多普勒组织成像联合超声心动图检查诊断乙型肝炎肝硬化并发肝硬化性心肌病价值研究*

doi:10.3969/j.issn.1672-5069.2025.05.026

摘要/Abstract

摘要： 目的探讨应用多普勒组织成像(DTI)联合超声心动图(ECG)参数诊断肝硬化(LC)患者并发LC性心肌病(CCM)的价值。方法 2019年2月～2024年2月西安医学院第二附属医院收治的乙型肝炎LC患者120例,所有患者入组时均接受DTI和ECG检查,测量左室收缩/舒张末期内径(LVESD/LVEDD)、左室射血分数(LVEF)、左房内径(LAD)、左室舒张早期与晚期最大血流峰值速度(E/A)比值。转换至TDI模式检测,根据二尖瓣和动脉瓣频谱获取射血时间(ET)、等容舒张/收缩时间(IRT/ICT),计算Tei指数。采用单因素和多因素Logistic回归分析影响患者发生CCM的因素,应用受试者工作特征(ROC)曲线下面积(AUC)分析DTI联合ECG参数预测CCM发生的效能。结果在120例LC患者中,发现CCM者37例(30.8%);CCM组年龄、吸烟史、饮酒史、Child-PughC级占比、血清总胆红素(TBIL)和肌酸激酶同工酶(CKMB)水平分别为(62.6±5.9)岁、43.2%、62.2%、35.1%、(47.3±9.4)μmol/l和(28.4±6.3)U/l,均显著高于或大于LC组【分别为(58.2±5.4)岁、8.4%、4.8%、4.8%、(14.8±7.4)μmol/l和(20.9±4.8)U/l,P＜0.05】;CCM组门静脉内径、LAD和Tei指数分别为(16.2±2.1)mm、(39.6±4.4)mm和(0.6±0.2),均显著大于LC组【分别为(13.2±1.2)mm、(34.2±3.6)mm和(0.4±0.1),P＜0.05】,而E/A比值为(0.8±0.1),显著小于LC组【(1.0±0.2),P＜0.05】;多因素Logistic回归分析结果显示,年龄、Child-Pugh分级、LAD和Tei指数均是LC患者发生CCM的独立危险因素(P＜0.05);经ROC曲线分析显示,LAD联合Tei指数预测乙型肝炎LC患者发生CCM的AUC为0.901(95%CI:0.836～0.967),其灵敏度为86.5%,特异度为84.3%,显著优于单个指标预测(P＜0.05)。结论应用DTI联合ECG参数可以帮助临床医生早期诊断LC患者发生CCM,做到早期干预。

关键词: 肝硬化, 肝硬化性心肌病, 多普勒组织成像, 超声心动图, Tei指数, 诊断

Abstract: Objective The purpose of this study was to investigate Doppler tissue imaging (DTI) and echocardiography (ECG) index in diagnosing cirrhotic cardiomyopathy (CCM) in patients with hepatitis B-induced liver cirrhosis (LC). Methods 120 patients with hepatitis B-induced LC were encountered in Second Affiliated Hospital, Xi 'an Medical University between February 2019 and February 2024, all patients underwent DTI and ECG for left atrial diameter (LAD)and ratio of peak velocity of left ventricular diastolic blood flow in early and late stages (E/A ratio), etc., and transferred to TDI model for detection and calculation of Tei index. Univariate and multivariate Logistic regression analysis was used to reveal influencing factors of occurrence of CCM, and the area under the receiver-operating characteristic (ROC) curve (AUC) was applied to assess diagnostic performance. Results Of 120 patients with LC, CCM was found in 37 cases(30.8%)base on QT-c interval＞440ms; ages, percentages of smoking, alcohol hobby, Child-Pugh class C, total serum bilirubin and creatine kinase isoenzyme (CKMB) levels in patients with CCM were (62.6±5.9)yr, 43.2%, 62.2%, 35.1%, (47.3±9.4)μmol/l and (28.4±6.3)U/l, all significantly higher or greater than [(58.2±5.4)yr, 8.4%, 4.8%, 4.8%, (14.8±7.4)μmol/l and (20.9±4.8)U/l, respectively, P＜0.05] in cirrhotics without CCM; portal vain diameter, LAD and Tei index in patients with CCM were (16.2±2.1)mm, (39.6±4.4)mm and (0.6±0.2), all significantly greater than [(13.2±1.2)mm, (34.2±3.6)mm and (0.4±0.1), respectively, P＜0.05], while E/A ratio was (0.8±0.1), much less than [(1.0±0.2), P＜0.05] in patients with LC; multivariate Logistic regression analysis showed that ages, Child-Pugh class, LAD and Tei index were all the independent risk factors for occurrence of CCM in patients with LC (P＜0.05);ROC analysis demonstrated that the AUCwas 0.901(95%CI:0.836-0.967), with sensitivity of 86.5% and specificity of 84.3%, when LAD and Tei index combination was applied to predict CCM in patients with LC, much superior to any one parameter did (P＜0.05). Conclusion Combination of LAD and Tei index could help clinicians find secondary CCM in patients with LC early, which might guide them to take appropriate measures.

Key words: Liver cirrhosis, Cirrhotic cardiomyopathy, Doppler tissue imaging, Echocardiography, Tei index, Diagnosis

李嘉亮, 段艳, 申健, 王煜. 多普勒组织成像联合超声心动图检查诊断乙型肝炎肝硬化并发肝硬化性心肌病价值研究^*[J]. 实用肝脏病杂志, 2025, 28(5): 743-746.

Li Jialiang, Duan Yan, Shen Jian, et al. Diagnosis of cirrhotic cardiomyopathy in patients with hepatitis B-induced liver cirrhosis by Doppler tissue imaging and echocardiography[J]. Journal of Practical Hepatology, 2025, 28(5): 743-746.

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多普勒组织成像联合超声心动图检查诊断乙型肝炎肝硬化并发肝硬化性心肌病价值研究^*

Diagnosis of cirrhotic cardiomyopathy in patients with hepatitis B-induced liver cirrhosis by Doppler tissue imaging and echocardiography

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