【摘要】 目的　了解尿毒症患者心肌声学密度的特征及其与血压、钙磷代谢等因素的关系。方法　根据尿毒症患者血透最初 6个月内血压水平 ,分成血压控制良好组 (A组 )和高血压组 (B组 ) ,各组取 15例患者 ,同时设健康对照组 15例 (C组 ) ,采用超声组织定征技术测量尿毒症患者和健康人群心肌背向散射积分值。结果　透析 6个月时 ,A、B两组患者的血红蛋白 (Hb)水平显著低于正常对照组 (P <0 .0 5 )。A、C组患者平均背向散射积分值 (AIB)显著低于B组 ,相应的心肌背向散射积分心动周期的变化幅度 (CVIB)显著大于B组 (P <0 .0 5 ) ,但A、C组患者AIB、CVIB组间差异无统计学意义。A组患者随访 12～ 18个月 ,配对t检验显示维持性血透患者在纠正高血压和贫血的前提下 ,其不同透析时期心肌AIB及CVIB无显著改变 ,上述心肌组织密度参数与同期血浆甲状旁腺激素 (iPTH)和钙磷水平无显著相关。结论　血压控制良好的患者心肌组织密度参数与正常人群相似。高血压是影响尿毒症心肌纤维化的主要因素。早期控制高血压很重要。尿毒症患者一旦发生心肌纤维化 ,则难以逆转更多还原

【Abstract】 Purpose To measure the ultrasonic backscatter parameters of myocardium by ultrasonic tissue characterization in uremic patients,try to evaluate the severity of myocardial fibrosis and its risk factors. Methods Thirty hemodialysis patients and 15 healthy volunteers(M∶F 4∶1) were involved.After first 6 months’ treatment,all the patients were divided into group A whose blood pressure were maintained in the normal range and group B who had hypertension.After 6 months’ hemodialysis,all the patients undertook echocardiography.Fifteen volunteers(group C) also took this examination as the control. Results After 6 months’ therapy,the mean hemoglobin in uremic patients[group A(95.6±17.7)g/L,group B(90.7± 13.8 )g/L] was lower than that in healthy volunteers[group C(128±15.6)g/L,( P <0.01)],but there were no significant difference between group A and group B.Average integrated backscatter of group B is higher than that of group A and group C,the corresponding cyclic variation of integrated backscatter is lower than that of group A and group C( P <0.05).With blood pressure and hemoglobin level well controlled,patients in group A had taken echocardiography twice to trice every 6 months since the beginning of dialysis.Paired T test showed that there were no difference between each test on ultrasonic backscatter parameters[AIB(Average integrated backscatter) and CVIB(cyclic variation of integrated backscatter)],immunoreactive parathyroid hormone and calcium phosphorus multiplication. Conclusions It is showed that hypertensive uremic patients had a higher intergrated backscatter value than non hypertensive patients.Blood pressure maybe the major factor contributing to myocardial fibrosis in the early stage of this cardiomyopathy.更多还原