实时剪切波弹性成像技术在慢性右心衰竭患者脾脏淤血评估中的价值  

Value of real-time shear wave elastography in assessing splenic congestion in patients with chronic right heart failure

作　　者：秦颢诚 李洪娥[1] 于明[1] 张淑琴[1] 沈来龙[2] Qin Haocheng;Li Honge;Yu Ming;Zhang Shuqin;Shen Lailong(Department of Ultrasound,Lianyungang First People's Hospital,Lianyungang 222061,China;Department of Cardiology,Lianyungang First People's Hospital,Lianyungang 222061,China)

机构地区：[1]连云港市第一人民医院超声科,连云港222061 [2]连云港市第一人民医院心内科,连云港222061

出　　处：《中国医师杂志》2022年第5期733-738,共6页Journal of Chinese Physician

基　　金：连云港市第一人民医院青年英才基金(QN1808,QN202118)。

摘　　要：目的探讨实时剪切波弹性成像技术(SWE)在慢性右心衰竭患者脾脏淤血评估中的价值。方法收集连云港市第一人民医院2020年3月至2021年2月收治的纽约心脏病协会(NYHA)心功能分级Ⅱ~Ⅳ级的慢性右心衰竭患者60例为研究组,另选取同期健康体检者20例为对照组。对所有受检者行常规超声心动图检查,应用SWE测量脾脏硬度值(SSM),检测并记录右心衰竭患者相关血液生化指标,对两组间SSM及其他相关参数进行分析;比较研究组不同心功能分级及病程患者的SSM;将60例患者根据所测得SSM(9.1~34.5 kPa)的三分位数分为低值组(SSM≤15.0 kPa),中值组(15.0 kPa<SSM<21.3 kPa)及高值组(SSM≥21.3 kPa),分析比较三组间患者各项临床指标差异,乘积极限法(KM)分析三组患者不良事件发生情况。受试者工作特征(ROC)曲线评价SSM预测慢性右心力衰竭患者右心房压力(RAP)≥10 mmHg的价值。多元线性回归分析慢性右心衰竭患者SSM增加的独立危险因素。结果研究组的SSM明显高于对照组[(22.09±6.99)kPa vs(10.23±1.95)kPa],差异有统计学意义(P<0.05)。心功能Ⅳ级患者的SSM[(25.24±4.53)kPa]明显高于Ⅲ级[(16.71±3.12)kPa]及Ⅱ级[(11.89±2.10)kPa]患者,差异均有统计学意义(均P<0.01)。病程≥1年患者的SSM[(24.71±4.61)kPa]明显高于病程<1年者[(14.95±4.00)kPa],差异有统计学意义(P<0.01)。与低值组和中值组比较,高值组的估测RAP、N端B型利钠肽原(NT pro-BNP)及右房容积指数(RAVI)更高(均P<0.05),下腔静脉塌陷指数(IVC-CI)更低(P<0.05)。KM法生存分析显示,高值组的不良事件发生率明显高于中值组和低值组(均P<0.001)。右心衰竭患者的SSM与NT pro-BNP、估测RAP、RAVI均呈正相关(均P<0.05),与IVC-CI呈负相关(P<0.05);当SSM≥26.1 kPa时,预测RAP≥10 mmHg的ROC曲线下面积为0.863(95%CI:0.771~0.955),灵敏度为76.5%,特异度为81.4%;多元线性逐步回归分析显示NT pro-BNP、估测RAP及IVC-CI是慢性右�Objective To investigate the value of real-time shear wave elastography(SWE)in the assessment of splenic congestion in patients with chronic right heart failure.Methods Sixty patients with chronic right heart failure with cardiac function gradeⅡ-Ⅳof New York Heart Association(NYHA)treated in Lianyungang First People′s Hospital from March 2020 to February 2021 were collected as the study group,and 20 healthy subjects in the same period were selected as the control group.Routine echocardiography was performed on all subjects;spleen stiffness measurement(SSM)was detected by SWE,and blood biochemical indicators related to patients with right heart failure were detected and recorded.SSM and other related parameters between the two groups were analyzed;the SSM in patients of different cardiac function classifications and course of disease were compared;60 patients were divided into low SSM group(SSM≤15.0 kPa),middle SSM group(15.0 kPa<SSM<21.3 kPa)and high SSM group(SSM≥21.3 kPa)according to the measured SSM(9.1-34.5 kPa).The differences in clinical indicators between the three groups were analyzed and compared,and the adverse events of the three groups were analyzed by the kaplan-Meier(KM)method.Receiver operating characteristic(ROC)curve was used to evaluate the value of SSM for predicting right atrial pressure(RAP)≥10 mmHg in patients with chronic right heart failure.Multiple linear regression was used to analyze the independent risk factors of increased SSM in patients with chronic right heart failure.Results Compared with the control group[(10.23±1.95)kPa],the SSM of the study group[(22.09±6.99)kPa]was significantly higher,and the difference between the two groups was statistically significant(P<0.05);the SSM in patients with cardiac function grade Ⅳ[(25.24±4.53)kPa]was higher than those of grade Ⅲ[(16.71±3.12)kPa]and grade Ⅱ[(11.89±2.10)kPa](all P<0.001);the SSM in patients with course of disease≥1 year[(24.71±4.61)kPa]was higher than those with a course of<1 year[(14.95±4.00)kPa](P<0.0

关 键 词：脾 剪切波弹性成像技术 右心衰竭 

分 类 号：R541.6[医药卫生—心血管疾病]