接受TIPS治疗的肝硬化患者术后心脏结构与功能指标的变化评价*

doi:10.3969/j.issn.1672-5069.2023.01.021

摘要/Abstract

摘要： 目的探讨经颈静脉肝内门体静脉分流术(TIPS)治疗的乙型肝炎肝硬化患者术后心脏结构和功能指标的变化。方法 2018年1月～2021年6月我院诊治的乙型肝炎肝硬化患者48例,均接受TIPS术治疗。采用心血管磁共振成像(CMR)检测右心房容积指数(RAVI)、右心室舒张末期容积指数(RVEDVI)、右心室收缩末期容积指数(RVESVI)、右心室每搏量(RVSVI)、右心室射血分数(RVEF)、左心房容积指数(LAVI)、左心室舒张末期容积指数(LVEDVI)、左心室收缩末期容积指数(LVESVI)、左心室每搏量(LVSVI)、左心室射血分数(LVEF)和左心室心肌质量指数(LVEDMI)。使用彩色多普勒超声诊断仪检测右心房面积(RA area)、三尖瓣收缩期运动幅度(TAPSE)、LAVI、LVEF和同一心动周期舒张早期二尖瓣血流峰值速度E与舒张早期二尖瓣瓣环峰值速度e'比值(E/e')。采用电化学发光免疫法检测血清N末端脑钠肽前体(NT-proBNP)水平,使用化学发光分析仪检测高敏肌钙蛋白T(hs-cTnT)。结果与术前比,术后6个月RAVI、RVEDVI、RVESVI和RVSVI发生了显著的改变(P<0.05),LAVI、LVEDVI、LVESVI、LVSVI和LVEDMI也变化显著(P<0.05);术前RA area、超声心动图检测的LAVI和E/e'比值分别为16(12,19)cm²、23(20,27)ml/m²和8(5,10),与术后6个月【分别为18(15,24)cm²、32(28,45)ml/m²和11(8,16)】比,差异具有统计学意义(P<0.05)。结论接受TIPS治疗的乙型肝炎肝硬化患者所有心腔容积增加,出现偏心性左心室肥大,其对心脏功能的影响仍需要研究。

关键词: 肝硬化, 经颈静脉肝内门体静脉分流术, 心血管磁共振成像, 心脏结构

Abstract: Objective The aim of this study was to explore the cardiac structural and functional changes in patients with hepatitis B cirrhosis after undergoing transjugular intrahepatic portosystemic shunt (TIPS). Methods 48 patients with hepatitis B-induced liver cirrhosis (LC) were encountered in our hospital between January 2018 and June 2021, and all underwent TIPS. The cardiac structural and functional parameters, including indexed right atrial volume (RAVI), indexed right ventricular end-diastolic volume (RVEDVI), indexed right ventricular end-systolic volume (RVESVI), indexed right ventricular stroke volume (RVSVI), right ventricular ejection fraction (RVEF), indexed left atrial volume (LAVI), indexed left ventricular end-diastolic volume (LVEDVI), indexed left ventricular end-systolic volume (LVESVI), indexed left ventricular stroke volume (LVSVI), left ventricular ejection fraction (LVEF) and indexed left ventricular myocardial mass (LVEDMI) were detected by cardiovascular magnetic resonance imaging (CMR). The RA area, tricuspid annular plane systolic excursion (TAPSE), LAVI, LVEF and ratio of E/e' were detected by echocardiography. Results At the end of six months after TIPS, the RAVI, RVEDVI, RVESVI, RVSVI, LAVI, LVEDVI, LVESVI, LVSVI and LVEDMI changed greatly as compared to before TIPS in the 48 patients with LC (P<0.05); the RA area, LAVI and ration E/e' echocardiography six months after TIPS were 18(15, 24)cm², 32(28, 45)ml/m² and 11(8,16), significantly different as compared to 16(12,19)cm², 23(20, 27)ml/m² and 8(5, 10)at presentation(P<0.05). Conclusion The heart volume increases and eccentric left ventricular hypertrophy occurs after TIPS in patients with LC, and their impact on cardiac functions needs further investigation.

Key words: Liver cirrhosis, Transjugular intrahepatic portosystemic shunt, Cardiovascular magnetic resonance imaging, Cardiac structure

陈晔, 陈晓岚, 曹丽玲, 刘昌华. 接受TIPS治疗的肝硬化患者术后心脏结构与功能指标的变化评价^*[J]. 实用肝脏病杂志, 2023, 26(1): 79-82.

Chen Ye, Chen Xiaolan, Cao Liling, et al. Cardiac structural and functional changes in patients with hepatitis B cirrhosis after undergoing transjugular intrahepatic portosystemic shunt[J]. Journal of Practical Hepatology, 2023, 26(1): 79-82.

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接受TIPS治疗的肝硬化患者术后心脏结构与功能指标的变化评价^*

Cardiac structural and functional changes in patients with hepatitis B cirrhosis after undergoing transjugular intrahepatic portosystemic shunt

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