右心超声联合肾血流多普勒评分对终末期肾病患者透析间期的应用价值

doi:10.3969/j.issn.1004-583X.2025.01.008

摘要/Abstract

摘要：

目的探究右心超声指标联合肾血流多普勒评分(RVDS)评估终末期肾病(ESRD)患者透析间期是否需再次透析的价值。方法根据是否需再次接受透析治疗,将46例符合ESRD诊断且处于透析间期患者分为需透析组及对照组,使用超声监测右心指标,并记录双侧肾脏RVDS。使用受试者工作特征曲线评价各参数诊断效能,并将RVDS与肾小球滤过率、肌酐指标进行相关性分析。结果需透析组较对照组具有较高的右心室内径(RVD)、三尖瓣最大反流速度、肺动脉收缩压、室间隔偏心指数,和较低的三尖瓣环收缩期位移(TAPSE)、三尖瓣环收缩期最大速度(S’)、R-RVDS和L-RVDS(P均<0.05)。RVD、室间隔偏心指数、TAPSE、S’、三尖瓣最大反流速度、肺动脉收缩压、R-RVDS预测ESRD患者再次少尿的AUC值分别为0.765、0.750、0.770、0.780、0.707、0.723、0.682。TAPSE联合R-RVDS的敏感度92.0%,特异度76.2%,AUC值0.850。相关性分析显示,R-RVDS和L-RVDS分别与肾小球滤过率呈正相关性(r值分别为0.514和0.544);R-RVDS和L-RVDS分别与肌酐呈负相关性(r值分别为-0.337和-0.484)。结论右心超声指标联合RVDS对ESRD患者需再次透析者具有较好的评估和预测价值。

关键词: 肾功能衰竭, 慢性, 超声检查, 多普勒, 肾透析, 肾脏血流, 右心功能

Abstract:

Objective To explore the value of right heart ultrasound index combined with renal vascular doppler score (RVDS) in evaluating the need for re-dialysis in patients with end-stage renal disease (ESRD). Methods According to the need for re-dialysis, 46 patients diagnosed as ESRD during dialysis were divided into the dialysis and control groups. Right heart ultrasound index was recorded by bedside ultrasonography, and the RVDS of bilateral kidneys was recorded. Receiver operating characteristic (ROC) curves were plotted to evaluate the diagnostic efficacy of each parameter. The correlation of RVDS with glomerular filtration rate and creatinine was analyzed. Results Compared with the control group, ESRD patients in the dialysis group had significantly higher right ventricular diameter (RVD), maximum tricuspid regurgitation velocity, pulmonary arterial systolic pressure, interventricular septal eccentricity index, and lower tricuspid annular plane systolic excursion (TAPSE), maximum velocity of tricuspid annulus contraction (S’), right-side RVDS (R-RVDS) and left-side RVDS (L-RVDS)(P<0.05). The area under the curve (AUC) of RVD, interventricular septal eccentricity index, TAPSE, S’, maximum tricuspid regurgitation velocity, pulmonary arterial systolic pressure and R-RVDS was 0.765, 0.750, 0.770, 0.780, 0.707, 0.723 and 0.682, respectively. TAPSE combined with R-RVDS had a sensitivity of 92.0%, specificity of 76.2% and AUC value of 0.850. Correlation analysis showed that R-RVDS and L-RVDS were positively correlated with glomerular filtration rate (r=0.514 and 0.544, respectively), but negatively correlated with creatinine (r=-0.337 and -0.484, respectively). Conclusion Right heart ultrasound index combined with renal vascular doppler score has higher evaluation and predictive value for patients who need re-dialysis with end-stage renal disease.

Key words: kidney failure, chronic, ultrasonography, doppler, renal dialysis, renal vascular, right heart function

中图分类号:

R692.5

刘奕, 赵浩天, 王晓娜, 刘元琳, 李丽, 王泽凯. 右心超声联合肾血流多普勒评分对终末期肾病患者透析间期的应用价值[J]. 临床荟萃, 2025, 40(1): 54-59.

