右心声学造影在肝硬化患者肺内血管分流评价中的应用

肝脏 ›› 2021, Vol. 26 ›› Issue (9): 972-976.

右心声学造影在肝硬化患者肺内血管分流评价中的应用

潘国栋, 侯斐, 张瑶, 刘玉凤, 王晓静, 刘尧, 段英, 王艳斌, 李炜, 郝一炜, 熊号峰

100015 首都医科大学附属北京地坛医院超声科(潘国栋,张瑶),重症医学科(侯斐,刘玉凤,熊号峰),中西医结合科(王晓静,刘尧),肝病中心(段英,王艳斌,李炜),统计中心(郝一炜)

收稿日期:2021-03-15 出版日期:2021-09-30 发布日期:2021-10-22
通讯作者: 熊号峰,Email:xionghaofengmd@qq.com
基金资助:
北京市医院管理中心杨帆计划重点医学专业-感染性疾病重症医学(ZYLX201802);首都医科大学附属北京地坛医院院内课题(DTQL201802);北京市中医药管理局(JJ-2020-53)

Application of right heart contrast echocardiography in the evaluation of intrapulmonary shunt in patients with liver cirrhosis

PAN Guo-dong¹, HOU Fei², ZHANG Yao¹, LIU Yu-feng², WANG Xiao-jing⁴, LIU Yao⁴, DUAN Ying³, WANG Yan-bin³, LI Wei³, HAO Yi-wei⁵, XIONG Hao-feng²

1. Department of Ultrasound,
2. Department of Critical Care Medicine,
3. Department of Liver Disease Center,
4. Department of Integrated Traditional Chinese and Western Medicine,
5. Department of Statistics Center, Beijing Ditan Hospital, Capital Medical University,Beijing 100015,China

Received:2021-03-15 Online:2021-09-30 Published:2021-10-22
Contact: XIONG Hao-feng, Email: xionghaofengmd@qq.com

摘要/Abstract

摘要： 目的探讨右心声学造影在肝硬化患者肺内血管分流的评价中的应用价值。方法 2019年7月至2019年9月,对首都医科大学附属北京地坛医院收治的186例肝硬化住院患者使用维生素B6与碳酸氢钠注射液的混合液进行右心声学造影。记录检查过程中的不良反应。通过采集动态图像,对于存在肺内分流的患者,选择左心房微泡最为密集的图像进行分析,对微泡量进行半定量分析评估是否存在肺内血管分流。收集分流阳性的患者的右心声学造影检查资料以及临床资料进行分析,评估其高危因素。结果 186例患者中,男性125例(67.2%),女性61例(32.8%)。年龄为(53.4±9.9)岁,范围为26～70岁。全部患者耐受性良好,仅2例患者感注射部位轻微疼痛,但不影响实验完成。无不良事件发生。检出存在大量分流4例(2.15%),中量分流 6例(3.22%),少量分流 38例(20.43%),无分流的患者138例(74.19%)。大量分流的患者与少量分流的患者相比,静脉注射混合液后心腔左房微气泡出现的时间更快。进一步分析显示,肝硬化患者肺内分流量大小与肝硬化程度之间Spearman相关系数为 0.463,呈正相关,肝硬化Child-Pugh分级越高的患者,肺内分流量也越大。结论维生素B6与碳酸氢钠混合液可安全有效地应用于肝硬化人群进行右心声学造影。肝硬化人群肺内分流大小与肝硬化严重程度密切相关。

关键词: 肝硬化, 肝肺综合征, 右心声学造影, 维生素B6, 碳酸氢钠

Abstract: Objective To investigate the application value of right heart contrast echocardiography in the evaluation of intrapulmonary shunt in patients with liver cirrhosis. Methods One hundred and eigthy-six inpatients with liver cirrhosis admitted to our hospital from July 2019 to September 2019 underwent the right heart contrast echocardiography, and vitamin B6 and sodium bicarbonate were used as contrast agents. The adverse reactions during the inspection were recorded. The dynamic images were collected. The image with the most densest area of microbubble in left atrium of patients with intrapulmonary shunt was analyzed, and the amount of microbubbles was semi-quantitatively analyzed to evaluate the existence of intrapulmonary vascular shunt. The right-heart contrast echocardiography and clinical data of patients with intrapulmonary shunt were analyzed to evaluate the high-risk factors. Results Among the 186 patients, 125 were males (67.2%) and 61 were females (32.8%), patients mean age ranged from 26 to 70 years old (53.4±9.9 years old). All patients had a good tolerance, and only 2 patients felt slight pain at the injection site, with no effect on the experiment. No adverse events occurred. 4 cases (2.15%) with a large volume of shunt, 6 cases with a medium volume of shunt (3.22%), 38 cases (20.43%) with a small volume of shunt, and 138 cases (74.19%) with no intrapulmonary shunt. Compared to the patients with a small volume of shunt, the appearance of microbubbles in the left atrium was earlier in patients with a large volume of shunt after contrast agents were injected. Further analysis showed that the Spearman correlation coefficient between the volume of the pulmonary shunt and the degree of cirrhosis in patients with liver cirrhosis was 0.463, which was a positive correlation. The volume of the intrapulmonary shunt became larger as the Child-Pugh grade of liver cirrhosis got higher. Conclusion The vitamin B6 and sodium bicarbonate mixed liquors can be a safe and effective contrast agent used in patients with liver cirrhosis for right-heart contrast echocardiography. The volume of intrapulmonary shunt is closely related to the severity of hepatic cirrhosis in patients with liver cirrhosis.

