone G, DeMaria AN. Contraction and relaxation velocities of the normal left ventricle using pulsed - wave tissue Doppler echocardiography. Am J Cardiol , 1998,81:609
[15] Kukulski T,J amal F,D'Hooge J ,et aLAcute ischemic changes in systolic and diastolic event s during clinical coronary angioplasty.a comparison of regional velocity ,strain rate an strain measurement J Amsoc Echocardiogr,2002,15:1212
[16] Mirsky I, Parmley WW. Assessment of passive elastic stiffness for isolated heart muscle and the intact heart. Circ Res 1973;33:233-43.
[17] Santos A, Ledesma2Carbayo MJ ,Malp ica N, et al. Accuracy of heart strain rate calculation derived from Doppler tissue velocity data[JJ. SP IE, 2001,4325: 5462555.
[18] Weidemann F, JIII all F.Sutherland GR. et al. Myocardial function defined by strain rote and strain during alterations in no tropic states and heart rate[J].Am J Physiol Heart Circ Physiol.2002.238(2):H7922799.
[19]Helmdal A.Stoylen A,Torp H.et al.Real-time strain rate imaging of the left ventricle by ultrasound[J].J Am Soe Echocardiography,1998,11(11):1013.
[20]Pislaru C,Abraham TP,Belohlavek M.Strain and strain rate echocardiography [J].Current Opinion in Cardiology,2002,17:443.
[21]D'Hooge J,Heimdal A,Jamal F,et al.Regional strain and strain rate Measurements by cardiac ultrasound:principles,implementation and limitations[J].Eur J Echocardiography,2000.17:154.
[22]Greenberg NL,FirstengergMS,Castro PL,et al.Doppler derived myocardial systolic strain rate is a strong index of left ventricular contractility[J].Circulation,2002,105(1):992105.
[23]杨军,任卫东,陈昕,等.背向散射参数测定对慢性肾功能衰竭心肌超声组织特征的研究.中国超声医学杂志,2006,16(5):359-361
[24]Koyama J,Davidoff R,Falk RH.Longitudinal myocardial velocity gradient derived from pulsed Doppler tissue imaging in AL amyloidosis:a sensitive indicator of systolic and diastolic dysfunction.J Am Soc Echocardiogr,2004,17:36-44.
[25]Hoffmann R,Altiok E,Nowak B,et al.Strain rate measurement by dopp lerechocardiography allows improved assessment of myocardial viability in patients with depressed left ventricular function[J].J Am Coll Cardiol,2002,39(3):4432449.
[26]Rusk RA,Li XN,Irvine T,et al.Surface integration of velocity vectors from 3D digital color Doppler:an angle independent method for laminar flow measurements.Eur J Echocardiogr,2002,3:177-184.
[27]Hoskins PR.Ultrasound techniques for measurement of blood flow and tissue motion.Biorheology,2002,39:451-459.
[28]Leitman M,Lysyansky P,Sidenko S,et al.Two-dimensional strain--a novel software for real-time quantitative echocardiographic assessment of myocardial function.J Am Soc Echocardiogr 2004,17:1021-9.
[29]Waldman LK,Fung YC,Covell JW.Transmural myocardial deformation in the canine left ventricle:normal in vivo three- dimensional finite strains.Circ Res,1985,57:152-163
[30]Freeman GL,LeWinter MM,Engler RL,et al.Relationship between myocardial fiber direction and segment shortening in the midwall of the canine left ventricle.Circ Res,1985,56:31-39
[31]London GM.Cardiovascular disease in chronic renal failure:pathophysiologic aspects.Semin Dial,2003,16(2):85-94.
[32]Wizemann V,Bland S,Krammer W.Diastolic dysfunction of the left ventricle in dialysis patients.Contrib Nephrol,1994;106:106
[33]Erbel R,Nesser HJ,Drozdz J.Atlas of Tissue Doppler Echocardiogrphy:TDE.Steinkopff:Darmstadt,1995
[34]Price DJA,Wallbridge DR,Stewart MJ.Tissue Doppler imaging:current and potential clinical applications.Heart,2000,84:11218
[35]Kiraly P,Kapusta L,Thijssen JM,et al.Left ventricular myocardial function in congenital valvar aortic stenosis assessed by ultrasound tissue - velocity and strainrate techniques.Ultrasound Med Biol,2003,29:615-20.
