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无创压力-应变环技术在早期发现慢性肾脏病患者左心室收缩功能损伤中的价值

Non-invasive pressure-strain loop technology for early detection of left ventricular systolic dysfunction in patients with chronic kidney disease

    摘要
  • 摘要:
    目的 探讨无创压力-应变环（pressure-strain loop, PSL）技术中的整体心肌做功参数在早期评估慢性肾脏病（chronic kidney disease，CKD）患者左心室收缩功能中的应用价值。
    方法 回顾性分析2021年8月至2021年12月于复旦大学附属中山医院厦门医院肾脏内科住院的左心室射血分数（left ventricular ejection fraction, LVEF）正常的CKD患者74例，根据CKD分期分为早期CKD组（CKD 1～3期）和晚期CKD组（CKD 4～5期）。另选取30名年龄、性别相匹配的健康志愿者作为对照组。收集并比较3组研究对象的一般临床资料、左心室常规超声指标、心肌应变和整体心肌做功参数。采用相关性检验和多元线性回归分析评估心肌做功的影响因素。
    结果 3组研究对象的左心室整体做功指数（global work index, GWI）、整体有用功（global constructive work, GCW）差异无统计学意义。与对照组相比，两组CKD患者的整体做功效率（global work efficiency, GWE）降低，整体无用功（global waste work, GWW）增加（P＜0.05）。晚期CKD组（n＝42）整体纵向应变（global longitudinal strain, GLS）绝对值（﹣17.09±0.82）% vs（﹣18.33±0.90）%, P＜0.05、GWE93.00%(90.00%, 95.00%) vs 96.00%(92.25%, 96.75%) , P＜0.05低于早期CKD组（n＝32），GWW高于早期CKD组150.00 mmHg%(105.25 mmHg%, 215.00 mmHg%) vs 88.00 mmHg% (64.25 mmHg%, 144.50 mmHg%), P＜0.05。相关性分析显示，GWE与GLS绝对值、峰值应变离散度（peak strain dispersion，PSD）负相关（r＝﹣0.396、﹣0.558，P＜0.05）；GWW与GLS绝对值、PSD正相关（r＝0.341、0.610，P＜0.01）。多元线性回归结果显示，PSD为GWE（β＝﹣0.558, P＜0.001）和GWW（β＝0.538, P＜0.001）的独立相关因素。
    结论 无创左心室PSL技术中的心肌做功参数GWE、GWW有助于早期定量识别CKD患者左心室收缩功能损伤。

     

    Abstract:
    Objective To investigate the application value of the global myocardial work parameters in the non-invasive pressure-strain loop (PSL) technology for early assessment of left ventricular systolic function in patients with chronic kidney disease (CKD).
    Methods A retrospective analysis was performed on 74 patients with normal left ventricular ejection fraction (LVEF) who were hospitalized in the Nephrology Department of Zhongshan Hospital (Xiamen Branch), Fudan University, from August 2021 to December 2021. Based on CKD stages, patients were divided into early group (CKD stages 1-3) and advanced group (CKD stages 4-5). Additionally, 30 healthy volunteers matched for age and gender were selected as the control group. General clinical data, routine left ventricular ultrasound indicators, myocardial strain, and global myocardial work parameters were collected and compared among the three groups. Correlation analysis and multiple linear regression were used to assess the influencing factors of myocardial work.
    Results There were no statistically significant differences in global work index (GWI) and global constructive work (GCW) among the three groups. Compared to the control group, both CKD groups showed significantly reduced global work efficiency (GWE), along with significantly increased global waste work (GWW, P＜0.05). The absolute value of global longitudinal strain (GLS) in the advanced CKD group (n＝42) was significantly lower than that in the early CKD group (n＝32; ﹣17.09±0.82% vs ﹣18.33±0.90%, P＜0.05), and GWE was also significantly lower (93.00%90.00%, 95.00% vs 96.00%92.25%, 96.75%, P＜0.05), while GWW was significantly higher than that in the early CKD group (150.00 mmHg%105.25 mmHg%, 215.00 mmHg% vs 88.00 mmHg%64.25 mmHg%, 144.50 mmHg%, P＜0.05). Correlation analysis showed that GWE was negatively correlated with the absolute value of GLS and peak strain dispersion (PSD; r＝﹣0.396, ﹣0.558, P＜0.05), GWW was positively correlated with absolute value of GLS, and PSD (r＝0.341, 0.610, P＜0.01). Multiple linear regression results indicated that PSD was an independent influencing factor for GWE (β＝﹣0.558, P＜0.001) and GWW (β＝0.538, P＜0.001).
    Conclusions The myocardial work parameters GWE and GWW in non-invasive left ventricular PSL technology can identify subclinical left ventricular systolic dysfunction in patients with CKD early and quantitatively.

     

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