Key words: Liver cirrhosis, Hepatopulmonary syndrome, Right heart echocardiography, Vitamin B6, Sodium bicarbonate

潘国栋, 侯斐, 张瑶, 刘玉凤, 王晓静, 刘尧, 段英, 王艳斌, 李炜, 郝一炜, 熊号峰. 右心声学造影在肝硬化患者肺内血管分流评价中的应用[J]. 肝脏, 2021, 26(9): 972-976.

PAN Guo-dong, HOU Fei, ZHANG Yao, LIU Yu-feng, WANG Xiao-jing, LIU Yao, DUAN Ying, WANG Yan-bin, LI Wei, HAO Yi-wei, XIONG Hao-feng. Application of right heart contrast echocardiography in the evaluation of intrapulmonary shunt in patients with liver cirrhosis[J]. Chinese Hepatolgy, 2021, 26(9): 972-976.

参考文献

[1] Raevens S, Geerts A, Devisscher L, et al. Recent advances in the approach to hepatopulmonary syndrome and portopulmonary hypertension. Acta Gastro-Enterologica Belgica, 2021, 84:95-99.
[2] Khiangte B, Kothakota S R, Sasidharan M, et al. Prevalence and determinants of hepatopulmonary syndrome in decompensated chronic liver disease. Indian J Gastroenterol, 2020, 39:1-8.
[3] 和雪改,谢万木,万钧,等. 右心声学造影检测肺动脉高压患者右向左分流的价值.中华医学杂志,2020,100:1715-1719.
[4] 刘少中,刘晓真,叶木奇,等.右心声学造影在静脉-静脉体外膜肺氧合插管中的应用.中国医学影像技术,2020,36:754-757.
[5] 潘宇,袁玉玲.右心声学造影联合选择性肺动脉栓塞治疗肺动静脉畸形1例.中国医学影像技术,2020,36:639.
[6] 王萤萤,邵敬,顾静,等.经胸右心声学造影在静脉曲张患者术前检出右向左分流的应用.中国超声医学杂志,2019,35:699-702.
[7] Fuhrmann V,Krowka M. Hepatopulmonary syndrome. J Hepatol, 2018,69: 744-745.
[8] Ceza MR, Garcia E, Anselmi CE et al. Prevalence and characteristics of hepatopulmonary syndrome in children with cirrhosis in southern Brazil. Eur J Gastroenterol Hepatol, 2019,31:10-15.
[9] Mokhtarifar A, Azimi H, Esmaeelzadeh A et al. Frequency of hepatopulmonary syndrome (HPS) among patients with liver cirrhosis: a letter to editor. Hepat Mon, 2016,16: e35990.
[10] Younis I, Sarwar S, Butt Z et al. Clinical characteristics, predictors, and survival among patients with hepatopulmonary syndrome. Ann Hepatol, 2015,14: 354-360.
[11] 赵维鹏, 李倬哲, 潘翠珍,等. 右心声学造影及肺动脉造影诊断肝肺综合征1例. 中国医学影像技术, 2017, 486.
[12] 李炳昆, 冯力军, 孙丽丽. 肝肺综合征误诊为间质性肺炎1例. 临床肺科杂志, 2017, 182-183.
[13] 吴克林, 吴天英, 桂心,等. 肝肺综合征一例并文献复习. 海南医学, 2015,3414-3414,3415.
[14] 靳文英, 于超, 朱天刚. 表现为活动后喘憋的肝肺综合征一例. 中华全科医师杂志, 2015, 564-566.
[15] Grilo I, Pascasio JM, Tirado JL, et al. The utility of the macro-aggregated albumin lung perfusion scan in the diagnosis and prognosis of hepatopulmonary syndrome in cirrhotic patients candidates for liver transplantation. Rev Esp Enferm Dig, 2017,109:335-343.
[16] Krowka MJ, Fallon MB, Kawut SM et al. International liver transplant society practice guidelines: diagnosis and management of hepatopulmonary syndrome and portopulmonary hypertension. Transplantation, 2016, 100: 1440-1452.
[17] Wu W, Zhang J, Yang W et al. Role of splenic reservoir monocytes in pulmonary vascular monocyte accumulation in experimental hepatopulmonary syndrome. J Gastroenterol Hepatol, 2016, 31: 1888-1894.
[18] Wang L, Zhuang L, Rong H et al. MicroRNA-101 inhibits proliferation of pulmonary microvascular endothelial cells in a rat model of hepatopulmonary syndrome by targeting the JAK2/STAT3 signaling pathway. Mol Med Rep, 2015, 12: 8261-8267.
[19] 熊奕, 李泉水, 于秀珍,等. 维生素B6与碳酸氢钠混合液用于右心声学造影机制的研究及临床应用. 南昌大学学报(医学版), 2003, 43: 109-113.
[20] 杨磊,管琰,潘翠珍, 等.维生素B6与碳酸氢钠混合液在先心病右心声学造影的应用价值.交通医学,2011,25:58-59.
[21] 李梅. 肝肺综合征的超声影像学研究进展. 实用心脑肺血管病杂志, 2011, 1060-1061.
[22] 马怀源, 李肖. 肝肺综合征的诊疗进展. 中华肝脏病杂志, 2016, 397-400.