[36]李文强,郭文彬,朱梅,等正常人左室心肌应变和应变率定量分析。医学影像学 杂志.2006,16:42-44
[37]Ritz E et al.Am J Kidney Dis,1995;26(5):P808-813
[38]Amann K et al.Nephrol Dial Transplant,1994;9:127-128
[39]Piovesan A,Casasso F.Left ventricular hypertrophy in primary hyperpavathyroidism Efects of successful parathyrcideetomy.Clin Endocrinol Oxf,1999,50(3):321
[40]Smogorzewski MJ,Massry SG.Liver metabolism in CRF.Am J Kidney Dis,2003,41(3):S127.
[41]孙晶,韩国锋,于秀峙,等.胰岛素抵抗对尿毒症血脂代谢的影响.临床肾脏病杂志,2002,2(1):9.
[42]O'Riordan E,Foley RN.Efects of anaemia on cardiovascular status.Nephrol Dial Transplant,2000,15 Suppl 3,19-22
[43]周永昌,郭万学.超声医学第五版.北京:科学技术文献出版社,2006
[44]KettelerMarkus,Gross Marie-Luise,RitzEberhard.Calcification and cardiovascular problems in renal failure.Kidneylnt,2005,94:120-127.
[45]National Kidney Foundation.K/DOQI clinical practice guidelines for chronic kidney disease:evaluation,classification,and stratification[J].Am J Kidney Dis,2002,39(2Suppl 1):S1-S266.
[1]Hunsicker LG.The consequences and costs of chronic kidney disease before ESRD[J].J Am Soc Nephrol,2004,15(5):1363-1364.
[2]Foley RN,Parfrey PS,Harnett JD,et al.Impact of hypertension on cardiomyopathy morbidity and mortality in end--stage renal disease[J].Kidney Int,1999,47:186-192.
[3]Foley RN,Parfrey PS,Samak MJ,et al.Clinical epidniology of cardiovascular disease in chronic renal disease.Am JKidney Dis,1999,32(5 Suppl 3):112-119.
[4]Foley RN,Parfrey PS,Samak MJ.Epidemiology of cardiovascular disease in chronic renal disease.J Am Soc Nephrol,1998,9(12 Sup2 p1):s16-s23.
[5]Parfrey PS et al.Am J Nephrol,1990;10:213-221.
[6]聂凌,杨惠标.尿毒症心脏病变的研究进展.国外医学泌尿系统分册,2004,24(3):408-411.
[7]Mall G et al.Nephrol Dial Transplant,1990;5:39-44
[8]Wizemann V,Bland S,Krammer W.Diastolic dysfunction of the left ventricle in dialysis patients.Contrib Nephrol,1994;106:106
[9]London GM.Cardiovascular disease in chronic renal failure:pathophysiologic aspects..Semin Dial,2003,16(2):85-94.
[10]Foley RN,Parfrey PS,Hamett JD et al.Clinical and echocardiograph ic disease in patients starting end-stage renal disease therapy.Kidney Int,1995;47:186
[11]谢红浪,季大玺.尿毒症心肌病变.肾脏病与透析肾移植杂志,1998,7(5):481-484.
[12]Kidus.diefed.Schliiten Hans Michael piper"Cardiovascular action of parathyroid hormone and paraghyroid hormone related peptide"[J],Cardiovascular Res,1998,37:54.
[13]湛冯岚,袁伟杰.慢性肾衰中甲状旁腺激素/甲状旁腺激素相关蛋白的研究进展.肾脏病与透析肾移植杂志,2001,10(1):72-77.
[14]孙晶,韩国锋,于秀峙,等.胰岛素抵抗对尿毒症血脂代谢的影响.临床肾脏病杂志,2002,2(1):9.
[15]Orueke TB,Eckardt KU.Role of secondary hyperparathyroidism in erythropoietin resistance of chronic renal failure patients.Nephrol Dial Transplant,2002,17[Suppl 5]:28-31.
