左房容积指数测定在血液透析患者中的应用

摘要

目的 本研究对血液透析患者心脏结构和功能进行了测定,探讨测量左房容积指数(Left Atrial Volume Index,LAVI)在血液透析患者中的应用.方法 采用PHLIPIS iE33彩色多普勒超声诊断仪,根据美国超声心动图协会所建议的双平面面积-长度法对101名规律血液透析患者左房容积(Left Atrial Volume,LAV)进行测量,并计算LAVI,同时常规测量左心室收缩末期容积(End Systolic Volume,ESV)和舒张末期容积(End Diastolic Volume,EDV),得出左室射血分数(Ejection Fraction,EF),于心尖四腔位测量二尖瓣血流频谱舒张早期血流峰值速度(Mitral In?ow Peak E, E)和舒张晚期血流峰值速度(Mitral Inflow Peak A,A)之比(E/A Ratio,E/A比值),并计算左室重量指数(Left Ventricular Mass Index,LVMI). 结果 101例血液透析患者,平均年龄62.6±10.8岁,中位透析龄52(12,218)月.LAVI均值为34.7±14.4ml/m2, LVMI均值为145.5±57.3g/m2,EF均值为63.3％±10.8％,E/A比值均值为0.80±0.27.51例患者(50.6％)左房增大.LAVI与透析龄呈正相关(r=0.267,P=0.042),与LVMI呈正相关(r=0.319,P=0.029);与EF呈负相关(r=-0.311,P=-0.033),与E/A比值呈负相关(r=-0.346,P=0.013)；而与年龄、性别无相关性.多元逐步回归分析显示,E/A比值(β=-0.324,P=0.018)是LAVI的独立影响因素.LAVI＞32ml/m2患者与LAVI≤32ml/m2患者相比较,E/A比值显著降低(0.72±0.27 vs 0.88±0.26,P=0.019), EF显著降低(60.0％±10.7％ vs 66.8％±9.8％,P=0.024). 结论 血液透析患者普遍存在左房扩大.左房结构变化可能是左室充盈压异常的慢性表达,对于评估血液透析患者心血管疾病风险可能具有重要临床意义.%Objective To evaluate the heart function and structure changes, and to investigate the correlation of left atrial volume index (LAVI) to left ventricular systolic and diastolic function and left ventricular mass index (LVMI) in hemodialysis patients. Methods We recruited 101 patients on maintenance hemodialysis. Doppler echocardiogram examinations were performed by an experienced physician in ultrasonography on interdialytic days to obtain the parameters of end systolic volume (ESV), end diastolic volume (EDV), and ejection fraction (EF%). From mitral inflow profile, the ratio of early (E) to late atrial (A) mitral Doppler peak flow velocity (E/A ratio) was calculated as an index of left ventricular diastolic function. Left atrial volume (LAV) was calculated by the biplane method of discs at the end of left ventricle systole. LAVI and LVMI were averaged by estimated body surface area. Results The patients were 62.6±10.8 years of age with the median hemodialysis duration of 52 months (12,218 months). They had mean LAVI of 34.7±14.4 ml/m2, mean LVMI of 145.5±57.3 g/m2; mean EF% of 63.3%±10.8%, and mean E/Aratio of 0.80±0.27. Augmentation in LAVI was found in 50.6% of the patients. E/Aratio and EF% were statistically different between patients with LAVI > 32 ml/m2 and those with LAVI ≤32 ml/m2. LAVI was negatively correlated to EF% (r = -0.311, P=0.033) and E/A ratio (r =-0.346, P=0.013), was positively correlated to hemodialysis age (r =0.267, P=0.042) and LVMI (r = 0.319, P=0.029), and was unrelated to age and gender. Multiple stepwise regression analysis showed that E/A ratio was an independent variable for LAVI (r =-0.324, P=0.018). Conclusion Enlargement of LAVI is frequently found in hemodialysis patients. Determination of LAVI changes by echocardiogram is an important approach to evaluate left ventricular diastolic function and to predict the morbidity of cardiovascular events in these patients.