摘要
目的应用二维斑点追踪技术（2D-STI）定量评价尿毒症患者动静脉内瘘（AVF）术后的心肌应变,观察容量负荷改变后,左心室心肌收缩力的变化情况。方法选取2012年7月至2015年2月山西大医院肾内科收治的尿毒症患者66例,作为AVF组;选取年龄与性别相匹配的健康志愿者30位作为健康对照组。应用2D-STI获取2组研究对象左心室收缩期各节段及整体纵向应变（LS）、环向应变（CS）、径向应变（RS）。根据健康对照组左心室舒张末期容积指数（LVEDVI）确定其正常值参考范围为53~70 ml/m2,将AVF组分为容量正常组（LVEDVI≤70 ml/m2）与容量增大组（LVEDVI〉70 ml/m2）。术前AVF组与健康对照组心肌应变比较采用单因素方差分析,两两比较采用LSD-t检验;AVF组术前、术后的比较采用配对t检验;心肌应变与容量负荷参数相关性分析采用拟合曲线;重复性的研究采用Bland-Altman分析法及线性相关,用相关系数（r）与差值表示。结果 （1）健康对照组左心室LS、CS从基底段至心尖段逐渐升高（F=14.19、13.60,P均〈0.05）,左心室RS中间段最大,心尖段最小（F=13.14,P〈0.05）,AVF组左心室LS、CS、RS各节段变化趋势消失,差异无统计学意义（容量正常组：F=0.02、0.50、0.07,容量增大组：F=0.37、0.12、0.63,P均〉0.05）;（2）与健康对照组比较,术前AVF容量正常组与容量增大组左心室各节段及整体LS、CS、RS均减低,术前AVF容量增大组左心室各节段及整体LS、CS、RS高于AVF容量正常组（心尖-中间-基底-整体：LS：F=117.49、61.66、24.91、80.70,CS：F=74.88、43.91、28.14、57.08,RS：F=33.65、96.09、89.86、85.85,P均〈0.05）;（3）与术前比较,AVF术后左心室各节段及整体LS减低（t=24.05、23.54、16.64、21.34,P〈0.05）;（4）左心室整体纵向应变（GLS）与LVEDVI的相关性：Y=-0.006X2＋0.956X-25.719（Y：GLS,X：LVEDVI,R2=0.703）,X=80时,Y值最大。结论 （1）容量负荷对尿毒症患者左心室心肌收缩力有规律性影响,LVEDVI〈80 ml/m2时心肌收缩力逐渐增大,LVEDVI〉80 ml/m2时逐渐减小。（2）左心室LS参数对容量负荷的变化较敏感,可以评价容量负荷对尿毒症患者心肌力学的影响。
Objective Evaluate myocardial strain of uremic patients after arteriovenous fistula（AVF） quantitatively by using 2-Dimensional Speckle Tracking Imaging（2D-STI）,observe change of myocardial contractility of left ventricular after change of volume load.Methods Sixty-six uremic patients from the Nephrology Department of Shangxi Dayi Hospital from July 2012 to February 2015 were chosen as AVF group,and 30 age and gender matched healthy volunteers were chosen as healthy control group.Longitudinal stain（LS）,circumferential stain（CS） and radial stain（RS） of each segment and global of systolic of left ventricular were obtained by using 2D-STI.Reference range of normal value is determined as 53-70 ml/m2 according to left ventricular end diastolic volume index（LVEDVI） of healthy control group.AVF group is divided into normal volume group（LVEDVI ≤ 70 ml/m2） and volume increase group（LVEDVI〉 70 ml/m2）.Adopt ANOVA for myocardial stain of AVF group before operation and healthy control group,comparison in pairs shall adopt LSD-t test; comparison of AVF group before and after operation shall adopt paired t-test; correlation analysis of parameters of myocardial stain and volume load shall adopt curve fitting.Research of repeatability shall adopt Bland-Altman analysis chart and linear correlation; express with correlation coefficient（r） and D-value.Results（1） In healthy control group,left ventricular LS,CS increase gradually from basal segment to apical segment（F=14.19,13.60,all P〈 0.05）,RS middle segment of left ventricular is the maximal,apical segment is the minimal（F=13.14,P 〈0.05）; In AVF group,variation trend LS,CS and RS segment of left ventricular disappears,the difference has no statistical significance（normal volume group： F=0.02,0.50,0.07; volume increase group： F=0.37,0.12,0.63,all P〉0.05）;（2） Each segment and global LS,CS,RS of left ventricular of AVF normal volume group and volume increase group before operation decrease compared with healthy control group; each segment and global LS,CS,RS of left ventricular of AVF volume increase group is higher than AVF normal volume group（apical-middle-basalt-global： LS： F=117.49,61.66,24.91,80.70,CS： F=74.88,43.91,28.14,57.08,RS： F=33.65,96.09,89.86,85.85,all P〈 0.05）;（3） Each segment and global LS of left ventricular decrease after AVF operation compared with pre-operation（t=24.05,23.54,16.64,21.34,all P〈 0.05）;（4） GLS and LVEDVI correlation of left ventricular： Y=-0.006X2＋ 0.956X-25.719（Y： GLS,X： LVEDVI,R2=0.703）,X=80,Y value was maximum.Conclusions（1） Volume load has regular influence on myocardial contractility of left ventricular of uremic patients.When LVEDVI 〈80 ml/m2,myocardial contractility increases gradually; when LVEDVI〉 80 ml/m2,myocardial contractility decreases gradually.（2） LS parameter of left ventricular is relatively sensitive to the change of volume load.The influence of volume load on myocardial mechanics of uremic patients can be evaluated by LS parameter of left ventricular.
出处
《中华医学超声杂志（电子版）》
CSCD
2016年第8期609-616,共8页
Chinese Journal of Medical Ultrasound(Electronic Edition)
关键词
超声心动描记术
动静脉内瘘
容量负荷
斑点追踪
应变
Echocardiography
Arteriovenous fistula
Volumetric overload
Speckle tracking
Strain
