天津医药

天津医药 ›› 2021, Vol. 49 ›› Issue (6): 636-641.doi: 10.11958/20203448

• 应用研究 • 上一篇    下一篇

四维超声定量技术评价不同分级肝硬化患者左房容积和功能的特征 #br#

戴敏，汪芸玏，彭丽娟，党时鹏，钱大钧，马芳山
  

  1. 1南京医科大学附属无锡市人民医院心功能科（邮编214023）；2无锡市第五人民医院超声科

  • 收稿日期:2020-12-14 修回日期:2021-01-14 出版日期:2021-06-15 发布日期:2021-06-15
  • 通讯作者: 戴敏 E-mail:daiminjh@126.com
  • 基金资助:
    国自然科学基金 青年基金项目

The quantitative evaluation of left atrial volume and function by four-dimensional echocardiography in patients with different grades of liver cirrhosis

DAI Min, WANG Yun-le, PENG Li-juan, DANG Shi-peng, QIAN Da-jun, MA Fang-shan #br#   

  1. 1 Department of Cardiac Function, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi 214023, China;
    2 Department of Ultrasonography, Wuxi Fifth People's Hospital
  • Received:2020-12-14 Revised:2021-01-14 Published:2021-06-15 Online:2021-06-15
  • Contact: dai min E-mail:daiminjh@126.com

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摘要：

目的探讨四维超声定量技术评价不同程度肝硬化患者左房容积和应变功能变化的价值。 方法纳入肝硬化患者60例，按照Child-Pugh分级分为Child-Pugh A组26例、Child-Pugh B组19例和Child-Pugh C组15例，对照组为60例同期健康体检者。应用四维超声左房定量技术（4D LAQ）检测，获得左房最大容积（LAVmax）、左房最小容积（LAVmin）及左房收缩前容积（LAVpreA），计算出左房每搏量（LAEV）和左房整体射血分数（LAEF）；获取左室收缩期、舒张早期和舒张晚期的左房心肌纵向应变（LASr、LAScd 和 LASct）和圆周峰值应变参数（LASr_c、LAScd_c 和LASct_c）；同时测量常规超声参数：左房内径（LAD）、左室舒张末期内径（LVEDD）和左室射血分数（LVEF）等。 结果与对照组相比，肝硬化各组的左房四维容积参数LAVmax、LAVmin、LAVpreA及LAEV均显著升高（P＜0.01）。肝硬化Child-Pugh A组患者的LASr、LASct、LASr_c和LASct_c的绝对值较对照组增大（P＜0.01），LAScd和LAScd_c的绝对值与对照组差异无统计学意义。Child-Pugh B和Child-Pugh C组患者LASr、LASct、LASr_c和LASct_c的绝对值均较Child-Pugh A组下降，LAScd和LAScd_c的绝对值较对照组降低（P＜0.05）。相关分析显示LAVmax、LAVmin和LAVpreA与肝硬化分级均呈正相关（rs分别为0.383、0.325、0.302，P＜0.05），LASr、LAScd、LASct、LASr_c、LAScd_c和LASct_c的绝对值与肝硬化的分级均呈负相关（rs分别为-0.387、-0.463、-0.623、-0.365、-0.456、-0.467，P＜0.01）。结论 四维超声左心房定量技术可敏感评价左房的结构和功能变化，为肝硬化心肌病患者早期诊断、治疗干预和疗效评价提供可靠的证据。

关键词: 肝硬化, 心肌疾病, 超声心动描记术, 四维, 心房功能, 左, 心肌应变

Abstract:

Objective To evaluate the strain and volume of left atrium (LA) by four-dimensional left atrium quantification (4D LAQ) in patients with different grades of liver cirrhosis. MethodsSixty patients with liver cirrhosis were enrolled and divided into Child-Pugh A group (n=26), Child-Pugh B group (n=19) and Child-Pugh C group (n=15) according to Child-Pugh grading. The control group consisted of 60 healthy subjects. The left atrial maximum volume (LAVmax), left atrial minimum volume (LAVmin) and left atrial pre-systolic volume (LAVpreA) were measured by 4D LAQ. The left atrial ejection volume (LAEV) and left atrial ejection fraction (LAEF) were calculated. The LA longitudinal and circumferential strain during the left ventricular systole, the early diastole and late diastole (LASr, LAScd, LASct, LASr_c, LAScd_c 和 LASct_c) were measured by 4D LAQ. The traditional echocardiography parameters, LA dimension (LAD), left ventricular end-diastolic dimension (LVEDD) and left ventricular ejection fraction (LVEF) were also analyzed. Results Compared with control group, LAVmax, LAVmin, LAVpreA and LAEV were all significantly increased in varying groups of liver cirrhosis (P＜0.01). The absolute values of LASr, LASct, LASr_c and LASct_c were higher in Child-Pugh A group than those in control group (P＜0.01). There were no significant differences in the absolute values of LAScd and LAScd_c between Child-Pugh A group and the control group. In Child-Pugh B and C groups, the absolute values of LASr, LASct, LASr_c and LASct_c were lower than those in Child-Pugh A group (P＜0.05), and the absolute values of LAScd and LAScd_c were reduced in Child-Pugh B and C groups compared with those in control group (P＜0.05). Correlation analysis showed that LAVmax, LAVmin and LAVpreA were positively correlated with Child-Pugh scores (r=0.383, 0.325 and 0.302, P＜0.05), and the absolute values of LASr, LAScd, LASct, LASr_c, LAScd_c and LASct_c were negatively correlated with ChildPugh scores (r=-0.387, -0.463, -0.623, -0.365, -0.456 and -0.467, P＜0.01). Conclusion 4D LAQ can sensitively evaluate the changes of morphology and function of left atrium in patients with cirrhosis at different stages, providing reliable evidence for the early diagnosis, treatment intervention and efficacy evaluation in patients with cirrhotic cardiomyopathy.

Key words: liver cirrhosis, cardiomyopathies, echocardiography, four-dimensional, atrial function, left, myocardial strain