超声三维斑点追踪技术检查肝硬化患者左心室收缩功能初步研究

目的 探讨三维斑点追踪成像技术（3D-STI）在肝硬化患者左心室收缩功能检查中的应用价值。 方法 选取68例肝炎肝硬化患者和30例健康体检者,进行超声检查,常规测量左室舒张末期内径（LVEDD）、左室收缩末期内径（LVESD）、左室舒张末期容积（LVEDV）、左室收缩末期容积（LVESV）、射血分数（LVEF）,并采用3D-STI测定心肌不同部位的收缩期峰值应变。采用ROC预测模型评估基底段、中间段、心尖段、心尖帽的收缩期峰值应变对患者预后的预测价值。 结果 肝硬化患者LVEDV和LVESV （122.7±16.3） ml和（46.2±6.2） ml]均显著高于健康人（102.6±12.2） ml和（35.3±5.2） ml,P<0.001],两组LVEDD、LVESD、LVEF差异无统计学意义（P>0.05）;肝硬化患者基底段、中间段、心尖段、心尖帽的收缩期峰值应变（18.8±4.3）、（19.2±4.2）、（18.6±3.5）、（19.2±4.1）]均显著低于健康人（21.3±5.2）、（23.8±3.9）、（22.4±4.1）、（23.9±4.3）,P<0.001];随访期间,失访3例,死亡21例。ROC曲线分析显示,基底段、中间段、心尖段、心尖帽的收缩期峰值应变对肝硬化患者死亡预测模型的曲线下面积分别为0.857、0.893、0.869、0.866,应变值分别为18.85、20.05、16.25、18.05,其敏感度分别为78.6%、69.0%、85.7%、74.7%,特异度分别为82.0%、91.0%、66.7%、84.5%。 结论 肝硬化患者多伴随左心室局部收缩功能减退,3D-STI检测有利于发现肝硬化患者左心室收缩障碍,且对患者预后有一定的预测作用。

Evaluation of left ventricular systolic function by three-dimensional speckle tracking imaging in patients with liver cirrhosis

Objective To investigate the evaluation of left ventricular systolic function by three-dimensional speckle tracking imaging（3D-STI） in patients with liver cirrhosis. Methods 68 patients with viral hepatitis liver cirrhosis and 30 healthy persons were recruited in this study,and ultrasound was performed. Left ventricular end diastolic diameter （LVEDD）,left ventricular end-diastolic diameter （LVESD）,left ventricular end-diastolic volume （LVEDV）,left ventricular end-systolic volume （LVESV）,ejection fraction（LVEF） were routinely measured, and the systolic peak strain of different parts of myocardium was assayed by 3D-STI.The LVEDD,LVESD,LVEDV,LVESV,LVEF,the systolic peak strain at the basal segment,middle segment,apical segment,and apex cap between patients with liver cirrhosis and healthy control were compared. The predictive value of systolic peak strain of the parameters on the prognosis of the patients was evaluated by ROC prediction model. Results The levels of LVEDV and LVESV in patients with liver cirrhosis （122.7±16.3）ml and （46.2±6.2）ml] were significantly higher than（102.6±12.2）ml and（35.3±5.2）ml,P<0.001] in healthy persons,while there were no significant differences between the levels of LVEDD,LVESD and LVEF in patients with liver cirrhosis and healthy control（P>0.05）; the peak systolic peak of basal segment,middle segment,apical segment and apex cap in cirrhotics （18.8±4.3）,（19.2±4.2）,（18.6±3.5）,（19.2±4.1）] were much lower than（21.3±5.2）,（23.8±3.9）,（22.4±4.1）,（23.9±4.3）,P<0.001] in the healthy person; during the follow-up period, 21 died and 3 lost. The ROC curves showed that the area under ROC by the systolic peak of the basal segment,middle segment,apical segment and apex cap were 0.857,0.893,0.869 and 0.866,the strain was 18.85,20.05,16.25,18.05,and the sensitivity were 78.6%,69.0%,85.7% and 74.7%,and the specificity were 82.0%,91.0%,66.7% and 84.5%,respectively. Conclusion The patients with liver cirrhosis tends to have left ventricular systolic dysfunction. The 3D-STI is an alternative approach to evaluate the left ventricular systolic dysfunction at early stage non-invasively.