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目的采用超声组织定征技术测量尿毒症维持性血液透析(MHD)患者的心肌背向散射积分值,了解MHD患者心肌声学密度特征并探讨贫血对其影响。方法选择透析龄3-6 月的MHD患者共45例,30例贫血(男:女20:10),15例无贫血(男:女10:5),血压均控制稳定。同时设健康对照组15例(男:女10:5),均接受超声组织定征检测。所有患者随访1年后再次接受超声组织定征检查。随访期间患者血压控制平稳,透析方案无改变。贫血组患者随机分成2 组,各15例(男:女10:5),1组经调整红细胞生成素(EPO)等药物后,3月内Hb上升至(109．75± 4．29)g/L,并基本维持该水平;另1组Hb水平维持在100g/L以下。非贫血组患者Hb水平保持稳定。结果入选时非贫血组患者心肌平均背向散射积分值(AIB)为6．21±0．22,其周期变化幅度(CVIB)为9．88±0．61;贫血组患者AIB为8．20±0．19,CVIB为7．87±0．51;对照组AIB为 5．94±0．21,CVIB为10．52±0．86。随访1年后,贫血纠正组患者AIB及CVIB值得以改善,但与正常人群仍有显著差异;贫血未纠正组AIB较基础值上升,CVIB较前有下降;非贫血组患者无显著变化。结论透析初期无贫血且血压控制良好的患者,其心肌AIB及CVIB与正常人群相似。贫血是影响尿毒症心肌纤维化的重要因素之一,早期纠正贫血很重要。尿毒症患者一旦发生心肌纤维化,则难以逆转。
OBJECTIVE: To measure myocardial integrated backscatter scores in patients with uremic patients with maintenance hemodialysis (MHD) by using ultrasound tissue characterization technique, to understand the characteristics of myocardial acoustic density in patients with MHD and to explore the effect of anemia on them. Methods A total of 45 patients with MHD aged 3-6 months were enrolled in this study. Thirty patients with anemia (20:10 males and 20 females) and 15 anemia patients (males and females 10: 5) had stable blood pressure. At the same time set the control group of 15 patients (male: female 10: 5), were tested by ultrasound tissue. All patients were followed up 1 year after the ultrasound tissue examination again. Patients during follow-up control of blood pressure was stable, no change in dialysis program. Patients in the anemia group were randomly divided into two groups (15 males and 10 females; female): Hb increased to (109.75 ± 4.29) g in 3 months after adjustment for erythropoietin (EPO) / L, and basically maintain this level; another group of Hb levels remained below 100g / L. Hb levels remained stable in non-anemic patients. Results In the non-anemia group, the mean myocardial integrated backscatter integral (AIB) was 6.21 ± 0.22 and the CVIB was 9.88 ± 0.61. The AIB of the anemia group was 8.20 ± 0.19, CVIB was 7.87 ± 0.51; control AIB was 5.94 ± 0.21, CVIB was 10.52 ± 0.86. After 1 year of follow-up, AIB and CVIB values in patients with anemia correction group were improved, but there was still significant difference with normal people; AIB in anemia-corrected patients group was higher than baseline value, and CVIB was lower than those in non-anemia group. Conclusions AIB and CVIB in myocardium are similar to those in normal subjects in patients without anemia and well-controlled blood pressure in the early stage of dialysis. Anemia is one of the important factors that affect myocardial fibrosis of uremia. It is very important to correct anemia in the early stage. Uremic patients in the event of myocardial fibrosis, it is difficult to reverse.