Liu Yi, Zhao Haotian, Wang Xiaona, Liu Yuanlin, Li Li, Wang Zekai. Application value of right heart ultrasound combined with renal vascular doppler score in patients with end-stage renal disease during dialysis[J]. Clinical Focus, 2025, 40(1): 54-59.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2025.01.008

https://huicui.hebmu.edu.cn/CN/Y2025/V40/I1/54

图/表 6

图1 右心功能超声参数测量 a. TAPSE测量值为11.3 mm;b. 三尖瓣最大反流速度测量值为3.3 m/s,伯努利方程法计算肺动脉收缩压为53 mmHg(1 mmHg=0.133 kPa)

Fig.1 Measurement of ultrasound parameters of right heart function a. the systolic displacement of TAPSE was 11.3 mm; b. the maximum return velocity of the tricuspid valve was 3.3 m/s, and the pulmonary artery systolic pressure was 53 mmHg via Bernoulli equation method (1 mmHg=0.133 kPa)

图2 左心室短轴偏心指数测量 a.对照组左心室短轴超声切面,偏心指数=横径(黄线)/纵径(蓝线),计算为0.97;b.需透析组左心室短轴超声切面,偏心指数计算为1.39

Fig.2 Short-axis eccentric indices measurements of the left ventricle a. the short axis ultrasound section with eccentricity index=transverse diameter (yellow line) / longitudinal diameter (blue line) was 0.97 in the control group; b. which was 1.39 in the dialysis group

表1 两组一般资料比较

Tab.1 Baseline data between the two groups

指标	例数		年龄 (岁)	性别[例(%)]				BMI (kg/m²)	心率 (次/min)		收缩压 (mmHg)		舒张压 (mmHg)
指标	例数		年龄 (岁)	男		女		BMI (kg/m²)	心率 (次/min)		收缩压 (mmHg)		舒张压 (mmHg)
需透析组	21		58.81±17.38	13(61.9)		8(38.1)		23.95(2.56)	89.71±17.01		145.76±21.07		84.38±15.28
对照组	25		53.20±14.57	17(68.0)		8(32.0)		25.62(6.89)	86.68±14.47		152.68±20.93		87.88±12.47
统计值			$t$ =1.191	χ²=0.187				$Z$ =-1.533	$t$ =0.654		$t$ =-1.113		$t$ =-0.856
$P$ 值			0.240	0.665				0.125	0.517		0.272		0.397
指标		肾小球滤过率 (ml/min)			肌酐 (μmol/L)		WBC (×10⁹/L)			NEUT (%)		下肢水肿 [例(%)]
需透析组		7.29±2.98			569.60(410.25)		8.18(5.80)			81.90(11.40)		8(38.1)
对照组		8.53±3.24			528.00(372.92)		6.98(1.83)			80.20(13.70)		12(48.0)
统计值		$t$ =-1.340			$Z$ =-0.827		$Z$ =-0.783			$Z$ =-0.805		χ²=0.456
$P$ 值		0.187			0.408		0.434			0.421		0.500

表1 两组一般资料比较

Tab.1 Baseline data between the two groups

指标	例数		年龄 (岁)	性别[例(%)]				BMI (kg/m²)	心率 (次/min)		收缩压 (mmHg)		舒张压 (mmHg)
指标	例数		年龄 (岁)	男		女		BMI (kg/m²)	心率 (次/min)		收缩压 (mmHg)		舒张压 (mmHg)
需透析组	21		58.81±17.38	13(61.9)		8(38.1)		23.95(2.56)	89.71±17.01		145.76±21.07		84.38±15.28
对照组	25		53.20±14.57	17(68.0)		8(32.0)		25.62(6.89)	86.68±14.47		152.68±20.93		87.88±12.47
统计值			$t$ =1.191	χ²=0.187				$Z$ =-1.533	$t$ =0.654		$t$ =-1.113		$t$ =-0.856
$P$ 值			0.240	0.665				0.125	0.517		0.272		0.397
指标		肾小球滤过率 (ml/min)			肌酐 (μmol/L)		WBC (×10⁹/L)			NEUT (%)		下肢水肿 [例(%)]
需透析组		7.29±2.98			569.60(410.25)		8.18(5.80)			81.90(11.40)		8(38.1)
对照组		8.53±3.24			528.00(372.92)		6.98(1.83)			80.20(13.70)		12(48.0)
统计值		$t$ =-1.340			$Z$ =-0.827		$Z$ =-0.783			$Z$ =-0.805		χ²=0.456
$P$ 值		0.187			0.408		0.434			0.421		0.500