[16]Yildi.Carotid atherosclerosis is a predictor of coronary calcification in chronic haemodialysis patients.Nephrol Dial Transplant,2004,19(4):885-891.
[17]Rostand S et al.Boston A,Kluwer.Academic,1992;59-60
[18]Hamett JD et al.Nephron,1993;65:212-214
[19]张云,周华琴,邵小南等.慢性肾衰患者mPTH检测的临床意义.放射免疫学杂志.2006,19(5):405-406
[20]Silver J,Levi R.Regulation of PrH synthesis and secretion relevant to the management of secondary hyperparathyroidism in chronic kidney disease.Kidney lnt,2005,(supp195):S8-12
[21]Sanellez CP,Goodman WG,Salusky IB.Prevention of renal ostendvstrophy in predialysis patients.Am J Med Sci,1999,317:398-404.
[22]Naveh--Many T,R Livni N et al.Parathyroid Cell proliferation in normal and chronic renal failure rats.The efects of calcium,phosphate,and vitamin D[J].J Clin Invest,1995,96:1786-1793.
[23]Felsenfeld AJ,Llach F.Parathyroid gland function in chronic renal failure[J].Kidney Int,1993,43:771-789.
[24]Gogusev J,Duchambon P.Hory B.et al.Depressed expression of calcium receptor in parathyroid gland tissue Of patients with hyperparathyroidism[J].Kidney Int.1997,51:328-336.
[25]Fernandez E,Borras M,Pais B,Montolih JJ Low-calcium dialysate stimulates parathormone secretion and its long--term use worsens secondary hyperpara thyroidism.J Am Soc Nophrol 1995.6:132-135
[26]S latopolskyE,Finch J,DendaM,et al.Phosphorus restriction prevents parathyroid gland growth.High phosphorus directly stimulates PTH secretion in vitro[J].J Clin Invest,1996,97:2534-2540.
[27]Moallem E,Kilav R,Silver J,Naveh--Many T.RNA--protein binding and post--transcriptional regulation of parathyroid hormone gene expression by calcium and phosphate.J Biol Chem,1998.273:5253-9.
[28]范炜,朱维平,邵洁.PTH检测对长期血透患者继发甲旁亢临床应用价值的研究.现代检验医学杂志,2003,18(4):51-53.
[29]Korkor AB.Reduced binding of[H]1,25-dihydroxyvitamin D3 in the parathyroid glands of patients with renal failure[J].N Engl J Med,1997.316:1573-1577.
[30]Graham KA,Hoenich NA,Tarbit M,et al.Correction of acidosis in hemodialysis patients increases the sensitivity of the parathyroid glands to calcium[J].J Am Soc Nephol,1999,8:627-631.
[31]刘平,黄哈尔.慢性肾功能衰竭中的心血管问题[J].中华肾脏病杂志,1996,2:21.
[32]Ritz E et al.Am J Kidney Dis,1995;26(5):P808-813
[33]Amann K et al.Nephrol Dial Transplant,1994;9:127-128
[34]Wu Y,Kumar R.parathyroid hormone regulation transformation growth factor betal and beta 2 synthesisin osteoblasts via divergent signalingpathways.J BoneMiner Res,2000,15(5):879
[35]Piovesan A,Casasso F.Left ventricular.hypertrophy in primary hyperpavathyroidism Efects of successful parathyrcideetomy.Clin Endocrinol Oxf,1999,50(3):321
[36]Block GA,Hulbert - Shearon TE,Levin NW,et al.Association of serum phosphorus and calcium x phosphate p roductwith mortality risk in chronic hemodialysis patients:a national study.Am J KidneyDis,1998,31(4):607-617.
[37]陆慧勤,汪克定,陈强等.PTH对尿毒症患者心脏结构和功能的影响.苏州大学学报(医学版)2005;25(4):668-669.
[38]曹艳,石光清.慢性肾衰竭患者全段甲状旁腺素测定的临床价值.放射免疫学杂志.2007,20(2):122-123.
[39]李全瑞,郭增玉,陈秉良,等.维持性血液透析对尿毒症患者血脂水平影响及相关分析.中国血液净化,2004,3(7):358-360
[9]Smogorzewski MJ,Massry SG.Liver metabolism in CRF.Am J Kidney Dis,2003,41(3):S127.
