慢性肾脏病患者心脏结构与功能变化的超声心动图研究

目的:研究慢性肾脏病(CKD)患者心脏结构及功能的变化.方法:选择我院肾内科175例慢性肾脏病未透析患者,按照2003年美国国家肾脏基金会-肾脏病转归质量(NKF-K/DOQI)指南的标准进行分期,观察所有患者心脏结构及功能在超声中的变化.结果:慢性肾脏病患者随着肾功能的恶化,各组之间比较,室间隔厚度(IVST)、左心室后壁厚度(LVPW)、左心室心肌重量指数(LVMI)、左心室舒张末期内径(LVDd)、左心房内径(LAD)具有升高的趋势(P＜0.05,P＜0.01);但E/A比值未出现伴随着肾功能恶化而逐渐减低的趋势(P＞0.05);射血分数(EF)、短轴缩短卒(FS)在各期之间无明显变化(P＞0.05);而TVI技术测定的Em、Em/Am具有显著减低的趋势(P＜0.05,P＜0.01);瓣膜返流以二尖瓣返流为主.结论:慢性肾脏病患者心脏结构与功能随肾功能减退而加重,超声心动图检查结合组织速度显像(TVI)技术能更好地检测心脏结构和功能变化,尤其是检测左心室舒张功能障碍.

Ultrasound in Assessing Cardiac Stracture and Funcion in Patients with Chronic Kidney Disease

Objective:To investigate the changes of cardiac structure and function Methods:175 patients with chronic kidney disease(CKD)were divided into five groups according to Kidney Disease Outcomes Quality Initiative of the National Kidney Foundation(NKF-K/DOQI)2003 guidelines.To investigate cardiac structure and function changes by Echocardiogram.Results:Compared with early stages of CKD,with the reducing of glomerular filtration rote(GFR),the interventricular septal thickness(IVST),left ventricular posterior wall thickness(LVPW),left ventricular mass index(LVMi),left ventricular end diastolic dimension(LVDd),left atrium dimension(LAD)increased in patients with chronic kidney disease(P＜0.05,P＜0.01).But the E/A ratio did not significant decreased accompanied by a gradual deterioration of renal function(P＞0.05),the cardiac systolic function indexes such as ejection fraction(EF)and fractional shortening(FS)were not decreased measured by echocardiography(P＞0.05).The peak early diastolic mitral annulus velocity(Em).The ratio of early and late diastolic peak velocity(Em/Am)measured by Tissue Velocity Imaging(TVI)decreased(P＜0.05,P＜0.01).The main valve regurgitation was mitral regurgitation.Conclusion:These results illustrated that the worse renal function,the more serious cardiac structure and function changes and that UCG examination,especially when combined with tissue velocity imaging(TVI)technology,is better in detecting the changes of cardiac structure and function,especially left ventricular diastolic dysfunction,than UCG examination.