杨道玲　　王戏丹　　陈静婉　　章义利　　殷洁

[摘要] 目的 采用超聲二维斑点追踪技术，探讨慢性肾功能不全患者血肌酐水平与心功能受损的相关性。 方法 选取2019年1—12月在我院治疗的左心室射血分数（LVEF）正常的慢性肾功能不全患者58例作为观察组，另选取年龄及性别相匹配的健康志愿者30例作为对照组。测定受试者血肌酐（Scr）水平及肌酐清除率（Ccr），并采用IE33彩色多普勒超声诊断仪对受试者行超声心动图检查，采用QLAB软件进行斑点追踪技术分析。比较两组血肌酐水平及左心室心肌应变值。 结果 观察组患者血肌酐（Scr）水平显著高于对照组，观察组肌酐清除率（Ccr）显著低于对照组，差异有统计学意义（P<0.05）;观察组患者左室纵向应变（LS）、圆周应变（CS）低于对照组，差异有统计学意义（P<0.05）;观察组LS、CS与Ccr呈正相关（r=0.521，P<0.05;r=0.356，P<0.05）;LS、CS与Scr呈负相关（r=-0.732，P<0.05;r=-0.698，P<0.05）。 结论 慢性肾功能不全患者高水平血肌酐对心肌有毒性作用，血肌酐水平异常升高与心功能受损有明显相关性;超声二维斑点追踪技术可为慢性肾功能不全患者心肌功能损害提供客观定量的依据。

[关键词] 斑点追踪;超声心动图;应变;慢性肾功能不全

[中图分类号] R445.1;R541          [文献标识码] B          [文章编号] 1673-9701（2021）13-0103-04

Evaluation of the correlation between serum creatinine level and cardiac function impairment by ultrasound speckle tracking technology in the patients with chronic renal insufficiency

YANG Daoling1   WANG Xidan1   CHEN Jingwan1   ZHANG Yili2   YIN Jie3

1.Department of Ultrasonography， Affiliated Jinhua Hospital of Zhejiang University School of Medicine， Jinhua   321000， China; 2.Health Management Centre，Affiliated Jinhua Hospital of Zhejiang University School of Medicine， Jinhua 321000， China; 3.Department of Radiology， Affiliated Jinhua Hospital of Zhejiang University School of Medicine， Jinhua 321000， China

[Abstract] Objective To investigate the correlation between blood creatinine levels and impaired cardiac function in patients with chronic renal insufficiency using ultrasound two-dimensional speckle tracking technology. Methods A total of 58 patients with chronic renal insufficiency and normal left ventricular ejection fraction（LVEF） treated in our hospital from January to December 2019 were selected as the observation group. 30 healthy volunteers with matching age and gender were selected as the control group. The subjects' blood creatinine（Scr） level and creatinine clearance（Ccr） were measured， and the IE33 color Doppler ultrasound diagnostic apparatus was used to perform echocardiography on the subjects. QLAB software was used for speckle tracking technology analysis. The blood creatinine levels and left ventricular myocardial strain values were compared between the two groups. Results The serum creatinine（Scr） level in the observation group was significantly higher than that in the control group， the creatinine clearance rate（Ccr） in the observation group was lower than that in the control group， and the differences were statistically significant（P<0.05）; the left ventricular longitudinal strain（LS） and circumferential strain（CS） in the observation group were lower than those in the control group，and the differences were statistically significant（P<0.05）. Ccr level in the observation group was positively correlated with LS and CS values（r=0.521， P<0.05; r=0.356， P<0.05）; Scr level in the observation group was negatively correlated with LS and CS values（r=-0.732， P<0.05; r=-0.698， P<0.05）. Conclusion High levels of serum creatinine in the patients with chronic renal insufficiency have a toxic effect on myocardium. Abnormal increase in blood creatinine level is obviously related to impaired heart function; two-dimensional ultrasound speckle tracking technology can provide an objective quantitative basis for myocardial dysfunction in patients with chronic renal insufficiency.

[Key words] Speckle tracking; Encocardiography; Stress; Chronic renal insufficiency

慢性肾功能不全（Chronic renal failure，CRF）患者常伴有严重的心血管并发症，而心血管疾病又是影响CRF患者预后的重要因素，是CRF患者死亡的主要原因。国外研究表明，终末期肾衰患者心血管病死亡率是正常人群的10～20倍[1-3]。CRF患者最典型的临床表现是血肌酐水平的持续升高，本研究拟利用超声二维斑点追踪技术定量评价CRF患者心肌损害及其与血肌酐水平的关系，旨在提高CRF患者早期心肌功能受损的检出率，为CRF患者心功能异常的早期检出提供更充分的科学依据，现报道如下。

1 资料与方法

1.1 一般资料

选取2019年1—12月在我院收治的左室射血分数正常的CRF患者58例作为观察组，其中男31例，女27例，年龄29～78岁，平均（42.56±8.35）岁。纳入标准：①原发病为肾脏疾病且未经过血液透析治疗者;②血肌酐值（Scr）>133 μmol/L者;③M型超声心动图检测左心功能正常者。排……