四维超声定量技术评价不同分级肝硬化患者左房容积和功能的特征  

The quantitative evaluation of left atrial volume and function by four-dimensional echocardiography in patients with different grades of liver cirrhosis

作　　者：戴敏[1] 汪芸玏 彭丽娟 党时鹏[1] 钱大钧[1] 马芳山 DAI Min;WANG Yun-le;PENG Li-juan;DANG Shi-peng;QIAN Da-jun;MA Fang-shan(Department of Cardiac Function,Wuxi People's Hospital Affiliated to Nanjing Medical University,Wuxi 214023,China;Department of Ultrasonography,Wuxi Fifth People's Hospital)

机构地区：[1]南京医科大学附属无锡市人民医院心功能科,214023 [2]无锡市第五人民医院超声科

出　　处：《天津医药》2021年第6期636-641,共6页Tianjin Medical Journal

基　　金：国家自然科学基金资助项目(81900312)。

摘　　要：目的探讨四维超声定量技术评价不同程度肝硬化患者左房容积和应变功能变化的价值。方法纳入肝硬化患者60例,按照Child-Pugh分级分为Child-Pugh A组26例、Child-Pugh B组19例和Child-Pugh C组15例,对照组为60例同期健康体检者。应用四维超声左房定量技术(4D LAQ)检测,获得左房最大容积(LAV_(max))、左房最小容积(LAV_(min))及左房收缩前容积(LAV_(preA)),计算出左房每搏量(LAEV)和左房整体射血分数(LAEF);获取左室收缩期、舒张早期和舒张晚期的左房心肌纵向应变(LASr、LAScd和LASct)和圆周峰值应变参数(LASr_c、LAScd_c和LASct_c);同时测量常规超声参数:左房内径(LAD)、左室舒张末期内径(LVEDD)和左室射血分数(LVEF)等。结果与对照组相比,肝硬化各组的左房四维容积参数LAV_(max)、LAV_(min)、LAV_(preA)及LAEV均显著升高(P<0.01)。肝硬化Child-Pugh A组患者的LASr、LASct、LASr_c和LASct_c的绝对值较对照组增大(P<0.01),LAScd和LAScd_c的绝对值与对照组差异无统计学意义。Child-Pugh B和Child-Pugh C组患者LASr、LASct、LASr_c和LASct_c的绝对值均较Child-Pugh A组下降,LAScd和LAScd_c的绝对值较对照组降低(P<0.05)。相关分析显示LAV_(max)、LAV_(min)和LAV_(preA)与肝硬化分级均呈正相关(rs分别为0.383、0.325、0.302,P<0.05),LASr、LAScd、LASct、LASr_c、LAScd_c和LASct_c的绝对值与肝硬化的分级均呈负相关(rs分别为-0.387、-0.463、-0.623、-0.365、-0.456、-0.467,P<0.01)。结论四维超声左心房定量技术可敏感评价左房的结构和功能变化,为肝硬化心肌病患者早期诊断、治疗干预和疗效评价提供可靠的证据。Objective To evaluate the strain and volume of left atrium(LA)by four-dimensional left atrium quantification(4D LAQ)in patients with different grades of liver cirrhosis.Methods Sixty patients with liver cirrhosis were enrolled and divided into Child-Pugh A group(n=26),Child-Pugh B group(n=19)and Child-Pugh C group(n=15)according to Child-Pugh grading.The control group consisted of 60 healthy subjects.The left atrial maximum volume(LAV_(max)),left atrial minimum volume(LAV_(min))and left atrial pre-systolic volume(LAV_(preA))were measured by 4D LAQ.The left atrial ejection volume(LAEV)and left atrial ejection fraction(LAEF)were calculated.The LA longitudinal and circumferential strain during the left ventricular systole,the early diastole and late diastole(LASr,LAScd,LASct,LASr_c,LAScd_c和LASct_c)were measured by 4D LAQ.The traditional echocardiography parameters,LA dimension(LAD),left ventricular end-diastolic dimension(LVEDD)and left ventricular ejection fraction(LVEF)were also analyzed.Results Compared with control group,LAV_(max),LAV_(min),LAV_(preA) and LAEV were all significantly increased in varying groups of liver cirrhosis(P<0.01).The absolute values of LASr,LASct,LASr_c and LASct_c were higher in Child-Pugh A group than those in control group(P<0.01).There were no significant differences in the absolute values of LAScd and LAScd_c between Child-Pugh A group and the control group.In Child-Pugh B and C groups,the absolute values of LASr,LASct,LASr_c and LASct_c were lower than those in Child-Pugh A group(P<0.05),and the absolute values of LAScd and LAScd_c were reduced in Child-Pugh B and C groups compared with those in control group(P<0.05).Correlation analysis showed that LAV_(max),LAV_(min)and LAV_(preA) were positively correlated with Child-Pugh scores(r=0.383,0.325 and 0.302,P<0.05),and the absolute values of LASr,LAScd,LASct,LASr_c,LAScd_c and LASct_c were negatively correlated with Child Pugh scores(r=-0.387,-0.463,-0.623,-0.365,-0.456 and-0.467,P<0.01).Conclusion 4D LAQ can sensitively evaluate th

关 键 词：肝硬化 心肌疾病 超声心动描记术 四维 心房功能 左 心肌应变 

分 类 号：R540.45[医药卫生—心血管疾病] R542.2[医药卫生—内科学]