[40]Smogorzewski M.PTH,chronic renal failure and myocardium.Miner Electrolyte Metab,1995,21:55.
[41]Smogorzewski MJ,Massry SG.Liver metabolism in CRF.Am J Kidney Dis,2003,41(3):S127.
[42]O'Riordan E,Foley RN.Efects of anaemia on cardiovascular status.Nephrol Dial Transplant,2000,15 Suppl 3,19-22
[43]KettelerMarkus,Gross Marie-Luise,RitzEberhard.Calcification and cardiovascular problems in renal failure.KidneyInt,2005,94:120-127.
[44]Diego Brancaccio,Ciro Tetta,Maurizio Gallieni,Vincenzo Panichi Inflammation,CRP,calcium overload and a high calcium -phosphate product:a'liaison dangereuse'.Nephrol Dial Transplant,2002,17:201-203.
[45]Cozzolino M.Dusso AS.Slatopolsky E Role of calcium-phosphate product and bone-associated proteins on vascular calcification in renal failure.J Am Nephrol,2001,122511-122516.
[46]Block GA.Control of serumphosphorus:implications for coronary artery calcification and calcific uremic arteriolopathy(calciphylaxis).Curt Opin Nephrol Hy--pertens,2001,10:741-747.
[47]Qunibi WY.Consequences of hyperphosphate s the end-stage renal disease (ESRD).Kidneylntemational,2004,66:8-12
[48]Mall G,Huther W,Schneider J,et al.Differt intermyocardiocytie fibrosis uraemic pa tients.Nephrol Dial Transplant,1990,5,39-44
[49]周永昌,郭万学.超声医学第五版.北京:科学技术文献出版社,2006
[50]杨军,任卫东,陈昕,等.背向散射参数测定对慢性肾功能衰竭心肌超声组织特征的研究.中国超声医学杂志,2006,16(5):359-361
[51]张艳,刘雪梅,王平,等.尿毒症心肌病的超声心动图异常表现及心功能评价.中国超声诊断杂志,2003,4(3):580-582
[52]Mani AV,Gianni P,Peng Li,et al.Effect of Cardiac Resynchronization Therapy on Longitudinal and Circumferential Left Ventricular Mechanics by Velocity Vector Imaging:Description and Initial Clinical Application of a Novel Method Using High-Frame Rate B-Mode Echocardiographic Images.Echocardiography,2005,22:826-830.
[53]Charlotte BI,Hans T,et al.Automated Analysis of Strain Rate and Strain:Feasibility and Clinical Implications.J Am Soc Echocardiogr 2005;18:411-8.)
[54]D'Hooge J,Bijnens B,Jamal F,et al.High frame rate myocardial integrated backscatter:dose this change our understanding of this acoustic parameter ? Eur J Echocardiogr,2000,1:32241
[2]Foley RN,Parfrey PS,Harnett JD,et al.Impact of hypertension on cardiomyopathy morbidity and mortality in end-stage renal disease[J].Kidney Int,1999,47:186-192.
[3]Foley RN,Parfrey PS,Samak MJ,et al.Clinical epidniology of cardiovascular disease in chronic renal disease.Am JKidney Dis,1999,32(5 Suppl 3):112-119.
[4]Foley RN,Parfrey PS,Sarnak MJ.Epidemiology of cardiovascular disease in chronic renal disease.J Am Soc Nephrol,1998,9(12 Sup2 p1):s16-s23.
[5]陆慧勤,汪克定,陈强等.PTH对尿毒症患者心脏结构和功能的影响.苏州大学学报(医学版)2005;25(4):668-669.
[6]曹艳,石光清.慢性肾衰竭患者全段甲状旁腺素测定的临床价值.放射免疫学杂志.2007,20(2):122-123.
[7]D'Hooge J,Bijnens B,Jamal F,et al.High frame rate myocardial integrated backscatter:dose this change our understanding of this acoustic parameter ? Eur J Echocardiogr,2000,1:32241
[8]Mani AV,Gianni P,Peng Li,et al.Effect of Cardiac Resynchronization Therapy on Longitudinal and Circumferential Left Ventricular Mechanics by Velocity Vector Imaging:Description and Initial Clinical Application of a Novel Method Using High-Frame Rate B-Mode Echocardiographic Images.Echocardiography,2005,22:826-830.
