Jin Xiucai, Rong Shu, Mei Changlin, Ye Chaoyang, Chen Jiabin, Chen Xiaoyu
Department of Ultrasound, Nephrology Institute, Changzheng Hospital, Second Military Medical University, Shanghai, China.
Hemodial Int. 2011 Apr;15(2):200-10. doi: 10.1111/j.1542-4758.2011.00537.x. Epub 2011 Mar 13.
Ultrasonic tissue characterization with integrated backscatter (IBS) offers a promising method for the noninvasive assessment of myocardial fibrosis and contractile performance. The aim of this study was to investigate the effect of thrice-weekly in-center nocturnal hemodialysis (INHD) and conventional hemodialysis (CHD) on myocardial fibrosis and left ventricular function in end-stage renal disease patients. Thirty-two INHD and 58 matched CHD patients were enrolled; baseline and 12-month measures of blood pressure (BP), serum calcium and phosphorus, echocardiographic left ventricular mass index (LVMI) and left ventricular function, the myocardial calibrated IBS (C-IBS), and systodiastolic cyclical variations in IBS (CV-IBS) were collected. The baseline characteristics were similar between groups, except that serum phosphorus and calcium × phosphorus were higher in the INHD group. At 12-month follow-up, there was a significant decrease in the mean C-IBS (-20.2 ± 3.7 to -28.1 ± 4.0 dB, P<0.01) and a significant increase in CV-IBS (5.0 ± 1.5 to 7.1 ± 1.6 dB, P<0.01) in INHD patients. Multivariate analysis showed that the mean C-IBS was positively related to SBP, DBP, LVMI, serum phosphorus, and left atrial volume index and inversely related to midwall fractional shortening, transmitral E/A ratio, and E(m) . The mean CV-IBS was positively correlated with left ventricular midwall fractional shortening, E/A ratio, E(m) and inversely correlated with SBP, DBP, LVMI, serum phosphorus, E/E(m) , and left atrial volume index. There was no significant change in the mean C-IBS, mean CV-IBS, and LVMI in the CHD group. Compared with CHD, INHD improves myocardial fibrosis and left ventricular function, and control of serum phosphorus is associated with the improvement of myocardial fibrosis. Improvement of myocardial fibrosis contributes to the reduction of left ventricle hypertrophy.
采用背向散射积分（IBS）进行超声组织特征分析为无创评估心肌纤维化和收缩功能提供了一种很有前景的方法。本研究旨在探讨每周三次的夜间中心血液透析（INHD）和传统血液透析（CHD）对终末期肾病患者心肌纤维化和左心室功能的影响。纳入了32例INHD患者和58例匹配的CHD患者；收集了血压（BP）、血清钙和磷、超声心动图左心室质量指数（LVMI）和左心室功能、心肌校正IBS（C-IBS）以及IBS的收缩舒张周期性变化（CV-IBS）的基线和12个月测量值。两组间基线特征相似，但INHD组的血清磷和钙×磷较高。在12个月的随访中，INHD患者的平均C-IBS显著降低（从-20.2±3.7 dB降至-28.1±4.0 dB，P<0.01），CV-IBS显著升高（从5.0±1.5 dB升至7.1±1.6 dB，P<0.01）。多因素分析显示，平均C-IBS与收缩压、舒张压、LVMI、血清磷和左心房容积指数呈正相关，与室壁中层缩短分数、二尖瓣E/A比值和E(m)呈负相关。平均CV-IBS与左心室室壁中层缩短分数、E/A比值、E(m)呈正相关，与收缩压、舒张压、LVMI、血清磷、E/E(m)和左心房容积指数呈负相关。CHD组的平均C-IBS、平均CV-IBS和LVMI无显著变化。与CHD相比，INHD可改善心肌纤维化和左心室功能，血清磷的控制与心肌纤维化的改善相关。心肌纤维化的改善有助于减轻左心室肥厚。
