3D-STI评价两种血液透析方式对尿毒症患者左心室整体收缩功能的影响

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摘要目的应用三维斑点追踪技术（3D-STI）评价两种血液透析方式对尿毒症患者左心室整体收缩功能影响。方法选取2019年1月至2020年12月三峡大学人民医院血液透析中心病情稳定的尿毒症透析患者35例。按不同透析方式对上述患者进行血液透析和血液滤过。分别于透析前，透析后30 min内各行1次心脏彩超检查。比较心脏彩超参数[左室整体收缩期峰值应变（LVGPSL）、左室整体纵向应变（LVGLS）、左室整体环向应变（LVGCS）、左室整体面积应变（LVGAS）、左室整体径向应变（LVGRS）、左室射血分数（LVEF）、左室舒张末期容积（LVEDV）、左室收缩末期容积（LVESV）]及患者相关临床及血液生化指标。分析两组血清β2微球蛋白（β2-MG）浓度变化值与3D-STI变化值的相关性。结果透析后血液透析及血液滤过左室舒张末期内径、左房内径、左房容积指数测值显著低于透析前，差异有统计学意义（P ＜ 0.05），而两法Sm值透析前后比较，差异无统计学意义（P ＞ 0.05）。单次透析后，血液透析LVGPSL、LVGLS、LVGCS、LVGAS、LVGRS、LVEDV、LVESV测值低于透析前，差异有高度统计学意义（P ＜ 0.01）；LVEF透析前后比较，差异无统计学意义（P ＞ 0.05）。单次透析后，血液滤过LVESV显著低于透析前，差异有统计学意义（P ＜ 0.05）。两法单次透析后血尿素、血肌酐低于透析前，差异有高度统计学意义（P ＜ 0.01）。血液透析透析后血清β2-MG高于透析前，而血液滤过透析后血清β2-MG低于透析前，差异有高度统计学意义（P ＜ 0.01）。血液滤过透析前后血清β2-MG浓度变化值与LVGLS呈负相关（r = -0.45，P ＜ 0.05）。结论血液透析对患者左室整体收缩功能具有一定的损害，而血液滤过对左室整体收缩功能具有保护作用，可能的机制是通过滤除大分子物质的缘故。

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	张秉宜陈小蓉陈红敏王婷陈璐董梦平杰

关键词 ：三维, 斑点追踪, 尿毒症, 血液透析, 血液滤过, 左心室功能

Abstract：Objective To evaluate the effects of different hemodialysis methods on the overall systolic function of the left ventricle in patients with uremia by using 3D spot tracking technique (3D-STI). Methods Thirty-five uremic dialysis patients with stable condition in the People’s Hospital of China Three Gorges University from January 2019 to December 2020 were selected. Hemodialysis and hemofiltration were performed on the above patients according to different dialysis methods. Cardiac ultrasonography was performed once before dialysis and within 30 minutes after dialysis. Comparison of cardiac ultrasound parameters (left ventricular global peak systolic strain [LVGPSL], left ventricular global longitudinal strain [LVGLS], left ventricular global circumferential strain [LVGCS], left ventricular global area strain [LVGAS], left ventricular global radial strain [LVGRS], left ventricular ejection fraction [LVEF], left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume [LVESV]) and patient-related clinical and blood biochemical indicators. The correlation between the changes of serum β2-microglobulin (β2-MG) concentrations and the changes of 3D-STI in the two groups was analyzed. Results The measured values of left ventricular end-diastolic diameter, left atrium diamete, left ventricular volumes index in hemodialysis and hemofiltration after dialysis were significantly lower than those before dialysis, and the differences were statistically significant (P ＜ 0.05); however, there was no significant difference in Sm between the two methods before and after dialysis (P > 0.05). After a single dialysis, the measured values of LVGPSL, LVGLS, LVGCS, LVGAS, LVGRS, LVEDV, and LVESV in the hemodialysis methods were lower than those before dialysis, and the differences were highly statistically significant (P ＜ 0.01); there was no significant difference in LVEF before and after dialysis (P ＞ 0.05). After a single dialysis, the LVESV in the hemofiltration methods was significantly lower than that before dialysis, and the difference was statistically significant (P ＜ 0.05). The serum urea and serum creatinine after a single dialysis in the two methods were lower than those before dialysis, and the differences were statistically significant (P ＜ 0.01). In the hemodialysis methods, the serum β2-MG after dialysis was higher than that before dialysis, and the difference was highly statistically significant (P ＜ 0.01). The serum β2-MG in the hemofiltration methods after dialysis was lower than that before dialysis, and the difference was highly statistically significant (P ＜ 0.01). The changes of serum β2-MG concentration before and after dialysis in the hemofiltration methods were negatively correlated with LVGLS (r = -0.45, P ＜ 0.05). Conclusion Hemodialysis has a certain damage to the overall systolic function of the left ventricle, while hemofiltration has a protective effect on the overall systolic function of the left ventricle. The possible mechanism is through filtering out macromolecular substances.