[9]Foley RN,Parfrey PS,Harnett JD et al.Clinical and echocardiograph ic disease in patients starting end-stage renal disease therapy. Kidney Int, 1995; 47: 186
[10] Kuecherer HF, Kee L, Modin G, Cheitlin MD, Schiller NB. Echocardiography in serial evaluation of left ventricular systolic and diastolic function: importance of image acquisition, quantification, and physiologic variability in clinical and investigational applications. J Am Soc Echocardiogr, 1991, 4:203-214.
[11] Charlotte BI, Hans T, et al. Automated Analysis of Strain Rate and Strain:Feasibility and Clinical Implications. J Am Soc Echocardiogr 2005;18:411-8.)
[12] Mc Dicken ,Moran CM , Groudstroem KWE ,et al . Potential application of color Doppler imaging of the myocardium in assessing contractility and perfusion [J] .Am Heart J, 1993,359 - 374.
[13] Garcia - Fernamdez MA , Zamorano J , Azevedo J . Doppler TissueImaging Echocardiography. Madrid, McGRAW- HILL, 1998 :7
[14] Galiuto L, Ignone G, DeMaria AN. Contraction and relaxation velocities of the normal left ventricle using pulsed - wave tissue Doppler echocardiography. Am J Cardiol , 1998,81:609
[15] Kukulski T,J amal F,D'Hooge J ,et aLAcute ischemic changes in systolic and diastolic event s during clinical coronary angioplasty.a comparison of regional velocity ,strain rate an strain measurement J Amsoc Echocardiogr,2002,15:1212
[16] Mirsky I, Parmley WW. Assessment of passive elastic stiffness for isolated heart muscle and the intact heart. Circ Res 1973;33:233-43.
[17] Santos A, Ledesma2Carbayo MJ ,Malp ica N, et al. Accuracy of heart strain rate calculation derived from Doppler tissue velocity data[JJ. SP IE, 2001,4325: 5462555.
[18] Weidemann F, JIII all F.Sutherland GR. et al. Myocardial function defined by strain rote and strain during alterations in no tropic states and heart rate[J].Am J Physiol Heart Circ Physiol.2002.238(2):H7922799.
[19]Helmdal A.Stoylen A,Torp H.et al.Real-time strain rate imaging of the left ventricle by ultrasound[J].J Am Soe Echocardiography,1998,11(11):1013.
[20]Pislaru C,Abraham TP,Belohlavek M.Strain and strain rate echocardiography [J].Current Opinion in Cardiology,2002,17:443.
[21]D'Hooge J,Heimdal A,Jamal F,et al.Regional strain and strain rate Measurements by cardiac ultrasound:principles,implementation and limitations[J].Eur J Echocardiography,2000.17:154.
[22]Greenberg NL,FirstengergMS,Castro PL,et al.Doppler derived myocardial systolic strain rate is a strong index of left ventricular contractility[J].Circulation,2002,105(1):992105.
[23]杨军,任卫东,陈昕,等.背向散射参数测定对慢性肾功能衰竭心肌超声组织特征的研究.中国超声医学杂志,2006,16(5):359-361
[24]Koyama J,Davidoff R,Falk RH.Longitudinal myocardial velocity gradient derived from pulsed Doppler tissue imaging in AL amyloidosis:a sensitive indicator of systolic and diastolic dysfunction.J Am Soc Echocardiogr,2004,17:36-44.
[25]Hoffmann R,Altiok E,Nowak B,et al.Strain rate measurement by dopp lerechocardiography allows improved assessment of myocardial viability in patients with depressed left ventricular function[J].J Am Coll Cardiol,2002,39(3):4432449.
[26]Rusk RA,Li XN,Irvine T,et al.Surface integration of velocity vectors from 3D digital color Doppler:an angle independent method for laminar flow measurements.Eur J Echocardiogr,2002,3:177-184.
[27]Hoskins PR.Ultrasound techniques for measurement of blood flow and tissue motion.Biorheology,2002,39:451-459.
