摘要目的:采用三维斑点追踪显像(3DSTE)评价维持性血液透析(MHD)患者左心房形态及功能变化并探索硫酸吲哚酚(IS)对左心房功能的影响。方法:2019年5月至2020年1月，连续入组复旦大学附属中山医院血液净化中心的MHD(透析龄>6个月)患者91例(MHD组)及年龄性别匹配的健康志愿者37例(对照组)，采集左房三维斑点追踪图像进行脱机分析，获得左房容积和应变参数，包括左房最大容积(LAV-max)、收缩期前容积(LAV-preA)、最小容积(LAV-min)、左房整体储备应变(LASr)、通道期应变(LAScd)和主动收缩应变(LASct)，同时采用高效液相色谱-电喷雾电离-串联质谱法(HPLC-ESI-MS/MS)检测血浆IS浓度，并分析其与左房参数的相关性。结果:与对照组相比，MHD组左房明显增大( P<0.05)，LASr及LAScd减小( P<0.05)，而LASct无显著变化( P>0.05)。根据血浆IS浓度将MHD组分为高IS组与低IS组，发现高IS组LASr、LAScd和LASct均显著下降( P<0.05)。相关性分析显示IS浓度与左房应变显著相关(LASr： rs＝-0.674；LAScd： rs＝0.454；LASct： rs＝0.376；均 P<0.001)，经年龄、血压、左室质量指数及肺动脉收缩压校正后，IS浓度与LASr独立负相关(β＝-0.206，95% CI＝-0.353～-0.059， P＝0.007)。 结论:MHD患者的左房增大，整体储备和通道功能受损；左房应变值与血浆IS浓度独立相关，可用于监测和评价IS效应性心脏损伤。

abstractsObjective:To investigate the influence of indoxyl sulfate(IS), a typical protein-bound uremic toxin, on left atrial (LA) functional strains using three-dimensional speckle tracking echocardiography (3DSTE).Methods:From May 2019 to January 2020, 128 individuals were consecutively enrolled, including 37 healthy controls and 91 patients, who received maintenance hemodialysis (MHD) in the blood purification center of Zhongshan Hospital affiliated to Fudan University. Conventional echocardiographic parameters and 3DSTE datas of LA were obtained on interdialytic days.LA reservoir, conduit and contraction strains (LASr, LAScd and LASct) were calculated and compared. IS concentration in plasma was assessed by high-performance liquid chromatography tandem mass spectrometry in the MHD cohort.According to the IS concentration, the MHD group was divided into high and low IS (HI and LI) groups. The LA data were also compared between the two groups and linear regression analysis was used to identify independent impact factors of LA strains.Results:Compared to the control group, MHD group had markedly enlarged LA volumes( P<0.05). With regard to the LA phasic strains, both of LASr and LAScd were decreased( P<0.05), while LASct remained unchanged( P>0.05). Compared to the LI group, LASr, LAScd and LASct of the HI group were significantly decreased(all P<0.05). Correlation analysis showed IS concentration correlated well with LASr( rs=-0.674, P<0.001), LAScd( rs=0.454, P<0.001) and LASct( rs=0.376, P<0.001). After adjustment of age, systolic blood pressure, left ventricular mass index(LVMI), and pulmonary systolic pressure, IS concentration remained independently associated with LASr (β=-0.206, 95% CI=-0.353--0.059, P=0.007). Conclusions:In MHD patients, LA is enlarged, and its reservoir function and conduit function are impaired.LA strains derived from 3DSTE are independently related to the IS concentration in plasma, which can be used for the monitoring and evaluation of IS induced cardiac injury.