二维超声斑点追踪显像技术评估肝硬化患者左心室功能及其与RPR、APRI关系分析  

Speckle tracking echocardiography in evaluation of left ventricular dysfunction and its relation with RPR,APRI in cirrhotic patients

作　　者：杨寸芯 张贺彬[1] 黄国庆[1] 高枫[1] 胡佩佩 YANG Cunxin;ZHANG Hebin;HUANG Guoqing;GAO Feng;HU Peipei(Department of Ultrasonography,the Affiliated Hospital of Hangzhou Normal University,Hangzhou 310015,China)

机构地区：[1]杭州师范大学附属医院超声科,310015

出　　处：《浙江医学》2021年第5期502-506,共5页Zhejiang Medical Journal

基　　金：浙江省基础公益研究计划项目(LGF18H180014);浙江省医药卫生科技计划项目(2018KY591)。

摘　　要：目的应用二维超声斑点追踪显像技术(2D-STI)评估肝硬化患者左心室功能,并分析其与红细胞分布宽度与PLT比值(RPR)、AST与PLT比值(APRI)的关系。方法选取2017年9月至2019年8月杭州师范大学附属医院临床确诊的肝硬化患者70例为肝硬化组,采用终末期肝病模型(MELD)评价肝硬化程度,MELD评分≤9分32例,>9~<20分26例,≥20分12例;同期在本院体检的健康者23例为健康对照组。采集受试者空腹肘静脉血检测血常规、肝肾功能等,计算RPR、APRI;采用常规超声心动图获得左心常规参数,另使用2D-STI评估左心室应变指标。比较不同程度肝硬化患者与健康对照者RPR、APRI以及常规超声心动图指标、左心室应变指标,分析肝硬化患者左心室应变指标与RPR、APRI的关系。结果不同程度肝硬化患者与健康对照者APRI、RPR比较,差异均有统计学意义(均P<0.05),且随肝硬化程度增加而升高(均P<0.05)。不同程度肝硬化患者与健康对照者左心房内径(LAd)、舒张末期室间隔厚度(IVSd)、左心室后壁厚度(LVPWd)、心排出量(CO)、脉冲多普勒二尖瓣舒张期血流频谱E峰值/A峰值(E/A)、脉冲多普勒二尖瓣舒张期血流频谱E峰值/组织多普勒二尖瓣环舒张早期速度(E/Ea)等常规超声心动图指标比较,差异均有统计学意义(均P<0.05);左心室整体收缩期峰值纵向应变(GLS)、心尖水平旋转角度达峰时间(TPAR)、左心室基底水平旋转角度达峰时间(TPBR)、心尖水平旋转角度峰值(PAR)、左心室扭转角度峰值(LVTW)等左心室应变指标比较,差异均有统计学意义(均P<0.05)。肝硬化患者GLS、PAR、TPAR、TPBR、LVTW与APRI、RPR均有相关性(r=-0.493、0.290、0.524、0.557、0.653和-0.467、0.263、0.575、0.576、0.683,均P<0.05)。结论应用2D-STI评估的左心室应变指标能灵敏反映肝硬化患者左心室功能受损情况,且与RPR、APRI呈一定相关性。Objective To assess the left ventricular dysfunction in cirrhosis patients by two-dimensional speckle tracking imaging(2D-STI),and its relation with red cell distribution width to platelet ratio(RPR)and aspartate aminotransferase to platelet ratio index(APRI).Methods Seventy cirrhotic patients diagnosed in the Affiliated Hospital of Hangzhou Normal University from September 2017 to August 2019 were enrolled in the study.According to the model for end-stage liver disease(MELD),there were 32 patients with MELD≤9 points,26 patients with MELD>9-<20 points and 12 patients with MELD≥20 points.Twenty-three healthy subjects who underwent physical examination in the hospital during the same period served as control group.Blood samples were collected for calculation of RPR and APRI.Routine parameters of left heart were measured by conventional echocardiography,meanwhile 2D-STI was used to obtain left ventricular strain parameters.The RPR,APRI,left ventricular routine parameters and strain parameters were compared among three cirrhosis groups and the normal control group.The relationships between left ventricular strain parameters and RPR,APRI in patients were analyzed.Results The levels of APRI and RPR were increased in cirrhosis patients compared with the healthy control group(P<0.05),while the levels were increased with MELD grades of cirrhosis(P<0.05).There were significant differences in routine parameters including left atrial diameter(LAd),interventricular septal depth(IVSd),left ventricular posterior wall thickness(LVPWd),cardiac output(CO),the mitral valve E/A and E/Ea measured by pulse Doppler and tissue Doppler imaging,among different cirrhosis groups and the control group(all P<0.05).There were also significant differences in strain parameters including left ventricular global longitudinal strain(GLS),the time to peak apical rotation(TPAR),the time to peak basal rotation(TPBR),peak apical rotation(PAR)and left ventricular twist(LVTW)(all P<0.05).The GLS,PAR,TPAR,TPBR,LVTW in cirrhosis groups were correlated

关 键 词：肝硬化 左心室功能 红细胞分布宽度/血小板计数比值 天冬氨酸氨基转移酶/血小板计数比值 超声斑点追踪显像技术 

分 类 号：R575.2[医药卫生—消化系统] R445.1[医药卫生—内科学]