[28]Leitman M,Lysyansky P,Sidenko S,et al.Two-dimensional strain--a novel software for real-time quantitative echocardiographic assessment of myocardial function.J Am Soc Echocardiogr 2004,17:1021-9.
[29]Waldman LK,Fung YC,Covell JW.Transmural myocardial deformation in the canine left ventricle:normal in vivo three- dimensional finite strains.Circ Res,1985,57:152-163
[30]Freeman GL,LeWinter MM,Engler RL,et al.Relationship between myocardial fiber direction and segment shortening in the midwall of the canine left ventricle.Circ Res,1985,56:31-39
[31]London GM.Cardiovascular disease in chronic renal failure:pathophysiologic aspects.Semin Dial,2003,16(2):85-94.
[32]Wizemann V,Bland S,Krammer W.Diastolic dysfunction of the left ventricle in dialysis patients.Contrib Nephrol,1994;106:106
[33]Erbel R,Nesser HJ,Drozdz J.Atlas of Tissue Doppler Echocardiogrphy:TDE.Steinkopff:Darmstadt,1995
[34]Price DJA,Wallbridge DR,Stewart MJ.Tissue Doppler imaging:current and potential clinical applications.Heart,2000,84:11218
[35]Kiraly P,Kapusta L,Thijssen JM,et al.Left ventricular myocardial function in congenital valvar aortic stenosis assessed by ultrasound tissue - velocity and strainrate techniques.Ultrasound Med Biol,2003,29:615-20.
[36]李文强,郭文彬,朱梅,等正常人左室心肌应变和应变率定量分析。医学影像学 杂志.2006,16:42-44
[37]Ritz E et al.Am J Kidney Dis,1995;26(5):P808-813
[38]Amann K et al.Nephrol Dial Transplant,1994;9:127-128
[39]Piovesan A,Casasso F.Left ventricular hypertrophy in primary hyperpavathyroidism Efects of successful parathyrcideetomy.Clin Endocrinol Oxf,1999,50(3):321
[40]Smogorzewski MJ,Massry SG.Liver metabolism in CRF.Am J Kidney Dis,2003,41(3):S127.
[41]孙晶,韩国锋,于秀峙,等.胰岛素抵抗对尿毒症血脂代谢的影响.临床肾脏病杂志,2002,2(1):9.
[42]O'Riordan E,Foley RN.Efects of anaemia on cardiovascular status.Nephrol Dial Transplant,2000,15 Suppl 3,19-22
[43]周永昌,郭万学.超声医学第五版.北京:科学技术文献出版社,2006
[44]KettelerMarkus,Gross Marie-Luise,RitzEberhard.Calcification and cardiovascular problems in renal failure.Kidneylnt,2005,94:120-127.
[45]National Kidney Foundation.K/DOQI clinical practice guidelines for chronic kidney disease:evaluation,classification,and stratification[J].Am J Kidney Dis,2002,39(2Suppl 1):S1-S266.
[1]Hunsicker LG.The consequences and costs of chronic kidney disease before ESRD[J].J Am Soc Nephrol,2004,15(5):1363-1364.
[2]Foley RN,Parfrey PS,Harnett JD,et al.Impact of hypertension on cardiomyopathy morbidity and mortality in end--stage renal disease[J].Kidney Int,1999,47:186-192.
[3]Foley RN,Parfrey PS,Samak MJ,et al.Clinical epidniology of cardiovascular disease in chronic renal disease.Am JKidney Dis,1999,32(5 Suppl 3):112-119.
[4]Foley RN,Parfrey PS,Samak MJ.Epidemiology of cardiovascular disease in chronic renal disease.J Am Soc Nephrol,1998,9(12 Sup2 p1):s16-s23.
[5]Parfrey PS et al.Am J Nephrol,1990;10:213-221.
[6]聂凌,杨惠标.尿毒症心脏病变的研究进展.国外医学泌尿系统分册,2004,24(3):408-411.
[7]Mall G et al.Nephrol Dial Transplant,1990;5:39-44
[8]Wizemann V,Bland S,Krammer W.Diastolic dysfunction of the left ventricle in dialysis patients.Contrib Nephrol,1994;106:106
[9]London GM.Cardiovascular disease in chronic renal failure:pathophysiologic aspects..Semin Dial,2003,16(2):85-94.