表2 两组超声参数比较

Tab.2 Ultrasound parameters between the two groups

指标	例数	RVD (mm)	TAPSE (mm)	S’ (cm/s)	室间隔偏心指数	三尖瓣最大反流速度 (m/s)	肺动脉收缩压 (mmHg)	R-RVDS (分)	L-RVDS (分)
需透析组	21	36.43±5.55	15.19±3.02	12.35±2.52	1.06(0.12)	3.00±0.81	47.00(26.50)	1.26±0.26	1.36±0.32
对照组	25	31.76±4.42	17.86±1.89	14.79±2.13	1.02(0.05)	2.57±0.45	35.00(15.00)	1.54±0.43	1.60±0.46
统计值		$t$ =3.178	$t$ =-3.512	$t$ =-3.566	$Z$ =-2.902	$t$ =2.149	$Z$ =-2.583	$t$ =-2.594	$t$ =-2.109
$P$ 值		0.003	0.001	0.001	0.004	0.040	0.010	0.013	0.041

表2 两组超声参数比较

Tab.2 Ultrasound parameters between the two groups

指标	例数	RVD (mm)	TAPSE (mm)	S’ (cm/s)	室间隔偏心指数	三尖瓣最大反流速度 (m/s)	肺动脉收缩压 (mmHg)	R-RVDS (分)	L-RVDS (分)
需透析组	21	36.43±5.55	15.19±3.02	12.35±2.52	1.06(0.12)	3.00±0.81	47.00(26.50)	1.26±0.26	1.36±0.32
对照组	25	31.76±4.42	17.86±1.89	14.79±2.13	1.02(0.05)	2.57±0.45	35.00(15.00)	1.54±0.43	1.60±0.46
统计值		$t$ =3.178	$t$ =-3.512	$t$ =-3.566	$Z$ =-2.902	$t$ =2.149	$Z$ =-2.583	$t$ =-2.594	$t$ =-2.109
$P$ 值		0.003	0.001	0.001	0.004	0.040	0.010	0.013	0.041

表3 各指标对预测终末期肾脏病患者的预测价值

Tab.3 Predictive value of each index for predicting ESRD patients

	AUC	$P$ 值	95% $C I$		敏感度	特异度	界值
	AUC	$P$ 值	下限	上限	敏感度	特异度	界值
RVD	0.765(0.621~0.908)	0.002	0.621	0.908	76.2	76.0	33.50
室间隔偏心指数	0.750(0.607~0.892)	0.004	0.607	0.892	66.7	72.0	1.035
TAPSE	0.770(0.626~0.913)	0.002	0.626	0.913	92.0	61.9	15.50
S’	0.780(0.640~0.920)	0.001	0.640	0.920	76.0	76.2	13.55
三尖瓣最大反流速度	0.707(0.543~0.870)	0.017	0.543	0.870	71.4	72.0	2.75
肺动脉收缩压	0.723(0.563~0.883)	0.010	0.563	0.883	81.0	68.0	37.50
R-RVDS	0.682(0.529~0.835)	0.035	0.529	0.835	32.0	100.0	1.75
L-RVDS	0.654(0.495~0.813)	0.074	0.495	0.813	44.0	90.5	1.75
TAPSE联合R-RVDS	0.850(0.736~0.963)	<0.001	0.736	0.963	92.0	76.2	-

表3 各指标对预测终末期肾脏病患者的预测价值

Tab.3 Predictive value of each index for predicting ESRD patients

	AUC	$P$ 值	95% $C I$		敏感度	特异度	界值
	AUC	$P$ 值	下限	上限	敏感度	特异度	界值
RVD	0.765(0.621~0.908)	0.002	0.621	0.908	76.2	76.0	33.50
室间隔偏心指数	0.750(0.607~0.892)	0.004	0.607	0.892	66.7	72.0	1.035
TAPSE	0.770(0.626~0.913)	0.002	0.626	0.913	92.0	61.9	15.50
S’	0.780(0.640~0.920)	0.001	0.640	0.920	76.0	76.2	13.55
三尖瓣最大反流速度	0.707(0.543~0.870)	0.017	0.543	0.870	71.4	72.0	2.75
肺动脉收缩压	0.723(0.563~0.883)	0.010	0.563	0.883	81.0	68.0	37.50
R-RVDS	0.682(0.529~0.835)	0.035	0.529	0.835	32.0	100.0	1.75
L-RVDS	0.654(0.495~0.813)	0.074	0.495	0.813	44.0	90.5	1.75
TAPSE联合R-RVDS	0.850(0.736~0.963)	<0.001	0.736	0.963	92.0	76.2	-

图3 各参数诊断效能的ROC曲线

Fig.3 ROC curve of the diagnostic efficacy of each parameter

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