, , , ,

(Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang 110004, China)



Three-dimensional circumferential strain in evaluating changes of left ventricular myocardial contractional function in early chronic kidney disease patients

LIUKaiwei,RENWeidong*,SUNLu,SONGGuang,LIUHui

(DepartmentofUltrasound,ShengjingHospitalofChinaMedicalUniversity,Shenyang110004,China)

ObjectiveTo assess the early changes of left ventricular myocardial contractional function in early chronic kidney disease (CKD) patients with three-dimensional global circumferential strain (GCS). MethodsTwenty-six cases of CKD2 group, 20 cases of CKD3 group and 30 cases of healthy subjects as control group were selected. Parameters of two-dimensional echocardiography including left ventricular at end-diastole diameter (LVEDd), interventricular septal thickness at end-diastole (IVSTd), left ventricular posterior wall thickness at end-diastole (LVPWTd), end-diastolic volume (EDV), end-systolic volume (ESV), and parameters of 3D-STE including three-dimensional left ventricular ejection fraction (3D-LVEF), three-dimensional left ventricular mass index (3D-LVMi), and GCS were calculated and compared. ResultsCompared with the control group, IVSTd increased and LVEDd, GCS decreased in CKD2 group, IVSTd, LVESV, 3D-LVMi increased and LVEDd, 3D-LVEF, GCS decreased (allP<0.05) in CKD3 group. Compared with the CKD2 group, IVSTd, 3D-LVMi increased and LVEDd, GCS decreased (allP<0.05) in CKD3 group. ConclusionIn the early stages of CKD, the left ventricular myocardial contractive function has reduced, which can be detected by 3D-STE with GCS.

Kidney disease; Echocardiography, three-dimensional; Ventricular function, left

肾脏疾病终末期常发生心脏衰竭和心源性猝死[1-2]。研究[3]表明，早期慢性肾病(chronic kidney disease, CKD)患者就已存在心脏功能损伤。因此，早期检测CKD患者的心脏功能对预防和降低CKD患者心脏危害十分关键。三维斑点追踪成像(three-dimensional speckle tracking echocardiography, 3D-STE)技术综合三维超声心动图和二维斑点追踪成像(two-dimensional speckle tracking echocardiography, 2D-STE)技术，是基于心肌运动形变和心脏运动机械学的定量评价方法，通过左心室全容积成像在三维空间上追踪心肌回声斑点粒子的运动轨迹，摆脱了组织多普勒成像技术的角度依赖性及2D-STE的二维平面局限性，可更客观、全面地评价心室的收缩功能。本研究采用整体圆周应变(global circumferential strain, GCS)评价CKD早期患者左心室心肌收缩功能，旨在了解患者心肌损伤后心肌圆周运动的变化，并为早期CKD患者左心室心肌收缩功能损伤提供依据。

1　资料与方法

1.1一般资料选取2014年4月—2015年5月于我院肾内科就诊的病情稳定的CKD早期患者46例，其中CKD2期组26例，男14例，女12例，年龄30～60岁，平均(46.5±9.9)岁，包括慢性肾小球肾炎12例，肾病综合征8例，多囊肾6例；CKD3期组20例，男11例，女9例，年龄26～59岁，平均 (49.0±9.7)岁，包括慢性肾小球肾炎14例，肾病综合征4例，多囊肾2例。入选标准：①依据2002年美国肾脏病基金会颁布的《慢性肾脏病的临床实践指南》(K/DOQI)诊断标准[4]； 2期，肾小球滤过率(glomerular filtration rate, GFR)60～89 ml/min，伴肾脏损害≥3个月，临床表现为肾脏病理学检测结果异常或出现反映肾脏损伤的指标，包括影像学检查和血、尿液等异常；3期，GFR 30～59 ml/min。根据MDRD公式计算GFR[5]；②CKD患者经二维及M型超声测量，左心室射血分数(left ventricular ejection fraction， LVEF)均>50%，无心包积液，未进行透析治疗。排除标准：……