肝硬化左心室机械力学功能不全的分层应变定量研究  

Systematical quantitative evaluation of left ventricular mechanical dysfunction in patients with cirrhosis using ultrasonic layer-specific strain imaging

作　　者：雷菊 尹立雪[1,2] 胥桐 何金梅 郭智宇[2] 王斯佳 谢盛华[2] 李文华 Lei Ju;Yin Lixue;Xu Tong;He Jinmei;Guo Zhiyu;Wang Sijia;Xie Shenghua;Li Wenhua(North Sichuan Medical College,Nanchong 637000,China;Department of Cardiovascular Ultrasound and Non-invasive Cardiology,Sichuan Academy of Medical Sciences&Sichuan Provincial People′s Hospital,Chengdu 610072,China;Department of Ultrasound,Sichuan Academy of Medical Sciences&Sichuan Provincial People′s Hospital,Chengdu 610072,China;Zunyi Medical University,Zunyi 563003,China)

机构地区：[1]川北医学院,南充637000 [2]四川省医学科学院·四川省人民医院心血管超声及心功能科,成都610072 [3]四川省医学科学院·四川省人民医院超声科,成都610072 [4]遵义医科大学,563003

出　　处：《中华超声影像学杂志》2021年第12期1026-1032,共7页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金(81671852);四川省科技计划资助项目(2018JY0649,2020YFS0404);中央高校基本科研业务费专项资金(ZYGX2020ZB038)。

摘　　要：目的应用超声分层应变成像技术评估肝硬化患者左心室心肌机械力学功能损伤。方法连续选取2020年10月至2021年3月于四川省人民医院确诊的无已知心血管疾病的肝硬化患者80例,根据是否合并门脉高压相关并发症将其分为代偿组(39例)和失代偿组(41例),同期选取年龄、性别相匹配的健康志愿者43例作为对照组。各组均采用常规超声心动图测量左心室构型和功能参数,应用分层应变技术获取左心室心内膜下心肌、中层心肌、心外膜下心肌整体纵向应变(GLSendo、GLSmid、GLSepi)和基底段、中间段、心尖段各层心肌纵向应变(LS)以及峰值应变离散度(PSD),计算整体心肌纵向应变跨壁差值ΔLS(GLSendo-GLSepi)。比较各组相关参数的差异。结果①常规超声心动图参数:与对照组比较,代偿组和失代偿组室间隔舒张末期厚度(IVSTd)、左心室后壁舒张末期厚度(LVPWd)、左心室质量(LVM)和左心室质量指数(LVMI)增加(均P<0.05);而代偿组与失代偿组间常规超声心动图参数差异无统计学意义(均P>0.05)。②整体分层应变:代偿组和失代偿组GLSendo、GLSmid、GLSepi和ΔLS较对照组降低,PSD较对照组增加(均P<0.05);失代偿组GLSendo、GLSmid、GLSepi较代偿组进一步降低(均P<0.05),而两组间ΔLS和PSD差异无统计学意义(均P>0.05)。③各水平分层应变:与对照组比较,代偿组和失代偿组基底段、中间段和心尖段各层心肌LS降低(均P<0.05);与代偿组比较,失代偿组各水平各层心肌LS呈降低趋势,但仅心尖段差异有统计学意义(均P<0.05)。结论不同严重程度肝硬化患者左心室不同层次和不同水平心肌机械力学功能均存在损伤,应用超声分层应变成像技术有可能量化评估肝硬化患者心脏受累状态,从而为心肌损伤的早期精准诊断提供可视化证据。Objective To assess the left ventricular(LV)myocardial mechanical dysfunction in patients with cirrhosis using ultrasonic layer-specific strain imaging and to explore its value in clinical application.Methods A total of 80 consecutive cirrhosis patients without cardiovascular diseases were prospectively enrolled from October 2020 to March 2021 in Sichuan Provincial People′s Hospital,39 of whom were assigned to the compensated group and 41 were assigned to the decompensated group according to the occurrence of portal hypertension.Forty-three healthy volunteers during the same period were randomly recruited as the control group.Transthoracic echocardiography was performed to assess the LV configuration and functional parameters.LV global longitudinal strain in endocardial,middle and epicardial myocardium(GLSendo,GLSmid,GLSepi),and longitudinal strain(LS)in basal,middle and apical segments,and peak strain dispersion(PSD)were obtained using ultrasonic layer-specific strain imaging.ΔLS was calculated by the formula of GLSendo-GLSepi.Then,the differences of related parameters among three groups were compared.Results①Conventional echocardiography:compared with the control group,the interventricular septum end-diastolic thickness(IVSTd),left ventricular posterior wall end-diastolic thickness(LVPWd),left ventricular mass(LVM)and LVM index(LVMI)were increased in compensated and decompensated groups(all P<0.05),while no significant differences in conventional echocardiographic parameters were identified between the two cirrhosis groups(all P>0.05).②Global layer-specific strain:compared with the control group,GLSendo,GLSmid,GLSepi andΔLS were decreased and PSD was increased in compensated and decompensated groups(all P<0.05);Moreover,the decompensated group showed a more impaired GLSendo,GLSmid and GLSepi than compensated group(all P<0.05),whereas there were no significant differences ofΔLS and PSD between the two groups(all P>0.05).③Segmental layer-specific strain:compared with the control group,LS values of thre

关 键 词：超声心动描记术 分层应变 肝硬化 心室功能 左 

分 类 号：R575.2[医药卫生—消化系统]