肝硬化左室心肌收缩功能与肝脏硬度相关性的临床研究
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摘要
目的应用二维斑点追踪超声心动图(2dimension speckle tracking echocardiography,2D-STE)分析肝硬化左室整体纵向应变在不同Child-Pugh分级之间的差异,并探讨肝硬化患者左室收缩功能、Child-Pugh分级与二维剪切波弹性成像(2dimension shear wave elastography,2D-SWE)测量肝脏杨氏模量之间的相关性。方法选取肝硬化患者60例,根据Child-Paugh分级,分为Child A、B、C级,各20例,健康对照组60例,应用2D-STE分析两组左心室长轴收缩期整体应变峰值GLS:包括三腔心GLS、四腔心GLS、二腔心GLS及平均GLS,并进行2D-SWE测量肝硬化组肝脏杨氏模量。结果 (1)肝硬化组三腔心GLS、四腔心GLS及平均GLS较对照组减低(P<0.05),且以Child C级减低最为明显。(2)肝硬化患者左室收缩功能减低与肝脏硬度呈正相关(P<0.05,OR值1.02)。结论肝硬化左室心肌收缩功能减低,且以Child C级减低最为明显;同时肝脏硬度越高出现左室心肌收缩功能减低的风险就越大。
Objective To apply Two-dimensional ultrasonic speckle tracking technique to analyze the differences of cirrhosis patients′left ventricular global longitudinal strain in different Child-Pugh grading,and to explore the left ventricular systolic function,the correlation between Child-Pugh grading and two-dimensional shear wave elastography in measuring liver Young′s modulus in cirrhosis patients.Methods According to the Child-Pugh grading,sixty patients definitely clinical diagnosed of cirrhosis with ultrasound images were selected and equally divided into Child A,B and C grades.There were 20 cases in each group and 60 cases in normal control group.To apply two-dimensional speckle tracking technology to analyze the global longitudinal peak systolic strain(GLS)of the left ventricle in two groups:including three-chamber heart GLS,four-chamber heart GLS,two-chamber heart GLS and average GLS,two-dimension shear wave elastography(2 D-SWE)was used to measure the liver Young′s modulus in cirrhosis group.Results(1)Compared with normal group,three-chamber heart GLS,four-chamber heart GLS and average GLS in cirrhosis group were decreased(P<0.05)and the reduction of Child C was the most obvious.(2)Left ventricular systolic function is positively correlated with liver stiffness in cirrhosis patients(P<0.05,ORvalue 1.02).Conclusions Left ventricular systolic function in cirrhosis patieants′is decreased,and the reduction of Child C is the most obvious;Besides,the harder the liver is,the greater the risk of left ventricular myocardial systolic dysfunction is.
Objective To apply Two-dimensional ultrasonic speckle tracking technique to analyze the differences of cirrhosis patients′left ventricular global longitudinal strain in different Child-Pugh grading,and to explore the left ventricular systolic function,the correlation between Child-Pugh grading and two-dimensional shear wave elastography in measuring liver Young′s modulus in cirrhosis patients.Methods According to the Child-Pugh grading,sixty patients definitely clinical diagnosed of cirrhosis with ultrasound images were selected and equally divided into Child A,B and C grades.There were 20 cases in each group and 60 cases in normal control group.To apply two-dimensional speckle tracking technology to analyze the global longitudinal peak systolic strain(GLS)of the left ventricle in two groups:including three-chamber heart GLS,four-chamber heart GLS,two-chamber heart GLS and average GLS,two-dimension shear wave elastography(2 D-SWE)was used to measure the liver Young′s modulus in cirrhosis group.Results(1)Compared with normal group,three-chamber heart GLS,four-chamber heart GLS and average GLS in cirrhosis group were decreased(P<0.05)and the reduction of Child C was the most obvious.(2)Left ventricular systolic function is positively correlated with liver stiffness in cirrhosis patients(P<0.05,ORvalue 1.02).Conclusions Left ventricular systolic function in cirrhosis patieants′is decreased,and the reduction of Child C is the most obvious;Besides,the harder the liver is,the greater the risk of left ventricular myocardial systolic dysfunction is.
