摘要
目的 应用四维自动左房定量技术(4D Auto LAQ)评价不同透析方式对尿毒症患者左房结构和功能的影响.方法 选取于我院肾内科就诊的尿毒症患者80例,根据透析方式分为血液透析组39例和腹膜透析组41例,另选同期健康体检者35例作为正常对照组.应用常规超声心动图获取左室射血分数(LVEF)、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);4D Auto LAQ获取左房应变参数,包括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),以及左房容积参数,包括左房最大容积(LAVmax)、左房最小容积(LAVmin)、左房收缩前容积(LAVpreA)、左房射血分数(LAEF),比较各组上述参数的差异;分析LAEF与左房应变参数的相关性.结果 ①各组常规超声心动图参数比较:腹膜透析组和血液透析组LAD、LVEDD、IVS、LVPW均较正常对照组增大,差异均有统计学意义(均P<0.05);各组LVEF比较差异无统计学意义.②各组4D Auto LAQ左房应变参数比较:与正常对照组比较,腹膜透析组LASr、LAScd、LASr-c、LAScd-c均减小,LASct、LASct-c均增大,血液透析组LASr、LAScd、LASct、LASr-c、LAScd-c、LASct-c均减小,差异均有统计学意义(均P<0.05);除LAScd外,血液透析组LASr、LAScd、LASct、LASr-c、LAScd-c、LASct-c均较腹膜透析组减小,差异均有统计学意义(均P<0.05).③各组4D Auto LAQ左房容积参数比较:与正常对照组比较,腹膜透析组LAVmax、LAVmin、LAVpreA均增大,LAEF减小,血液透析组LAVmax、LAVmin、LAVpreA均增大,LAEF减小,差异均有统计学意义(均P<0.05);与腹膜透析组比较,血液透析组LAVmax、LAmin、LAVpreA均增大,LAEF减小,差异均有统计学意义(均P<0.05).④相关性分析显示,LAEF与LASr、LAScd、LASr-c、LAScd-c、LASct、LASct-c均呈正相关(r=0.531、0.522、0.705、0.686、0.306、0.376,均P<0.001).结论 4D Auto LAQ可用于评价不同透析方式对尿毒症患者左房结构和功能的影响,其中血液透析较腹膜透析对左房结构和功能影响更大.
Abstract
Objective To evaluate the effects of different dialysis methods on left atrial structure and function in uremic patients by four-dimensional automatic left atrial quantification technology(4D Auto LAQ).Methods Totally 80 patients with uremia in the department of nephrology of our hospital were selected,they were divided into the hemodialysis group consisting of 41 cases and the peritoneal dialysis group consisting of 39 cases according to their dialysis method.Additionally,during the same period,the normal control group consisting of 35 healthy individuals who underwent physical examinations were selected.The left ventricular ejection fraction(LVEF),left atrial diameter(LAD),left ventricular end diastolic diameter(LVEDD),interventricular septal thickness(IVS)and left ventricular posterior wall thickness(LVPW)were obtained by conventional echocardiography.The left atrial strain parameters,including left atrial reserve longitudinal strain(LASr),left atrial ductal longitudinal strain(LAScd),left atrial systolic longitudinal strain(LASct),left atrial reserve circumferential strain(LASr-c),left atrial ductal circumferential strain(LAScd-c)and left atrial systolic circumferential strain(LASct-c),as well as the left atrial volume parameters,including left atrial maximum volume(LAVmax),left atrial minimum volume(LAVmin),left atrial pre systolic volume(LAVpreA)and left atrial ejection fraction(LAEF)were obtained by 4D Auto LAQ technology.The differences of the above parameters in each group were compared.The correlation between LAEF and left atrial strain parameters was analyzed.Results ①Comparison of the conventional echocardiographic parameters of each group:the LAD,LVEDD,IVS and LVPW in the peritoneal dialysis group and the hemodialysis group were higher than those in the normal control group,and the differences were statistically significant(all P<0.05).There was no significant difference in LVEF among the groups.②Comparison of 4D Auto LAQ left atrial strain parameters in each group:compared with the normal control group,the LASr,LAScd,LASr-c and LAScd-c were decreased in the peritoneal dialysis group,while LASct and LASct-c were increased.The LASr,LAScd,LASct,LASr-c,LAScd-c and LASct-c in the hemodialysis group were decreased,and the differences were statistically significant(all P<0.05).Except for LAScd,the LASr,LAScd,LASct,LASr-c,LAScd-c and LASct-c in the hemodialysis group were significantly lower than those in the peritoneal dialysis group(all P<0.05).③Comparison of volume parameters of 4D Auto LAQ left chamber in each group:compared with the normal control group,LAVmax,LAVmin and LAVpreA were increased and LAEF was decreased in the peritoneal dialysis group,LAVmax,LAVmin and LAVpreA were increased and LAEF was decreased in the hemodialysis group,and the differences were statistically significant(all P<0.05).Compared with the peritoneal dialysis group,the LAVmax,LAmin and LAVpreA in the hemodialysis group were increased while LAEF was decreased,and the differences were statistically significant(all P<0.05).④Correlation analysis showed that LAEF was positively correlated with LASr,LAScd,LASr-c,LAScd-c,LASct and LASct-c(r=0.531,0.522,0.705,0.686,0.306,0.376,all P<0.001).Conclusion 4D Auto LAQ can be used to assess the effects of different dialysis methods on the structure and function of the left atrium in uremia patients.Hemodialysis exerts more pronounced effects on both left atrial structure and function compared to peritoneal dialysis.
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)
NETL
NSTL
维普
万方数据