Di Bello V, Panichi V, Pedrinelli R, Giorgi D, Bianchi M, Bertini A, Taccola D, De Pietro S, Talini E, Paterni M, Giusti C
Dipartimento di Medicina Interna, University of Pisa, Italy.
Nephrol Dial Transplant. 1999 Sep;14(9):2184-91. doi: 10.1093/ndt/14.9.2184.
The aim of this study was to investigate videodensitometric parameters of the myocardium, in dialysis patients, who represent a complex pathophysiological model of pressure volume overload, and in essential hypertensive patients with the same level of left ventricular mass.
We compared a group of male dialysis patients (D) with two groups: hypertensive patients (H) with comparable left ventricular mass and normotensive healthy subjects as controls (C). The groups (n=15 each) were age- (53 +/- 9 years) and gender-matched. Quantitative analysis of echocardiographic digitalized imaging was performed to calculate the mean grey level (MGL) and cyclic variation index (CVI).
The haemodialysis patients had a significantly lower CVI compared with hypertensives and controls both for septum (D): -2.5 +/- 17.4% vs (H); 11.8 +/- 17% vs (C); 43.2 +/- 15.4% (P<0.001) and for posterior wall (D): -10.1 +/- 261% vs (H); 14.2 +/- 14.7% vs (C); 46.6 +/- 17.2% (P<0.001). A significant inverse relationship was found between intact parathyroid hormone (iPTH) and CVI.
Abnormalities of two-dimensional echocardiographic grey level distribution are present in both haemodialysis patients and hypertensive patients, but seem unrelated to the degree of echocardiographic hypertrophy. These videodensitometric myocardial alterations are significantly higher in dialysis patients than in hypertensive patients with the same extent of left ventricular hypertrophy. The iPTH level may play a role in the development of the ultrasonic myocardial alterations, which probably represent an early stage of uraemic cardiomyopathy.
本研究旨在调查透析患者的心肌视频密度测定参数，这些患者代表了压力容量超负荷的复杂病理生理模型，同时也调查左心室质量相同的原发性高血压患者的心肌视频密度测定参数。
我们将一组男性透析患者（D组）与两组进行比较：左心室质量相当的高血压患者（H组）以及作为对照的血压正常的健康受试者（C组）。每组（每组n = 15）在年龄（53±9岁）和性别上相匹配。对超声心动图数字化图像进行定量分析，以计算平均灰度水平（MGL）和循环变化指数（CVI）。
血液透析患者的CVI显著低于高血压患者和对照组，无论是室间隔（D组）：-2.5±17.4% 对比（H组）；11.8±17% 对比（C组）；43.2±15.4% （P<0.001），还是后壁（D组）：-10.1±261% 对比（H组）；14.2±14.7% 对比（C组）；46.6±17.2% （P<0.001）。发现完整甲状旁腺激素（iPTH）与CVI之间存在显著的负相关关系。
血液透析患者和高血压患者均存在二维超声心动图灰度水平分布异常，但似乎与超声心动图肥厚程度无关。这些视频密度测定的心肌改变在透析患者中比在左心室肥厚程度相同的高血压患者中显著更高。iPTH水平可能在超声心动图心肌改变的发生中起作用，这些改变可能代表尿毒症性心肌病的早期阶段。
