组织多普勒Tei指数对肝硬化患者心功能的评估价值

摘要/Abstract

摘要： 目的评估肝硬化患者左心及右心功能的损害情况,探讨组织多普勒 Tei 指数评价肝硬化患者心功能的临床应用价值。方法选择2017年8月至2018年8月北京佑安医院肝硬化患者92例,另选80名健康体检者作为健康对照。彩色多普勒超声心动图检测患者及健康体检者左房收缩末期内径(left atrial end-systolic diameter, LADs)、左室舒张末期内径(left ventricular end-diastolic diameter, LVDd)、右房收缩末期内径(right atrial end-systolic diameter, RADs)、右室舒张末期内径(right ventricular end-diastolic diameter, RVDd)、左/右室射血分数(ejection fraction, EF)。记录二尖瓣和三尖瓣舒张早期峰值流速(early-diastolic peak velocity, E)及舒张晚期峰值流速(late-diastolic peak velocity, A),计算E/A比值,并分别测量左心室和右心室组织多普勒Tei指数。分析心脏结构和功能各项参数在组间的差异。结果 ①肝硬化组患者LADs比对照组增大(37.15±4.13比35.26±3.28)(P<0.05),LVDd也比对照组增大(49.29±2.94比47.93±3.10)(P<0.05);而两组间RADs和RVDd无明显差异。②肝硬化组患者左心室Tei指数高于对照组(0.48±0.06比0.41±0.04)(P<0.05),肝硬化组患者右心室Tei指数也高于对照组(0.42±0.05比0.38±0.05)(P<0.05);两组间左、右心室的EF及E/A比值均没有显著差异(P>0.05)。③ 肝硬化Child-Pugh A、B、C级患者的左心室Tei指数分别为0.45±0.05、0.48±0.06、0.51±0.06,右心室Tei指数分别为0.39±0.05、0.42±0.06、0.44±0.04。随着肝硬化患者Child-Pugh评分的增加,左、右心室Tei指数均呈逐渐上升趋势,且在Child A、B、C组间比较差异均有统计学意义(P<0.05)。结论肝硬化患者左心结构发生改变,同时左、右心功能不同程度受损。组织多普勒Tei指数在整体评估肝硬化患者心功能方面具有简易、准确的应用价值。

关键词: 肝硬化, Child-Puch分级, 心功能, 组织多普勒, Tei指数

Abstract: Objective To assess cardiac function impairment in patients with cirrhosis, and to investigate the clinical value of Tei index measured by tissue Doppler imaging (TDI) in evaluating cardiac function in patients with cirrhosis.Methods A total of 172 visits in our hospital from August 2017 to August 2018 were enrolled, including 92 cirrhosis patients as the liver cirrhosis group and 80 healthy individuals as the control group. According to the Child-Pugh grading standard, patients in the cirrhosis group were further divided into Child-Pugh A, B and C subgroups. The parameters of the cardiac structure and function were measured using echocardiography, including left atrial end-systolic diameter (LADs), left ventricular end-diastolic diameter (LVDd), right atrial end-systolic diameter (RADs), right ventricular end-diastolic diameter (RVDd), left ventricular ejection fraction (LVEF), right ventricular ejection fraction (RVEF), early-diastolic peak velocity (E) and late-diastolic peak velocity (A) of mitral and tricuspid valves. Then E/A ratio, left and right ventricle Tei indexes were calculated. All the parameters were analyzed among groups. Results 1. Compared with the control group, the cirrhotic group showed significantly increased LADs (37.15±4.13 vs. 35.26±3.28, P< 0.05) and LVDd (49.29±2.94 vs. 47.93±3.10, P<0.05). While there was no significant difference in RADs and RVDd between the 2 groups (P>0.05). 2. The Tei index of left ventricular in the liver cirrhosis group was significantly higher than that in the control group (0.48±0.06 vs. 0.41±0.04, P<0.05), and as was the Tei index of right ventricular (0.42±0.05 vs. 0.38±0.05, P<0.05). While there was no significant difference in LVEF, RVEF, and E/A ratio between the 2 groups (P>0.05). 3. The Tei index of left ventricular in Child-Pugh A, B and C subgroups were 0.45±0.05, 0.48±0.06 and 0.51±0.06, respectively. The Tei index of right ventricular in the 3 subgroups were 0.39±0.05, 0.42±0.06 and 0.44±0.04, respectively. The Tei index of left and right ventricular increased gradually with the increase of Child-Pugh score, and the differences were statistically significant in the 3 subgroups (P<0.05).Conclusion The left cardiac structure has changed in patients with cirrhosis, and both left and right cardiac functions are reduced in different degrees. Tei index measured by TDI has simple and accurate application value in overall evaluation of cardiac function in patients with cirrhosis.

Key words: Liver cirrhosis, Child-Pugh grading, Cardiac function, Tissue Doppler imaging, Tei index

胡星, 孟繁坤, 韩晶, 左俏. 组织多普勒Tei指数对肝硬化患者心功能的评估价值[J]. 肝脏, 2019, 24(3): 239-242.

HU Xing, MENG Fan-kun, HAN Jing, ZUO Qiao. Evaluation of the cardiac function in patients with liver cirrhosis by tissue Doppleimag Tei index[J]. Chinese Hepatolgy, 2019, 24(3): 239-242.

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