中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (03): 126-129.

• 临床研究 • 上一篇    下一篇

左房容积指数测定在血液透析患者中的应用

姜维1,周亦伦2,沈洋1,刘婧2,吴亚峰1,崔太根2,孙芳2   

  1. 1. 北京朝阳医院肾内科

    2. 北京朝阳医院超声医学科
  • 收稿日期:2012-08-16 修回日期:2012-10-08 出版日期:2013-03-12 发布日期:2015-10-08
  • 通讯作者: 孙芳 E-mail:bjsunfang1974@yahoo.com.cn
  • 基金资助:

    中科级.863

Application of Left Atrial Volume Index in Hemodialysis Patients

  • Received:2012-08-16 Revised:2012-10-08 Online:2013-03-12 Published:2015-10-08

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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 In?ow 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。

关键词: 超声心动图, 左房容积指数, 血液透析

Abstract: Objective To evaluate the function and structure of the heart and to investigate the relationship between left atrial volume index (LAVI) with left ventricular systolic and diastolic function, left ventricular mass index(LVMI) in hemodialysis patients. Methods One hundred and one patients on maintenance hemodialysis were recruited. Doppler echocardiogram examinations were performed by one well-trained physician in ultrasonography on interdialytic days. The following measurements were obtained: end systolic volume(ESV), end diastolic volume(EDV), ejection fraction(EF%). From the 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 ventficular diastolic function. LAV was calculated by the biplane method of discs at the end of left ventricle systole. LAVI and LVMI were analyzed as body surface area indexed estimates. Results The mean age was 62.6±10.8 years and median duration of hemodialysis was 52（12,218） months. The mean LAVI was 34.7±14.4ml/m2. The mean LVMI was 145.5±57.3g/m2. The mean EF was 63.3%±10.8% and the mean E/A ratio was 0.80±0.27. Augmentation in LAVI was present in 50.6% of the patients. There were statistical differences in E/A ratio and EF% between patients with LAVI > 32 ml/m2 and patients with LAVI≤ 32ml/m2. LAVI was negatively correlated with EF%（r=-0.311，p=0.033）, as well as with E/A ratio（r=-0.346，p=0.013）, and was positively correlated with duration of hemodialysis（r=0.267，p=0.042）, as well as with LVMI（r=0.319，p=0.029）, but was not correlated with age and gender. In multiple stepwise regression analysis, E/A ratio（β=-0.324，p=0.018）was identified as an independent variable for the LAVI. Conclusion Enlargement in LAVI was prevalent in hemodialysis patients. Determination of the changes in LAVI by echocardiogram is very important to evaluate left ventricular diastolic function and to predict the morbidity of cardiovascular events.