Key words： Three-dimensional Spot tracking Echocardiography Uremia Hemodialysis Hemofiltration Left ventricular function

基金资助:湖北省卫生健康委员会联合基金项目（WJ2019 H509）；
湖北省宜昌市医疗卫生研究项目（A19-301-29）。

作者简介: 张秉宜（1980.4-），男，博士，主任医师；研究方向：超声心动图新技术临床应用。

引用本文:

张秉宜陈小蓉陈红敏王婷陈璐董梦平杰. 3D-STI评价两种血液透析方式对尿毒症患者左心室整体收缩功能的影响[J]. 中国医药导报, 2022, 19(10): 89-93.
ZHANG Bingyi CHEN Xiaorong CHEN Hongmin WANG Ting CHEN Lu DONG Meng PING Jie. Evaluate of the effect of two hemodialysis methods on the overall left ventricular systolic function in patients with uremia by three-dimensional speckle tracking technology#br#. 中国医药导报, 2022, 19(10): 89-93.

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https://www.yiyaodaobao.com.cn/CN/ 或 https://www.yiyaodaobao.com.cn/CN/Y2022/V19/I10/89

[1] Saran R，Robinson B，Abbott KC，et al. US Renal Data System 2018 Annual Data Report：Epidemiology of Kidney Disease in the United States [J]. Am J Kidney Dis，2019，73（3S1）：A7-A8.
[2] Green D，Roberts PR，New DI，et al. Sudden cardiac death in hemodialysis patients：an in-depth review [J]. Am J Kidney Dis，2011，57（6）：921-929.
[3] 张秉宜，郭瑞强，周青，等.三维斑点追踪技术评价单次透析对尿毒症患者左心室收缩功能的影响[J].中华超声影像学杂志，2014，23（8）：651-655.
[4] Alhaj E，Alhaj N，Rahman I，et al. Uremic cardiomyopathy：an underdiagnosed disease [J]. Congest Heart Fail，2013， 19（4）：E40-E45.
[5] 孙敏敏，郭瑶，曹学森，等.三维斑点追踪显像技术评价单次血液透析对右室的影响[J].中国超声医学杂志，2018， 34（5）：466-469.
[6] Nie Y，Zhang Z，Zou J，et al. Hemodialysis-induced regional left ventricular systolic dysfunction [J]. Hemodial Int，2016，20（4）：564-572.
[7] 陈莉，唐冬茹，章敏芝，等.血液透析与血液透析滤过对中小分子物质清除的比较和临床观察[J].实用临床医学，2009，10（5）：48-49.
[8] 张群英，龚兰，张强，等.实时三维超声心动图分析尿毒症血液透析患者左心室收缩同步性特征[J].医学研究杂志，2015，44（11）：140-143.
[9] 刘文渊，刘玉东，赵寒辉，等.常规超声心动图与斑点追踪技术评价不同透析方式对左心室功能的影响[J].中华消化病与影像杂志（电子版），2016，6（3）：107-110.
[10] 余坷坷，程瑞洪，王朝晖，等.超声心动图对尿毒症患者透析前后左心室结构及功能的评价[J].疑难病杂志，2016，15（4）：344-346.
[11] 张秉宜，郭瑞强，周青，等.实时三平面自动功能成像评价单次透析对尿毒症患者左室纵向收缩功能的即刻影响[J].中国医药导报，2018，15（10）：123-125.
[12] 马忠超，李雪，杨瑞衡，等.超声心动图评价透析方式对终末期肾脏病心脏结构及功能的影响[J].中国血液净化，2016，15（11）：591-594.
[13] 张洁，黄志新.超声心动图检测血液透析病人左心室及左心功能的改变[J].影像研究与医学应用，2019，3（3）：111-113.
[14] Zuidema MY，Dellsperger KC. Myocardial Stunning with Hemodialysis：Clinical Challenges of the Cardiorenal Patient [J]. Cardiorenal Med，2012，2（2）：125-133.
[15] Ingec M，Oguz EG，Yildirim T，et al. The effect of hemodialysis on cardiac enzyme levels and echocardiographic parameters [J]. Int J Artif Organs，2014，37（7）：513-520.
[16] 马云伶，杨雪莲，唐子勇.血液透析联合血液灌流对维持血液透析患者左心室功能的保护作用[J].中国血液净化，2013，12（4）：175-179.
[17] 姜梅，托娅，魏金凤，等.不同血液透析方式对尿毒症左心结构和功能的影响[J].中国疗养医学，2021，30（10）：1116-1118.
[18] 李小莉，赵波.血液透析滤过和高通量透析对β2微球蛋白清除效果的比较[J].中国社区医师，2017，33（3）：24-26.
[19] 陈莉，唐冬茹，章敏芝.血液透析与血液透析滤过对中小分子物质清除的比较和临床观察[J].实用临床医学，2009，10（5）：48-49.
[20] 王维平，何萍，姜璐．高通量血液透析对维持性血液透析患者β-微球蛋白和甲状旁腺激素及左心功能的影响[J]．实用心脑肺血管病杂志，2014，22（3）：27-29.