关键词: 超声心动图, 组织多普勒速度成像, 血液透析, 腹膜透析, 心血管疾病

Abstract: Objective To investigate the effects of hemodialysis and peritoneal dialysis on cardiac structure and function in patients with end-stage renal disease by color Doppler echocardiography (ECHO) and tissue velocity imaging (TVI) technologies. Methods Chronic kidney disease 5 stage group (CKD5), maintenance
hemodialysis group (MHD), and continuous ambulatory peritoneal dialysis (CAPD) group were enrolled in this cross-sectional study. ECHO and TVI technologies were used to acquire the changes of cardiac structure and function in different groups. Results ①Interventricular septum thickness (IVST), left ventricular end- diastolic diameter (LVDd), left ventricular wall thickness (LVPW), left ventricular mass index (LVMI), left atrial diameter (LAD), E/A ratio, ejection fraction (EF), and peak late diastolic velocity (Am) showed no significant differences among the three groups (F=1.595, P=0.211 for IVST; F=0.146, P=0.864 for LVDd; F=1.543, P=0.222 for LVPW; F=0.904, P=0.410 for LVMI; F=0.986, P=0.379 for LAD; F=0.543, P=0.588 for E/A; F=1.038, P=0.360 for EF; F=1.330, P= 0.270 for Am). Peak early diastolic velocity (Em) and Em/ Am ratio were higher in CAPD group than in MHD group (t=2.375, P=0.021 for Em; t=2.940, P= 0.005 for Em/Am).②The prevalence of left ventricular diastolic dysfunction (LVDD) in CKD5, MHD, CAPD groups were 77%, 83% and 66% respectively, and the prevalence of left ventricular hypertrophy (LVH) in CKD5, MHD, CAPD groups were 73%, 83% and 69% respectively, without statistical differences among the three groups (c2=2.570, P=0.277 for LVDD; c2=1.735, P=0.420 for LVH). The main reflux changes were mitral regurgitation (MR) followed by tricuspid regurgitation (TR), and the reflux rates had no significant differences among the three groups (c2=3.344, P=0.188 for MR; c2=2.067, P=0.356 for TR). Conclusions ① Cardiac structure and function alterations mainly manifested left ventricular hypertrophy, diastolic dysfunction, mitral valvular regurgitation, tricuspid regurgitation in end- stage renal disease patients regardless of renal replacement therapy. TVI technology was more sensitive than ECHO in the evaluation of left ventricular diastolic dysfunction. ②Hemodialysis and peritoneal dialysis did not improve left ventricular hypertrophy and ventricular systolic and diastolic dysfunction, but peritoneal dialysis may be better than hemodialysis to delay the onset and progression of ventricular diastolic dysfunction.

Key words: Echocardiography, Tissue velocity imaging, Hemodialysis, Peritoneal dialysis, Cardiovascular
disease