中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (12): 993-998.doi: 10.3969/j.issn.1671-4091.2025.12.006

• 临床研究 • 上一篇    下一篇

三维斑点追踪技术联合红细胞体积分布宽度对血液透析患者并发主要心血管不良事件的预测价值

陈 莹    李 静    赵宝丽    孙宁宁   

  1. 750000 银川，中国人民解放军联勤保障部队第九四二医院1超声诊断科 3心肾内科 4检验科
    750000 银川，2宁夏银川市第一人民医院超声医学科
  • 收稿日期:2025-03-17 修回日期:2025-08-14 出版日期:2025-12-12 发布日期:2025-12-12
  • 通讯作者: 陈莹 E-mail:cy188950@163.com
  • 基金资助:
    宁夏回族自治区医疗卫生科技计划项目(2021-NW-118)

Predictive value of three-dimensional speckle tracking imaging combined with red blood cell distribution width for major adverse cardiovascular events in hemodialysis patients

CHEN Ying, LI Jing, ZHAO Bao-li, SUN Ning-ning   

  1. Department of Ultrasound Diagnosis, 3Department of Nephrology and 4Department of Laboratory Medicine, The No. 942 Hospital of the Joint Logistics Force of PLA, Yinchuan 750000, China; 2Department of Ultrasound Diagnosis, The First People's Hospital of Yinchuan City, Yinchuan 750000, China
  • Received:2025-03-17 Revised:2025-08-14 Online:2025-12-12 Published:2025-12-12
  • Contact: 750000 银川，中国人民解放军联勤保障部队第九四二医院1超声诊断科 E-mail:cy188950@163.com

摘要： 目的 探讨三维斑点追踪(3-dimensional speckle tracking imaging，3D-STI)技术联合红细胞分布宽度(red blood cell distribution width，RDW)对血液透析(hemodialysis，HD)患者并发主要心血管不良事件(major adverse cardiovascular events，MACE)的预测价值。 方法 本研究为回顾性队列研究，选取2023年1月—2024年6月中国人民解放军联勤保障部队第九四二医院收治的HD患者350例，随访6个月，根据是否并发MACE分为MACE组(117例)和非MACE组(233例)，收集临床资料、常规超声心动图参数、3D-STI参数[全局面积应变(global area strain，GAS)、全局圆周应变(global circumferential strain，GCS)、全局纵向应变(global longitudinal strain，GLS)、全局径向应变(global radial strain，GRS)、三维左心室射血分数(three-dimensional left ventricular ejection fraction，3D-LVEF)]，并通过全自动血液分析仪测量RDW。分析HD患者并发MACE的影响因素；受试者工作特征(receiver operating characteristics，ROC)曲线分析3D-STI参数联合RDW对HD患者并发MACE的预测价值。 结果  随访6个月，MACE并发率为33.43%(117/350)。与非MACE组比较，MACE组年龄、左心房内径(left atrial diameter，LAD)、GAS、GCS、GLS、RDW、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol，LDL-C)、全段甲状旁腺激素(intact parathyroid hormone，iPTH)水平升高，透析龄延长，GRS、3D-LVEF降低(t/Z＝3.752、2.906、5.322、5.499、3.756、9.609、5.271、5.967、4.835、5.922、5.288，均P＜0.001)。透析龄(OR=1.042，95% CI：1.023～1.062，P＜0.001)、LDL-C(OR=1.281，95% CI：1.154～1.422，P＜0.001)、iPTH(OR=1.002，95% CI：1.001～1.004，P＜0.001)、GAS(OR=1.129，95% CI：1.051～1.214，P=0.001)、GCS(OR=1.217，95% CI：1.107～1.339，P＜0.001)、GLS(OR=1.137，95% CI：1.034～1.250，P=0.008)、RDW(OR=2.522，95% CI：1.832～3.473，P＜0.001)为HD患者并发MACE的独立危险因素，GRS(OR=0.965，95% CI：0.938～0.992，P=0.012)、3D-LVEF(OR=0.922，95% CI：0.878～0.968，    P=0.001)为独立保护因素。3D-STI参数联合RDW预测HD患者并发MACE的曲线下面积为0.887，大于3D-STI参数、RDW单独预测的0.821、0.770(Z=3.876、5.319，均P＜0.001)。 结论 3D-STI参数(GAS、GCS、GLS、GRS、3D-LVEF)联合RDW预测HD患者并发MACE的价值较高。

关键词: 血液透析, 三维斑点追踪技术, 红细胞分布宽度, 主要心血管不良事件

Abstract: Objective  To explore the predictive value of three-dimensional speckle tracking imaging (3D-STI) combined with red blood cell distribution width (RDW) for major adverse cardiovascular events (MACE) in hemodialysis (HD) patients.  Methods  This is a retrospective cohort study, which includes 350 HD patients admitted to the 942nd Hospital of the Joint Logistics Support Force of Chinese PLA from January 2023 to June 2024. Patients were followed for 6 months and divided into MACE group (n=117) and non-MACE group (n=233) based on the presence or absence of MACE. Clinical data, conventional echocardiographic parameters, and 3D-STI parameters, which include global area strain (GAS), global circumferential strain (GCS), global longitudinal strain (GLS), global radial strain (GRS) and three-dimensional left ventricular ejection fraction (3D-LVEF), were collected, and RDW was measured using a fully automated hematology analyzer. Risk factors for MACE were analyzed, and receiver operating characteristic (ROC) curve was used to evaluate the predictive value of 3D-STI combined with RDW for MACE in HD patients.  Results  During the 6-month follow-up, the incidence of MACE was 33.43% (117/350). Compared with the non-MACE group, the MACE group had higher age, higher levels of left atrial diameter (LAD), GAS, GCS, GLS, RDW, low-density lipoprotein cholesterol (LDL-C) and intact parathyroid hormone (iPTH), and longer dialysis vintage, but lower GRS and 3D-LVEF (t/Z=3.752, 2.906, 5.322, 5.499, 3.756, 9.609, 5.271, 5.967, 4.835, 5.922 and 5.288 respectively; all P＜0.001). Multivariate logistic regression identified dialysis vintage (OR=1.042, 95% CI: 1.023～1.062, P＜0.001), LDL-C (OR=1.281, 95% CI: 1.154～1.422, P＜0.001), iPTH (OR=1.002, 95% CI: 1.001～1.004, P＜0.001), GAS (OR=1.129, 95% CI: 1.051～1.214, P=0.001), GCS (OR=1.217, 95% CI: 1.107～1.339, P＜0.001), GLS (OR=1.137, 95% CI: 1.034～1.250, P=0.008), and RDW (OR=2.522, 95% CI: 1.832～3.473, P＜0.001) as the independent risk factors for MACE, while GRS (OR=0.965, 95% CI: 0.938～0.992, P=0.012) and 3D-LVEF (OR=0.922, 95% CI:0.878～0.968, P=0.001) as the independent protective factors for MACE. The area under ROC curve (AUC) for predicting MACE using 3D-STI parameters (including GAS, GCS, GLS, GRS and 3D-LVEF) combined with RDW was 0.887, higher than that using 3D-STI parameters (0.821) or RDW (0.770) alone (Z=3.876 and 5.319, P＜0.001).  Conclusion  3D-STI parameters (GAS, GCS, GLS, GRS and 3D-LVEF) and RDW are independently associated with MACE in HD patients. 3D-STI parameters combined with RDW has higher predictive value for MACE in HD patients.

Key words: Hemodialysis, Three-dimensional speckle tracking imaging, Red blood cell distribution width, Major adverse cardiovascular events

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