应用TVI技术评价2型糖尿病终末期肾病血液透析患者左心结构与功能的研究

    Clinical value of tissue velocity imaging technique in evaluating left ventricular structure and function in patients with type 2 diabetic end-stage renal disease undergoing hemodialysis

    • 摘要: 目的 探索应用组织多普勒速度成像技术(tissue velocity imaging,TVI)评价行血液透析的2型糖尿病终末期肾病患者左心结构与功能的临床价值。方法 选取2018年5月至2019年10月邢台市第五医院收治的206例原发疾病为2型糖尿病的终末期肾病患者作为研究对象,根据肾脏替代治疗不同阶段,将其分成未透析组(n=95)和血液透析组(n=111),同时选择同期来我院行身体检查的80名健康者作为对照组(n=80)。分别采用超声心动图(color doppler echocardiography,ECHO)和TVI技术对受试者左心结构和功能进行影像学检查,比较左心结构和功能指标、左心室收缩功能障碍、左心室舒张功能障碍、左心室肥厚及瓣膜反流发生率等指标。结果 ECHO检查结果显示,对照组受试者室间隔厚度、左心室舒张末期内径、左心室后壁厚度、左心室心肌质量指数和左心房内径水平明显低于未透析组和血液透析组(P<0.05),对照组受试者二尖瓣舒张早期和晚期峰值流速比值及左心室射血分数水平均明显高于未透析组和血液透析组(P<0.05),未透析组受试者左心室心肌质量指数和左心室后壁厚度水平明显低于血液透析组(P<0.05);未透析组与血液透析组患者左心室肥厚、左心室收缩功能减退和左心室舒张功能障碍发生率差异无统计学意义(P>0.05);未透析组与血液透析组患者二尖瓣反流、三尖瓣反流、主动脉反流及肺动脉反流等发生率差异无统计学意义(P>0.05)。TVI检查结果显示,3组受试者在舒张早期峰值速度、舒张晚期峰值速度及其比值差异存在统计学意义(P<0.05),血液透析组受试者舒张早期峰值速度、舒张晚期峰值速度及其比值明显低于未透析组和对照组,未透析组受试者舒张早期峰值速度、舒张晚期峰值速度及其比值明显低于对照组(P<0.05);未透析组与血液透析组患者左心室舒张功能障碍发生率差异无统计学意义(P>0.05)。结论 终末期肾病患者均存在左心室肥厚、左心室舒张和收缩功能障碍等心脏结构和功能异常情况,心脏瓣膜反流以二尖瓣反流为主,其次为三尖瓣反流,TVI技术比ECHO能更敏感的评价左心室舒张功能障碍。

       

      Abstract: Objective To explore the clinical value of tissue velocity imaging technique in evaluating left ventricular structure and function in patients with type 2 diabetic end-stage renal disease undergoing hemodialysis.Methods A total of 206 patients with end-stage renal disease with type 2 diabetes from May 2018 to October 2019 were selected as observation subjects.According to the different stages of renal replacement therapy,they were divided into two groups of non-hemodialysis(n=95) and hemodialysis(n=111).At the same time,80 healthy volunteers for physical examination in the same period were selected as control group(n=80).The parameters of left ventricular structure and function,left ventricular systolic dysfunction,left ventricular diastolic dysfunction,left ventricular hypertrophy and valvular regurgitation were compared.Results The results of echocardiography showed that significant differences existed in echocardiographic parameters among three groups(P<0.05).Interventricular septum thickness,left ventricular end-diastolic diameter,left ventricular posterior wall thickness,left ventricular mass index and left atrial diameter were significantly lower in control group than those in non-hemodialysis and hemodialysis groups(P<0.05).The ratio of early and late peak flow velocity of mitral valve and the level of left ventricular ejection fraction were significantly higher in control group than those in non-hemodialysis and hemodialysis groups(P<0.05);left ventricular mass index and left ventricular posterior wall thickness were significantly lower in non-hemodialysis group than those in hemodialysis group(P<0.05).No significant inter-group difference existed in the incidence of left ventricular hypertrophy,left ventricular systolic dysfunction or left ventricular diastolic dysfunction(P>0.05).No significant inter-group difference existed in the incidence of mitral regurgitation,tricuspid regurgitation,aortic regurgitation or pulmonary regurgitation(P>0.05).The results of tissue Doppler velocity imaging indicated that significant differences existed in early diastolic peak velocity,late diastolic peak velocity and their ratio among three groups(P<0.05).The early diastolic peak velocity,late diastolic peak velocity and their ratio were significantly lower in hemodialysis group than those in non-hemodialysis and control groups(P<0.05).Peak early diastolic velocity,late diastolic peak velocity and their ratio were significantly lower in non-hemodialysis group than those in control group(P<0.05).No significant inter-group difference existed in the incidence of left ventricular diastolic dysfunction(P>0.05).Conclusions All patients with end-stage renal disease have abnormal left ventricular structure and function,including left ventricular hypertrophy,left ventricular diastolic and systolic dysfunction.Mitral regurgitation is more common than tricuspid regurgitation.And TVI technology is more sensitive to evaluating left atrial lysosis dysfunction than color Doppler echocardiography.

       

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