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目的:探讨应用三维斑点追踪技术(three-dimensional speckle tracking imaging,3DSTI)评价慢性肾功能不全患者右心功能的价值。方法:选择67例慢性肾功能不全患者,根据肺动脉收缩压(PASP)的水平分为肺动脉收缩压正常组(Ⅰ组)34例、肺动脉收缩压升高组(Ⅱ组)33例;并选择正常人31例作为对照组;应用3DSTI技术测量右室整体纵向收缩期峰值应变(GLS)、右室整体圆周收缩期峰值应变(GCS)、右室整体径向收缩期峰值应变(GRS)、右室射血分数(RVEF)及右室游离壁收缩期纵向、径向及圆周向峰值应变(LS、RS、CS)值。结果:Ⅰ组与Ⅱ组患者右室GLS均较正常组显著减低,差异有统计学意义(P<0.05),且Ⅱ组患者右室GLS较Ⅰ组减低,差异有统计学意义(P<0.05);而三组间右室GRS、GCS差异无统计学意义(P>0.05)。Ⅰ组与Ⅱ组患者右室游离壁基底段(LS、RS、CS)测值较正常组减低,差异有统计学意义(P<0.05),且Ⅱ组患者游离壁基底段(LS、RS、CS)测值较Ⅰ组减低,差异有统计学意义(P<0.05);而三组间右室游离壁中间段(LS、RS、CS)测值差异无统计学意义(P>0.05)。结论:慢性肾功能不全患者其纵向心肌的形变能力已经早于右室整体收缩功能出现下降,且早于径向、圆周方向上的整体形变能力,右室基底段的纵向、径向及圆周向方向上的形变能力要早于其他节段出现下降,应用三维斑点追踪技术可准确地检测右心室亚临床功能异常。
Objective: To evaluate the value of three-dimensional speckle tracking imaging (3DSTI) in evaluating right ventricular function in patients with chronic renal insufficiency. Methods: Thirty-seven patients with chronic renal insufficiency were selected and divided into three groups according to their pulmonary arterial systolic pressure (PASP): normal pulmonary systolic pressure group (group Ⅰ), pulmonary hypertension systolic pressure group (group Ⅱ, n = 33) 31 patients were used as control group. The 3DSTI was used to measure the global longitudinal peak systolic strain (GLS), global systolic peak strain (GCS), global right ventricular systolic peak strain (GRS) Ejection fraction (RVEF) and longitudinal, radial and circumferential peak strain (LS, RS, CS) of systolic RV free wall. Results: The GLS of right ventricle of group Ⅰ and group Ⅱ were significantly lower than that of normal group (P <0.05), and the GLS of right ventricle of group Ⅱ was lower than that of group Ⅰ, the difference was statistically significant (P0.05 ). There was no significant difference in GRS and GCS between the three groups (P> 0.05). The basal segments of right ventricular free wall (LS, RS, CS) in group Ⅰ and group Ⅱ were significantly lower than those in normal group (P <0.05) CS) were significantly lower than those in group I (P <0.05). There were no significant differences in the measured values of LS, RS and CS between the three groups (P> 0.05). Conclusion: The ability of longitudinal myocardial degeneration in patients with chronic renal insufficiency has been earlier than that in the right ventricle, and earlier than that in the radial and circumferential directions. The longitudinal, radial and circumferential directions of the right ventricular base segment Deformation in the direction of the ability to decline earlier than other segments, the application of three-dimensional speckle tracking technology can accurately detect subclinical right ventricular dysfunction.