[10]Foley RN,Parfrey PS,Hamett JD et al.Clinical and echocardiograph ic disease in patients starting end-stage renal disease therapy.Kidney Int,1995;47:186
[11]谢红浪,季大玺.尿毒症心肌病变.肾脏病与透析肾移植杂志,1998,7(5):481-484.
[12]Kidus.diefed.Schliiten Hans Michael piper"Cardiovascular action of parathyroid hormone and paraghyroid hormone related peptide"[J],Cardiovascular Res,1998,37:54.
[13]湛冯岚,袁伟杰.慢性肾衰中甲状旁腺激素/甲状旁腺激素相关蛋白的研究进展.肾脏病与透析肾移植杂志,2001,10(1):72-77.
[14]孙晶,韩国锋,于秀峙,等.胰岛素抵抗对尿毒症血脂代谢的影响.临床肾脏病杂志,2002,2(1):9.
[15]Orueke TB,Eckardt KU.Role of secondary hyperparathyroidism in erythropoietin resistance of chronic renal failure patients.Nephrol Dial Transplant,2002,17[Suppl 5]:28-31.
[16]Yildi.Carotid atherosclerosis is a predictor of coronary calcification in chronic haemodialysis patients.Nephrol Dial Transplant,2004,19(4):885-891.
[17]Rostand S et al.Boston A,Kluwer.Academic,1992;59-60
[18]Hamett JD et al.Nephron,1993;65:212-214
[19]张云,周华琴,邵小南等.慢性肾衰患者mPTH检测的临床意义.放射免疫学杂志.2006,19(5):405-406
[20]Silver J,Levi R.Regulation of PrH synthesis and secretion relevant to the management of secondary hyperparathyroidism in chronic kidney disease.Kidney lnt,2005,(supp195):S8-12
[21]Sanellez CP,Goodman WG,Salusky IB.Prevention of renal ostendvstrophy in predialysis patients.Am J Med Sci,1999,317:398-404.
[22]Naveh--Many T,R Livni N et al.Parathyroid Cell proliferation in normal and chronic renal failure rats.The efects of calcium,phosphate,and vitamin D[J].J Clin Invest,1995,96:1786-1793.
[23]Felsenfeld AJ,Llach F.Parathyroid gland function in chronic renal failure[J].Kidney Int,1993,43:771-789.
[24]Gogusev J,Duchambon P.Hory B.et al.Depressed expression of calcium receptor in parathyroid gland tissue Of patients with hyperparathyroidism[J].Kidney Int.1997,51:328-336.
[25]Fernandez E,Borras M,Pais B,Montolih JJ Low-calcium dialysate stimulates parathormone secretion and its long--term use worsens secondary hyperpara thyroidism.J Am Soc Nophrol 1995.6:132-135
[26]S latopolskyE,Finch J,DendaM,et al.Phosphorus restriction prevents parathyroid gland growth.High phosphorus directly stimulates PTH secretion in vitro[J].J Clin Invest,1996,97:2534-2540.
[27]Moallem E,Kilav R,Silver J,Naveh--Many T.RNA--protein binding and post--transcriptional regulation of parathyroid hormone gene expression by calcium and phosphate.J Biol Chem,1998.273:5253-9.
[28]范炜,朱维平,邵洁.PTH检测对长期血透患者继发甲旁亢临床应用价值的研究.现代检验医学杂志,2003,18(4):51-53.
[29]Korkor AB.Reduced binding of[H]1,25-dihydroxyvitamin D3 in the parathyroid glands of patients with renal failure[J].N Engl J Med,1997.316:1573-1577.
[30]Graham KA,Hoenich NA,Tarbit M,et al.Correction of acidosis in hemodialysis patients increases the sensitivity of the parathyroid glands to calcium[J].J Am Soc Nephol,1999,8:627-631.
[31]刘平,黄哈尔.慢性肾功能衰竭中的心血管问题[J].中华肾脏病杂志,1996,2:21.
