Pardała Agnieszka, Lupa Mariusz, Chudek Jerzy, Kolonko Aureliusz
Dialysis Centre, Fresenius Nephrocare, 34-600 Limanowa, Poland.
Department of Internal Medicine, District Hospital, 34-600 Limanowa, Poland.
Medicina (Kaunas). 2019 Feb 12;55(2):45. doi: 10.3390/medicina55020045.
Reliable assessment of the fluid status in hemodialysis (HD) patients is often difficult. A lung ultrasound with an assessment of the B-lines ("lung comets" (LCs)) number is a novel hydration status measure. However, the occurrence of left ventricular dysfunction may have a significant effect on pulmonary congestion and further modulate the LC number. The aim of this study was to analyze to what extent left ventricular dysfunction, pulmonary hypertension, and hypervolemia affect the occurrence of LC in a cohort of prevalent HD patients.
This cross-sectional study included 108 assessments performed in 54 patients who attended thrice weekly outpatient HD. Each patient's fluid status was evaluated twice, prior to HD sessions, using echocardiography, LC number assessment, measurement of inferior vena cava (IVC) diameters, and bioelectric impedance analysis (BIA). Patients were stratified into three subgroups according to their LC number.
There were 76 separate assessments with mild (<14), 16 with moderate (14⁻30), and 16 with severe (>30) LC occurrence. There was a negative correlation between the LC number and left ventricular ejection fraction (LVEF), and positive correlations between the LC number and mitral gradient, and the left and right atrium area and volume, but not with the BIA-derived relative fluid overload. Multivariate linear regression analysis revealed that the LC number was proportionally related to the mitral gradient (β = 0.407 (0.247⁻0.567), p < 0.001) and IVC max diameter (β = 0.219 (0.060⁻0.378), p < 0.01), and was inversely related to LVEF (β = -0.431 (-0.580 to -0.282), p < 0.001).
The number of LCs appears to reflect both overhydration and left ventricular dysfunction in our HD patients cohort. Therefore, heart failure must be considered as an important factor limiting the usefulness of LCs number assessment in this population.
可靠评估血液透析（HD）患者的液体状态往往很困难。通过评估B线（“肺彗星征”（LCs））数量的肺部超声检查是一种新的水化状态测量方法。然而，左心室功能障碍的发生可能对肺充血有显著影响，并进一步调节LC数量。本研究的目的是分析在一组维持性HD患者中，左心室功能障碍、肺动脉高压和血容量过多对LC发生的影响程度。
这项横断面研究包括对54例每周接受三次门诊HD治疗的患者进行的108次评估。在HD治疗前，使用超声心动图、LC数量评估、下腔静脉（IVC）直径测量和生物电阻抗分析（BIA）对每位患者的液体状态进行两次评估。根据患者的LC数量将其分为三个亚组。
共有76次单独评估显示LC发生情况为轻度（<14），16次为中度（14⁻30），16次为重度（>30）。LC数量与左心室射血分数（LVEF）呈负相关，与二尖瓣梯度、左心房和右心房面积及容积呈正相关，但与BIA得出的相对液体超负荷无关。多因素线性回归分析显示，LC数量与二尖瓣梯度（β = 0.407（0.247⁻0.567），p < 0.001）和IVC最大直径（β = 0.219（0.060⁻0.378），p < 0.01）成比例相关，与LVEF呈负相关（β = -0.431（-0.580至-0.282），p < 0.001）。
在我们的HD患者队列中，LC数量似乎既反映了水合过多，也反映了左心室功能障碍。因此，心力衰竭必须被视为限制该人群中LC数量评估效用的一个重要因素。
