尿毒症患者三尖瓣环位移运动与右心室功能指标相关性研究

摘要

Objective To investigate the correlation between tricuspid annulus motion and right ventricular integral cardiac function in uremic patients with maintenance hemodialysis.Methods One hundred and thirty five uremic patients with maintenance hemodialysis and 41 healthy subjects (control group) were enrolled in the study.The systolic strain (Ss) and strain rate (SRs) of basal,mid,apical segments of anterior,inferior,lateral walls of right ventricle were measured by strain imaging and strain rate imaging.The right ventricular end distolic volume (RVEDV),right ventricular end systolic volume (RVESV),right ventricular cardiac output (RVCO),right ventricular stroke volume (RVSV),right ventricular ejection fraction (RVEF) were measured by bi-plane method.The linear regression was used to analyze the correlation between tricuspid annulus motions parameters (tricuspid annulus midpoint displacement,TAD;tricuspid annulus midpoint displacement rate,TADr) and SRs,Ss of every segment and integral sytolic function parameters of right ventricle in uremic patients with maintenance hemodialysis.Results Except ASRas,ASms,ASas,the mesurements of SRs,Ss of every segment of right ventricle,RVSV,RVEF,TAD,TADr in uremia group were significantly lower than those in control group,while the means of RVEDV,RVESV were significantly higher than those in control group(all P＜0.05).In uremia group,there were linear correlations between TAD,TADr and RVEDV,RVCO,RVSV.There was positive correlation between TAD and RVSV (r=0.38,P＜0.05,the linear regression equation was Y=0.83X+12.03),and between TAD,TADr and several parameters of SRs,Ss;the correlation between TAD and average systolic strain (ASs) was positive (r=0.36,P＜0.05,Y=0.30X+8.18).Conclusion The right ventricular integral cardiac functions and local myocardial functions can be assessed by using tricuspid annulus displacement in uremic patients with maintenance hemodialysis.%目的 探讨维持性血液透析尿毒症患者三尖瓣环位移运动与右心室功能及局部心肌收缩功能指标的相关性.方法 选取行维持性血液透析的尿毒症患者135例(尿毒症组),另选取同期来院体检的正常成人41例为正常对照组.两组患者均行超声心动图检查,采用应变和应变率成像测定右心室前、下、侧壁基底段、中段、心尖段的收缩期应变(Ss)和应变率(SRs);采用双平面法测定RVEDV、RVESV、RVCO、RVSV、RVEF.将尿毒症组患者的三尖瓣环位移运动参数(TAD与TADr)分别与右心室壁各节段SRs和Ss以及右心室心功能指标进行直线回归分析.结果 除ASRas、ASms、ASas外,尿毒症组患者右心室壁各节段的应变和应变率参数以及ASRs、ASs均小于正常对照组(均P＜ 0.05).尿毒症组患者RVEDV、RVESV均大于正常对照组(均P＜ 0.05),RVSV、RVEF、TAD、TADr均小于正常对照组(均P＜ 0.05).TAD与ASRbs、ASRms、LSRms、ASbs、ASms、LSbs、ASRs、ASs均存在直线相关性,r值分别为0.30、0.17、021、0.26、0.19、0.35、0.32、0.36(均P＜ 0.05),其中与ASs相关性最高,直线回归方程为y=0.30X+8.18;TADr与ASRbs、ISRbs、ASbs、LSbs、LSms、ASRs、ASs也均存在直线相关性,r值分别为0.24、0.23、0.26、0.28、0.19、0.32、0.32(均P＜0.05),其中与ASs相关性最高,直线回归方程为Y=0.27X+13.09.TAD与RVEDV、RVCO、RVSV均存在直线相关性,r值分别为0.31、026、0.38(均P＜ 0.05),其中与RVSV相关性最高,直线回归方程为Y=0.83X+12.03;TADr与RVEDV、RVCO、RVSV也均存在直线相关性,r值分别为0.21、0.21、0.31(均P＜ 0.05),其中与RVSV相关性最高,直线回归方程为Y=0.48X+14.35.结论 三尖瓣环位移可反映维持性血液透析尿毒症患者右心室功能及局部心肌收缩功能.