剪切波弹性成像定量评价左心室不同构型的尿毒症患者颈动脉弹性的应用价值

Application value of shear wave elastography in the quantitative evaluation of carotid artery elasticity in uremic patients with different left ventricular configurations

摘要:

目的]探讨剪切波弹性成像(SWE)定量评价左心室不同构型的尿毒症患者颈动脉弹性的应用价值。 [方法]根据左心室不同构型将纳入的139例确诊为尿毒症的患者分成4组:正常构型组(NG,n＝37)、向心性重构组(CR,n＝37)、向心性肥厚组(CH,n＝38)和离心性肥厚组(EH,n＝27),并从健康人群中选择40例作为对照组。收集并比较受试者的一般资料及生物化学指标；应用颈动脉常规超声测量左侧颈动脉内膜中膜厚度(IMT)、颈动脉收缩期内径(Ds)、颈动脉舒张期内径(Dd)及收缩期峰值速度(PSV),并计算管壁运动度(ΔD)和动脉僵硬度系数(β)；应用SWE获取颈动脉前壁内膜中膜弹性模量最大值(ME_max)、弹性模量平均值(ME_mean)、弹性模量最小值(ME_min)。 [结果]与对照组相比,NG组和CR组IMT和β增高,但三组间差异均无显著性(P＞0.05)；CH组和EH组IMT和β较对照组、NG组和CR组均显著增高(P＜0.05)。与对照组相比,NG组、CR组、CH组和EH组ME_max、ME_mean和ME_min均显著增高,且EH组＞CH组＞CR组＞NG组＞对照组,各组间差异均有显著性(P＜0.05)。各组ME_max、ME_mean和ME_min与IMT、β、甘油三酯(TG)均呈正相关(均r＞0.39,均P＜0.01)。线性回归分析结果显示,尿毒症患者的左心室不同构型与SWE参数之间存在显著相关性(P＜0.05)。 [结论]不同左心室构型的尿毒症患者颈动脉受累程度不同,SWE可早期评价该类患者颈动脉弹性。

Abstract:

Aim To explore the application value of shear wave elastography (SWE) in the quantitative evaluation of carotid elasticity in uremic patients with different left ventricular configurations. Methods A total of 139 uremic patients were classified into four groups based on different left ventricular configurations:normal geometry group (NG, n＝37), concentric remodeling group (CR, n＝37), concentric hypertrophy group (CH, n＝38), and eccentric hypertrophy group (EH, n＝27). Additionally, 40 healthy individuals were selected as the control group. General clinical data and biochemical indicators of the subjects were collected and compared. Conventional carotid ultrasound was used to assess the intima-media thickness (IMT), peak systolic velocity (PSV), and the systolic and diastolic diameters (Ds and Dd) of the left common carotid artery. The wall motion degree (ΔD) and arterial stiffness coefficient (β) were calculated. The maximum elastic modulus (ME_max), mean elastic modulus (ME_mean), and minimum elastic modulus (ME_min) of the carotid artery anterior wall intima-media were obtained using SWE. Results Compared with the control group, IMT and β were elevated in the NG group and CR group, but there were no significant differences among the three groups (P＞0.05). In contrast, IMT and β values were increased in the CH group and EH group compared with the control group, NG group, and CR group (P＜0.05). Compared with the control group, ME_max, ME_mean, and ME_min were significantly elevated in the NG group, CR group, CH group and EH group, with a progressive increase observed in the order:EH group ＞ CH group ＞ CR group ＞ NG group ＞ control group, statistically significant differences were found among all groups (P＜0.05). ME_max, ME_mean and ME_min in all groups were positively correlated with IMT, β and triglyceride (TG) (all r＞0.39, all P＜0.01). The linear regression analysis revealed a statistically significant association between different left ventricular configurations and SWE parameters in uremic patients (P＜0.05). Conclusions Uremic patients with different left ventricular configurations exhibit varying degrees of carotid artery involvement. SWE can provide quantitative and early evaluation of carotid artery elasticity in these patients.