采用实时三维超声和斑点追踪技术评价非酒精性脂肪性肝病肝硬化患者右心功能*

doi:10.3969/j.issn.1672-5069.2019.02.023

摘要/Abstract

摘要： 目的探讨采用实时三维超声（RT-3DE）和二维斑点追踪技术（2D-STI）检测评价非酒精性脂肪性肝病肝硬化患者右心功能变化的价值。方法 2015年2月~2016年11月诊治的非酒精性脂肪性肝病肝硬化患者70例,其中代偿期肝硬化35例,失代偿期肝硬化患者35例,选择同期健康志愿者35例作为对照组。采用RT-3DE测量右心房容积指数（RAVI）,常规测量左心房前后径（LAD）、右心室舒张末内径（RVIDd）、右心室收缩末内径（RVIDs）、室间隔（IVS）和左心室后壁（LVPW）,计算右心室面积变化分数（RVFAC）。测量三尖瓣口前向血流舒张早期E峰（ETV）,运用脉冲多普勒超声成像测量三尖瓣环舒张早期峰值e' （e'TV）,计算ETV/e'TV比值。采用M型超声测量三尖瓣环收缩期位移（TAPSE）。采用2D-STI技术测量右左心室收缩期右心房心肌平均峰值应变（MSs）、左心室舒张早期右心房心肌平均峰值应变（MSe）、左心室舒张晚期右心房心肌平均峰值应变（MSa）,并获得左心室收缩期右心房心肌平均峰值应变率（MSRs）、左心室舒张早期右心房心肌平均峰值应变率（MSRe）和左心室舒张晚期右心房心肌平均峰值应变率（MSRa）。结果与健康人比较,代偿期肝硬化患者LAD、LVPW、ETV/e'TV升高,TAPSE降低（P<0.05）;与失代偿期肝硬化患者比较,代偿期肝硬化患者RVIDs、IVS、LVPW、ETV/e'TV降低,TAPSE升高（P<0.05）;与健康人比,代偿期肝硬化和失代偿期肝硬化患者RAV max、RAV min、RAV pre、RAVIa和RAVIt显著增大,而RAVIp显著减小,差异具有统计学意义（P<0.05）;与失代偿期肝硬化患者比,代偿期肝硬化患者RAV max、RAV min、RAV pre、RAVIa和RAVIt显著减小,而RAVIp显著增大,差异具有统计学意义（P<0.05）;与健康人比,代偿期肝硬化患者MSe、MSRs和MSRa显著增大,而MSRe和MSa显著减小,差异具有统计学意义（P<0.05）;与失代偿期肝硬化患者比,代偿期肝硬化患者MSs、MSe、MSRs、MSRe和MSRa显著增大,而MSa显著减少,差异具有统计学意义（P<0.05）。结论借助RT-3DE和2D-STI技术检测可以敏感地反映非酒精性脂肪性肝病肝硬化患者左心功能状况,对早期正确评估心脏功能有极大的帮助。

关键词: 肝硬化, 非酒精性脂肪性肝病, 实时三维超声, 斑点追踪成像, 右心功能

Abstract: Objective To evaluate right atrial and ventricular functions in patients with nonalcoholic fatty liver disease （NAFLD） -induced liver cirrhosis （LC） by real-time three-dimensional echocardiography （RT-3DE） and speckle tracking imaging （2 D-STI）. Methods 70 patients （compensated in 35 and decompensated in 35） with NAFLD-induced LC and 35 healthy persons were recruited in our hospital between February 2015 and November 2016. The RAVI,LAD,RVIDd,RVIDs,IVS and LVPW were obtained by RT-3DE,and the RVFAC was calculated. The ETV and e'TV were measured and the ratio of ETV/e'TV was calculated. The TAPSE was obtained by M mode echocardiography. The MSs,MSe,MSa,MSRs,MSRe and MSRa were also measured by 2D-STI. Results The LAD,LVPW and ETV/e'TV in patients with compensated cirrhosis decreased as compared to those in healthy persons（P<0.05）;the RVIDs,IVS,LVPW and ETV/e'TV in patients with compensated cirrhosis decreased as compared to those in patients with decompensated cirrhosis（P<0.05）;the RAV max,RAV min,RAV pre,RAVIa and RAVIt in patients with liver cirrhosis significantly increased,while the RAVIp decreased as compared to those in control （P<0.05）;the RAV max,RAV min,RAV pre,RAVIa and RAVIt in patients with compensated cirrhosis significantly decreased,while the RAVIp increased as compared to those in patients with decompensated cirrhosis（P<0.05）;the MSe,MSRs and MSRa in patients with liver cirrhosis significantly increased,while the MSRe and MSa decreased as compared to those in control（P<0.05）;the MSs,MSe,MSRs,MSRe and MSRa in patients with compensated cirrhosis significantly increased,while the MSa decreased in patients with decompensated cirrhosis（P<0.05）. Conclusion The application of RT-3DE and 2D-STI in evaluating right atrial and ventricular functions in patients with NAFLD-induced LC might be helpful for clinicians to early predict the cardiac deficiency,which needs further investigations.

Key words: Liver cirrhosis, Nonalcoholic fatty liver disease, Real-time three-dimensional echocardiography, Speckle tracking imaging, Cardiac functions

霍会芹,巩晓红,李正宏. 采用实时三维超声和斑点追踪技术评价非酒精性脂肪性肝病肝硬化患者右心功能^*[J]. 实用肝脏病杂志, 2019, 22(2): 244-247.

Huo Huiqin, Gong Xiaohong, Li Zhenghong. Assessment of right atrial and ventricular functions in patients with nonalcoholic fatty liver disease-induced liver cirrhosis by real-time three-dimensional echocardiography and speckle tracking imaging[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2019, 22(2): 244-247.

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采用实时三维超声和斑点追踪技术评价非酒精性脂肪性肝病肝硬化患者右心功能^*

Assessment of right atrial and ventricular functions in patients with nonalcoholic fatty liver disease-induced liver cirrhosis by real-time three-dimensional echocardiography and speckle tracking imaging

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