[32]Ritz E et al.Am J Kidney Dis,1995;26(5):P808-813
[33]Amann K et al.Nephrol Dial Transplant,1994;9:127-128
[34]Wu Y,Kumar R.parathyroid hormone regulation transformation growth factor betal and beta 2 synthesisin osteoblasts via divergent signalingpathways.J BoneMiner Res,2000,15(5):879
[35]Piovesan A,Casasso F.Left ventricular.hypertrophy in primary hyperpavathyroidism Efects of successful parathyrcideetomy.Clin Endocrinol Oxf,1999,50(3):321
[36]Block GA,Hulbert - Shearon TE,Levin NW,et al.Association of serum phosphorus and calcium x phosphate p roductwith mortality risk in chronic hemodialysis patients:a national study.Am J KidneyDis,1998,31(4):607-617.
[37]陆慧勤,汪克定,陈强等.PTH对尿毒症患者心脏结构和功能的影响.苏州大学学报(医学版)2005;25(4):668-669.
[38]曹艳,石光清.慢性肾衰竭患者全段甲状旁腺素测定的临床价值.放射免疫学杂志.2007,20(2):122-123.
[39]李全瑞,郭增玉,陈秉良,等.维持性血液透析对尿毒症患者血脂水平影响及相关分析.中国血液净化,2004,3(7):358-360
[9]Smogorzewski MJ,Massry SG.Liver metabolism in CRF.Am J Kidney Dis,2003,41(3):S127.
[40]Smogorzewski M.PTH,chronic renal failure and myocardium.Miner Electrolyte Metab,1995,21:55.
[41]Smogorzewski MJ,Massry SG.Liver metabolism in CRF.Am J Kidney Dis,2003,41(3):S127.
[42]O'Riordan E,Foley RN.Efects of anaemia on cardiovascular status.Nephrol Dial Transplant,2000,15 Suppl 3,19-22
[43]KettelerMarkus,Gross Marie-Luise,RitzEberhard.Calcification and cardiovascular problems in renal failure.KidneyInt,2005,94:120-127.
[44]Diego Brancaccio,Ciro Tetta,Maurizio Gallieni,Vincenzo Panichi Inflammation,CRP,calcium overload and a high calcium -phosphate product:a'liaison dangereuse'.Nephrol Dial Transplant,2002,17:201-203.
[45]Cozzolino M.Dusso AS.Slatopolsky E Role of calcium-phosphate product and bone-associated proteins on vascular calcification in renal failure.J Am Nephrol,2001,122511-122516.
[46]Block GA.Control of serumphosphorus:implications for coronary artery calcification and calcific uremic arteriolopathy(calciphylaxis).Curt Opin Nephrol Hy--pertens,2001,10:741-747.
[47]Qunibi WY.Consequences of hyperphosphate s the end-stage renal disease (ESRD).Kidneylntemational,2004,66:8-12
[48]Mall G,Huther W,Schneider J,et al.Differt intermyocardiocytie fibrosis uraemic pa tients.Nephrol Dial Transplant,1990,5,39-44
[49]周永昌,郭万学.超声医学第五版.北京:科学技术文献出版社,2006
[50]杨军,任卫东,陈昕,等.背向散射参数测定对慢性肾功能衰竭心肌超声组织特征的研究.中国超声医学杂志,2006,16(5):359-361
[51]张艳,刘雪梅,王平,等.尿毒症心肌病的超声心动图异常表现及心功能评价.中国超声诊断杂志,2003,4(3):580-582
[52]Mani AV,Gianni P,Peng Li,et al.Effect of Cardiac Resynchronization Therapy on Longitudinal and Circumferential Left Ventricular Mechanics by Velocity Vector Imaging:Description and Initial Clinical Application of a Novel Method Using High-Frame Rate B-Mode Echocardiographic Images.Echocardiography,2005,22:826-830.
[53]Charlotte BI,Hans T,et al.Automated Analysis of Strain Rate and Strain:Feasibility and Clinical Implications.J Am Soc Echocardiogr 2005;18:411-8.)
[54]D'Hooge J,Bijnens B,Jamal F,et al.High frame rate myocardial integrated backscatter:dose this change our understanding of this acoustic parameter ? Eur J Echocardiogr,2000,1:32241