接受TIPS治疗的肝硬化患者术后心脏结构与功能指标的变化评价  

Cardiac structural and functional changes in patients with hepatitis B cirrhosis after undergoing transjugular intrahepatic portosystemic shunt

作　　者：陈晔 陈晓岚 曹丽玲 刘昌华 Chen Ye;Chen Xiaolan;Cao Liling(Department of Radiology,73rd Group Army Hospital,Affiliated to Xiamen University,Xiamen 361000,Fujian province,China)

机构地区：[1]厦门大学附属成功医院/解放军陆军第73集团军医院医学影像科,福建省厦门市361000

出　　处：《实用肝脏病杂志》2023年第1期79-82,共4页Journal of Practical Hepatology

基　　金：福建省自然科学基金资助项目(编号:2017J01180)

摘　　要：目的探讨经颈静脉肝内门体静脉分流术(TIPS)治疗的乙型肝炎肝硬化患者术后心脏结构和功能指标的变化.方法2018年1月~2021年6月我院诊治的乙型肝炎肝硬化患者48例,均接受TIPS术治疗.采用心血管磁共振成像(CMR)检测右心房容积指数(RAVI)、右心室舒张末期容积指数(RVEDVI)、右心室收缩末期容积指数(RVESVI)、右心室每搏量(RVSVI)、右心室射血分数(RVEF)、左心房容积指数(LAVI)、左心室舒张末期容积指数(LVEDVI)、左心室收缩末期容积指数(LVESVI)、左心室每搏量(LVSVI)、左心室射血分数(LVEF)和左心室心肌质量指数(LVEDMI).使用彩色多普勒超声诊断仪检测右心房面积(RA area)、三尖瓣收缩期运动幅度(TAPSE)、LAVI、LVEF和同一心动周期舒张早期二尖瓣血流峰值速度E与舒张早期二尖瓣瓣环峰值速度e'比值(E/e').采用电化学发光免疫法检测血清N末端脑钠肽前体(NT-proBNP)水平,使用化学发光分析仪检测高敏肌钙蛋白T(hs-cTnT).结果与术前比,术后6个月RAVI、RV-EDVI、RVESVI和RVSVI发生了显著的改变(P<0.05),LAVI、LVEDVI、LVESVI、LVSVI和LVEDMI也变化显著(P<0.05);术前RA area、超声心动图检测的LAVI和E/e'比值分别为16(12,19)cm^(2)、23(20,27)ml/m^(2)和8(5,10),与术后6个月[分别为18(15,24)cm^(2)、32(28,45)ml/m^(2)和11(8,16)]比,差异具有统计学意义(P<0.05).结论接受TIPS治疗的乙型肝炎肝硬化患者所有心腔容积增加,出现偏心性左心室肥大,其对心脏功能的影响仍需要研究.Objective The aim of this study was to explore the cardiac structural and functional changes in patients with hepatitis B cirrhosis after undergoing transjugular intrahepatic portosystemic shunt(TIPS).Methods 48 patients with hepatitis B-induced liver cirrhosis(LC)were encountered in our hospital between January 2018 and June 2021,and all underwent TIPS.The cardiac structural and functional parameters,including indexed right atrial volume(RAVI),indexed right ventricular end-diastolic volume(RVEDVI),indexed right ventricular end-systolic volume(RVESVI),indexed right ventricular stroke volume(RVSVI),right ventricular ejection fraction(RVEF),indexed left atrial volume(LAVI),indexed left ventricular end-diastolic volume(LVEDVI),indexed left ventricular end-systolic volume(LVESVI),indexed left ventricular stroke volume(LVSVI),left ventricular ejection fraction(LVEF)and indexed left ventricular myocardial mass(LVEDMI)were detected by cardiovascular magnetic resonance imaging(CMR).The RA area,tricuspid annular plane systolic excursion(TAPSE),LAVI,LVEF and ratio of E/e’were detected by echocardiography.Results At the end of six months after TIPS,the RAVI,RVEDVI,RVESVI,RVSVI,LAVI,LVEDVI,LVESVI,LVSVI and LVEDMI changed greatly as compared to before TIPS in the 48 patients with LC(P<0.05);the RA area,LAVI and ration E/e’echocardiography six months after TIPS were 18(15,24)cm^(2),32(28,45)ml/m^(2) and 11(8,16),significantly different as compared to 16(12,19)cm^(2),23(20,27)ml/m^(2) and 8(5,10)at presentation(P<0.05).Conclusion The heart volume increases and eccentric left ventricular hypertrophy occurs after TIPS in patients with LC,and their impact on cardiac functions needs further investigation.

关 键 词：肝硬化 经颈静脉肝内门体静脉分流术 心血管磁共振成像 心脏结构 

分 类 号：R657.3[医药卫生—外科学]