河北医科大学学报 ›› 2021, Vol. 42 ›› Issue (3): 268-272.doi: 10.3969/j.issn.1007-3205.2021.03.004

• • 上一篇    下一篇

动静脉内瘘透析患者术侧肱动脉弹性与左心室功能Tei指数的变化及相关性研究

  

  1. 1.河北省石家庄市第三医院超声医学科，河北 石家庄 050011；2.沧州医学高等专科学校医学技术系影像教研室，河北 沧州 061001
  • 出版日期:2021-03-25 发布日期:2021-04-01
  • 作者简介:郭卫东（1978-），男，河北邯郸人，河北省石家庄市第三医院副主任医师，医学硕士，从事超声医学诊断研究。
  • 基金资助:
    石家庄市科学技术研究与发展指导计划(131461393)

Research on changes of brachial artery elasticity and Tei index for left ventricular function and their correlation in patients with internal arteriovenous fistula undergoing hemodialysis

  1. 1.Department of Ultrasound Medicine, the Third Hospital of Shijiazhuang City, Hebei Province，
    Shijiazhuang 050017，China;  2.Department of Imaging,  Medical Technology of Cangzhou
    Medical College， Hebei Province， Cangzhou 061001， China
  • Online:2021-03-25 Published:2021-04-01

HTML

PDF (PC)

44

摘要： 目的  应用超声血管回声跟踪技术评价透析患者术侧肱动脉血管弹性的临床变化，同时结合患者心脏左心室组织多普心肌做功指数（Tei index，Tei指数）的变化，评价两种参数变化的相关性。
方法  收集行自体动静脉内瘘透析治疗患者55例，同时征集40例健康体检者作对照研究，应用超声血管回声跟踪技术检测患者术侧肱动脉弹性参数：僵硬指数（stiffness parameter,β）、弹性系数（elastic  coefficient,Eρ）、顺应性（compliance,AC）、脉搏波传播速度（pulse wave velocity,PWVβ）、膨大指数（swelling index,AI）指标，同时应用组织多普勒超声测量左心室功能指标：等容收缩时间( isovolumic contraction time,ICT)，等容舒张时间(isovolemic diastolic time,IRT)，射血时间（ejection time，ET），计算Tei 指数=（ICT +IRT）/ET、等容收缩指数（ICT/ET）和等容舒张指数（IRT/ET）。
结果  ①透析组β、Ｅρ、PWVβ高于正常对照组，AC低于正常对照组（P＜0.05），透析组AI与对照组比较差异无统计学意义（P＞0.05）；②透析组IRT/ET、Tei指数高于正常对照组（P＜0.05），ICT/ET、ET组间比较差异均无统计学意义（P＞0.05）；③相关分析表明透析组IRT/ET与动脉弹性指数β、Ｅρ、PWVβ呈正相关（r=0.789、0.777、0.739，P＜0.05），透析组IRT/ET与AC呈负相关（r=-0.442，P＜0.05）；Tei指数与 β、Ｅρ、PWVβ呈正相关（r=0.667、0.617、0.979，P＜0.05）。
结论  透析患者可通过超声检测出动脉弹性功能和左心室功能的改变，手术侧动脉弹性功能变化与左心室舒张功能变化呈正相关，左心室整体功能随着血管弹性的降低而减低，且以左心室的舒张功能减低较为显著，临床可以参考内瘘术后肱动脉弹性变化预测心血管并发症风险，以期及时有效进行干预心脏与血管病变的进程，降低透析患者心血管疾病的发病率及病死率。

关键词: 动静脉瘘, 动脉弹性, 血管回声跟踪技术, 左心室Tei指数

Abstract: Objective  To evaluate the changes of brachial artery elasticity by echo- tracking technique and left ventricular Tei Index obtained by tissue Doppler imaging in patients undergoing hemodialysis, and to evaluate the correlation between two parameters.
Methods  We randomly selected 55 patients with autologous internal arteriovenous fistula(IAF) undergoing hemodialysis, and 40 healthy subjects were recruited as controls. The parameters of brachial artery elasticity, including stiffness parameter(β), elastic coefficient(Eρ), compliance(AC), pulse wave velocity(PWVβ), swelling index(AI), were measured by ET technique; in the meantime, left ventricular function was measured by tissue Doppler ultrasound， including isovolumic contraction time(ICT), isovolemic diastolic time(IRT)， and ejection time(ET). Tei index(ICT+IRT)/ET, isometric contraction index ICT/ET and isometric relaxation index IRT/ET were calculated.
Results  ①The levels of β, Ｅρ, and PWVβ were higher in the hemodialysis group than in the normal control group, while the AC was lower in the hemodialysis group than in the normal control group(P＜0.05). No significant difference was found in AI between two groups(P＞0.05). ②The levels of IRT/ET and Tei index were higher in the dialysis group than in the normal control group(P＜0.05), whereas no significant difference was found in the ICT/ET and ET between two groups(P＞0.05). ③Correlation analysis showed that IRT/ET in hemodialysis group was positively correlated with arterial elastic indexes including β,Ｅρ, and PWVβ(r=0.789, 0.777, 0.739, P＜0.05) , while IRT/ET in hemodialysis group was negatively correlated with AC(r=-0.442， P＜0.05). Tei Index was positively correlated with β, Ｅρ and PWVβ(r=0.667, 0.617, 0.979, P＜0.05).
Conclusion  Ultrasound could be used to detect the changes of arterial elastic function and left ventricular function in patients undergoing hemodialysis,  and the changes of arterial elastic function are positively correlated with the changes of left ventricular diastolic function. The global function of the left ventricle decreased with the decrease of vascular elasticity, and the decrease of diastolic function of the left ventricle is more significant. The changes of brachial artery elasticity after fistulectomy can be used to predict the risk of cardiovascular complications, and the intervention process of heart and vascular disease should be performed early and effectively, thereby reducing morbidity and mortality of patients with cardiovascular disease undergoing hemodialysis.

Key words: arteriovenous fistula, arterial elasticity, echo-tracking technique, left ventricular Tei index

版权所有 © 《河北医科大学学报》编辑部
本系统由北京玛格泰克科技发展有限公司设计开发