| Objective:To evaluate the ratio of left ventricular mass index(LVMI)and early mitral flow velocity(E)to the mitral filling velocity(A)ratio(E/A ratio)during atrial contraction.Diagnostic value of cardiovascular disease in patients with diabetic nephropathy peritoneal dialysis.Methods:195 patients undergoing peritoneal dialysis in the Department of Nephrology of the Second Affiliated Hospital of Kunming Medical University from January 2016 to December 2017 were selected as subjects and divided into diabetic nephropathy(DN)group and non-diabetic nephropathy(NDN).group.All clinical data and related indicators including age,gender,body mass index(BMI),hemoglobin,albumin,blood lipids,and total urea clearance index were collected from the study subjects,and cardiac function and structure were evaluated by Doppler ultrasound.Univariate analysis and multivariate logistic regression analysis were used to analyze the cardiovascular injury factors in two groups of patients.The value of LVMI and E/A ratio in Doppler echocardiography was evaluated in the diagnosis of cardiovascular disease in DN peritoneal dialysis patients.Results:56 patients were enrolled in the DN group,including 26 males and 30 females;NDN 139 patients,76 males and 63 females.There was no statistically significant difference in gender composition ratio between the two groups(P>0.05).The age and BMI of the two groups were tested by t-test.The results showed that the age and BMI of the DN group were higher than those of the NDN group.Significance(P<0.05).Laboratory tests such as blood cell analysis and blood biochemistry in the two groups were tested by independent sample t-test/Wilcoxon W rank sum test.The results suggested that the hemoglobin(HGB)in the NDN group was higher than that in the DN group,and the total cholesterol in the NDN group was higher than that in the DN group.High-density lipoprotein cholesterol(H-DLC)was higher in the NDN group than in the DN group;LDLC was higher in the NDN group than in the DN group;GLU was higher in the DN group than in the NDN group;calcium was found in the NDN group(Ca)Higher than the DN group;the difference in HGB,TCHOL.H-DLC,L-DLC,GLU,and Ca between the two groups was statistically significant(P<0.05).Echocardiographic index analysis of the two groups of peritoneal dialysis patients showed that E/A ratio of evaluating left ventricular diastolic function was higher than that of DN group.Among them,the mean value of E/A ratio in NDN group was 0.91±0.32 and 0.80±in DN group.At 0.18,the E/A ratio in the two groups was tested by the Wilcoxon W rank sum test.The difference was statistically significant(P<0.05).The probability of E/A<1 in the DN group was higher than that in the NDN group.Among them,103 patients(74.10%)had E/A<1 in the NDN group and 48 cases(85.74%)in the DN group.The difference between the two groups was statistically significant(P<0.05),suggesting that left ventricular diastolic function was poor in DN group;LVMI index of left ventricular hypertrophy was higher than NDN group,and the average LVMI of NDN group was 101.31±11.94.The DN group was 109.08±17.11.The LVMI of the two groups was tested by two independent samples t test,the difference was statistically significant(P<0.05).The probability of LVH in the DN group was higher than that in the NDN group.Among them,57 cases were in the ND group.(41.01%)in the DN group was 34 cases(60.71%).The two groups were compared by the chi-square test,the difference was statistically significant(P<0.05),suggesting that patients with DN were more likely to have left ventricular hypertrophy;A in both groups The differences among the indicators such as LVDD,IVST,and LVPWT were statistically significant.Logistic regression showed that E/A ratio,LVMI,BMI,HGB,LAD,and LVDd were the influencing factors of diabetic nephropathy.In conclusion:(1)The study found that diabetic nephropathy patients with peritoneal dialysis peritoneal dialysis patients with high age.BMI,GLU,serum HGB,TCHOL,LDLC is low,indicating that the elderly patients with peritoneal dialysis,high body mass index,low hemoglobin,high blood sugar,high cholesterol and The prognosis of diabetic nephropathy patients with peritoneal dialysis is closely related.(2)Patients with peritoneal dialysis often have cardiovascular events due to inadequate dialysis.This study found that the differences in rKt/V,pKt/V,and tKt/V of all enrolled patients were not statistically significant,suggesting that peritoneal dialysis is adequate in both diabetic nephropathy and non-diabetic nephropathy,and this can be excluded in this study.Insufficient dialysis causes cardiovascular damage.(3)LVM is a well-recognized and important index for evaluating left ventricular remodeling clinically.The fluctuation of this index is related to interventricular systolic end-diastolic thickness(IVST),left ventricular end-diastolic diameter(LVDd)and left ventricular posterior diastolic thickness(LVPWT)index fluctuations,regardless of one of the values increased,LVMI immediately increased,it can be earlier and sensitive prediction of left ventricular hypertrophy.This study found that the LVMI was significantly higher in the DN group than in the NDN group,suggesting that LVMI could predict the cardiovascular complications of DN patients with peritoneal dialysis earlier.(4)Left ventricular diastolic function is a sensitive index for evaluating chronic heart failure,E/A ratio can be used to evaluate left ventricular diastolic dysfunction,the fluctuation of E/A ratio with early mitral flow velocity(E)and atrial contraction When the mitral filling peak speed(A)index changes and fluctuates,as long as one of them changes,the E/A ratio changes immediately.When the patient's diastolic function is impaired,early diastolic left ventricular pressure decreases and the mitral flow velocity(E)slows and fills less,while the late diastolic filling(A)increases relatively,resulting in a decrease in the E/A ratio.With the decrease of E/A<1,the degree of left ventricular diastolic dysfunction gradually increased,resulting in a significant increase in cardiovascular mortality.This study found that E/A<1 in the DN group was significantly higher than that in the NDN group,indicating that the DN group was more severely impaired in diastolic function.It is suggested that the E/A ratio can be used to predict cardiovascular complications of DN in patients with peritoneal dialysis earlier.(5)The use of left ventricular hypertrophy or left ventricular diastolic dysfunction to assess cardiovascular damage has certain limitations.The common use of the two can be used to more comprehensively assess changes in cardiac structure and function,and LVMI and E/A ratio can be relatively Comprehensive and sensitive reflection... |
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