引文
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[10]刘艳午,黄红梅,曹礼庭,等.二维斑点追踪技术评价冠心病患者缺血心肌的应变、旋转和扭转的研究[J].中国超声医学杂志,2014,30(7):609-613.
[11]张妍,马春燕,刘爽,等.二维斑点追踪技术评价不同程度冠状动脉狭窄患者心肌应变改变[J].中国超声医学杂志,2014,30(3):223-226.
[12]于立友,汪龙德.肝纤维化检测方法的临床研究进展[J].甘肃中医学院学报,2013,30(2):80-83.
[13]汪慧鹏,程惠芳,王学梅.非酒精性脂肪肝剪切波弹性值与肝功能指标的相关性研究[J].中国超声医学杂志,2016,32(6):522-524.
[14]杨振亚,卞东林,黄崑.剪切波弹性成像技术在评估常见病因肝硬化及其结节中的临床应用[J].中国超声医学杂志,2016,32(3):237-239.
[2] ROSA C M,GIMENES R,CAMPOS D H,et al.Apocynin influence on oxidative stress and cardiac remodeling of spontaneously hypertensive rats with diabetes mellitus[J].Cardiovasc Diabetol,2016,15(1):126.
[3] MARWICK T H,LEANO R L,BROWN J,et al.Myocardial strain measurement with 2-dimensional speckle-tracking echocardiography:definition of normal range[J].JACC Carduivasc Imaging,2009,2(1):80-84.
[4]常荷,贾春梅,徐琨,等.实时三维超声心动图定量评价肝硬化患者左心室功能及同步性[J/OL].中华医学超声杂志:电子版,2016,13(1):39-44.
[5] CIANCIULLI T F,SACCHERI M C,LAX J A,et al.Twodimensional speckle tracking echocardiography for the assessment of atrial function[J].World J Cardiol,2010,2(7):163-170.
[6]苗俊旺,尹立雪.超声速度向量成像联合等长负荷试验评价肝硬化右心室收缩期心肌力学功能[J].中华超声影像学杂志,2014,23(8):656-661.
[7]纪文静,阿里木江·阿不都热合曼,阿孜古力·阿不来提,等.肝硬化患者心功能改变与终末期肝病模型评分的相关性研究[J].现代生物医学杂志,2016,16(11):81-84.
[8] WANG J,FANG F,YIP G W,et al.Importance of chronotropic response and left ventricular long-axis function for exercise performance in patients with heart failure and preserved ejection fraction[J].Int J Cardiol,2016,202:339-343.
[9] ERSBOLL M,VALEUR N,MOGENSEN U M,et al.Relationship between left ventricular Longitudinal deformation and clinical heart failure during admission for acute Myocardial infarction:a two-dimensional speckle-tracking study[J].J Am Soc Echocardiogr,2012,25(12):1280-1289.
[10]刘艳午,黄红梅,曹礼庭,等.二维斑点追踪技术评价冠心病患者缺血心肌的应变、旋转和扭转的研究[J].中国超声医学杂志,2014,30(7):609-613.
[11]张妍,马春燕,刘爽,等.二维斑点追踪技术评价不同程度冠状动脉狭窄患者心肌应变改变[J].中国超声医学杂志,2014,30(3):223-226.
[12]于立友,汪龙德.肝纤维化检测方法的临床研究进展[J].甘肃中医学院学报,2013,30(2):80-83.
[13]汪慧鹏,程惠芳,王学梅.非酒精性脂肪肝剪切波弹性值与肝功能指标的相关性研究[J].中国超声医学杂志,2016,32(6):522-524.
[14]杨振亚,卞东林,黄崑.剪切波弹性成像技术在评估常见病因肝硬化及其结节中的临床应用[J].中国超声医学杂志,2016,32(3):237-239.