实时三维超声心动图定量评价肝硬化患者左心室收缩功能及同步性

目的探讨实时三维超声心动图（RT-3DE）定量评价不同程度肝硬化患者左心室收缩功能及收缩同步性的价值。 方法收集2012年11月至2014年6月山西医科大学第一医院诊断明确的肝硬化患者50例，分为Child A、B、C级，分别18例、21例、11例；选择年龄、性别及体重相匹配的门诊健康体检者30名，为健康对照组，分别行心脏超声检查，测得常规超声参数：左心房前后径（LAAPD）、室间隔厚度（IVST）、左心室后壁厚度（LVPWT）、左心室舒张末期内径（LVEDD）、收缩末期内径（LVESD）及左心室射血分数（LVEF），并采集三维动态图像，采用Qlab软件脱机分析，获得左心室17节段容积-时间曲线、左心室舒张末容积（LVEDV)、收缩末容积（LVESV）及LVEF，分别测得左心室16、12、6个节段达到收缩末期最小容积的时间标准差及时间最大差值，并用心率校正。 结果肝硬化患者心率、收缩期动脉压、舒张期动脉压及脉压与健康对照组比较，差异有统计学意义（t=-5.635、4.208、2.183、-2.308，P值均<0.05）。与健康对照组比较，肝硬化患者常规超声参数LAAPD增大，IVST增厚，差异有统计学意义（t=-6.918、-2.940，P值均<0.05）。两组间RT-3DE定量参数T_msv16-SD、T_msv12-SD、T_msv6-SD、T_msv16-Dif、T_msv12-Dif、T_msv6-Dif、T_msv16-SD%、T_msv12-SD%、T_msv6-SD%、T_msv16-Dif%、T_msv12-Dif%、T_msv6-Dif%、LVEDV、LVESV差异有统计学意义（t=-2.408、-3.142、-2.788、-2.761、-2.610、-2.507、-3.125、-3.725、-3.593、-2.384、-3.763、-3.657、-4.291、-4.388，P值均<0.05）。各级肝硬化与健康对照组RT-3DE参数T_msv16-SD、T_msv12-SD、T_msv6-SD、T_msv16-Dif、T_msv12-Dif、T_msv6-Dif、T_msv16-SD%、T_msv12-SD%、T_msv6-SD%、T_msv16-Dif%、T_msv12-Dif%、T_msv6-Dif% 、LVEDV、LVESV、LVEF比较，差异有统计学意义（F=7.563、12.544、7.482、5.211、7.197、5.131、6.232、11.327、7.233、4.296、8.906、8.563、10.904、9.809、0.382，P值均<0.05）。随肝硬化程度加重，LVEF呈逐渐减低趋势，余RT-3DE参数T_msv16-SD、T_msv12-SD、T_msv6-SD、Tmsv16-Dif、T_msv12-Dif、T_msv6-Dif、T_msv16-SD%、T_msv12-SD%、T_msv6-SD%、T_msv16-Dif%、T_msv12-Dif%、T_msv6-Dif%、LVEDV、LVESV呈逐渐增加趋势。 结论肝硬化患者左心室收缩同步性较差，局部心肌收缩功能受损，并随着肝硬化程度的加重而加重；实时三维超声心动图能客观评价不同程度肝硬化患者左心室功能异常。

Assessment of left ventricular systolic function and synchronicity in patients with different degrees of cirrhosis by real-time three-dimensional echocardiography

ObjectiveTo quantitatively assess the left ventricular systolic dysfunction and synchronicity in patients with different degrees of cirrhosis by real-time three-dimensional echocardiography. MethodsCollecting 50 cirrhotic patients who were divided into Child A, B and C classes and 30 healthy subjects whose age, sex and weight matched with cirrhotic patients. Ultrasonography was performed to obtain the conventional ultrasonic parameters (LAAPD, IVST, LVPWT, LVEDD, LVESD, LVEF), and three-dimensional moving images. Qlab software was used to obtain the 17-segmental volume-time curves and left ventricular end-diastolic volume (LVEDV), end-systolic volume (LVESV), ejection fraction (LVEF). The standard deviation and the maximal difference of the time to the point with minimal systolic volume of 16, 12, 6 segments. The above quantitative parameters were corrected by heart rate. ResultsBetween cirrhosis and control group, there were statistical differences of heart rate, Systolic arterial pressure, Diastolic arterial pressure and pulse pressure (t=-5.635, 4.208, 2.183, -2.308, all P<0.05). LAAPD by 2DE in patients with cirrhosis was larger than control group, while IVST was thicker (t=-6.918, -2.940, both P<0.05). The RT-3DE quantitative parameters (T_msv16-SD, T_msv12-SD, T_msv6-SD, T_msv16-Dif, T_msv12-Dif, T_msv6-Dif, T_msv16-SD%, T_msv12-SD%, T_msv6-SD%, T_msv16-Dif%, T_msv12-Dif%, T_msv6-Dif?%, LVEDV, LVESV) have statistically differences between the two groups (t=-2.408, -3.142, -2.788, -2.761, -2.610, -2.507, -3.125, -3.725, -3.593, -2.384, -3.763, -3.657, -4.291, -4.388, all P<0.05). Comparing different cirrhosis subgroup with control group, the RT-3DE quantitative parameters (T_msv16-SD, T_msv12-SD, T_msv6-SD, T_msv16-Dif, T_msv12-Dif, T_msv6-Dif, T_msv16-SD%, T_msv12-SD%, T_msv6-SD%, T_msv16-Dif%, T_msv12-Dif%, T_msv6-Dif%, LVEDV, LVESV, LVEF) have statistically differences (F=7.563, 12.544, 7.482, 5.211, 7.197, 5.131, 6.232, 11.327, 7.233, 4.296, 8.906, 8.563, 10.904, 9.809, 0.382, all P<0.05). With the aggravation of cirrhosis, LVEF showed the decreasing tendency, while the other RT-3DE parameters (T_msv16-SD, T_msv12-SD, T_msv6-SD, T_msv16-Dif, T_msv12-Dif, T_msv6-Dif, T_msv16-SD%, T_msv12-SD%, T_msv6-SD%, T_msv16-Dif%, T_msv12-Dif%, T_msv6-Dif%, LVEDV, LVESV) showed the tendency of increasing. ConclusionsThe left ventricular systolic synchrony and part of the myocardial systolic function in patients with cirrhosis was damaged. The condition was aggravated with the degree of cirrhosis. RT-3DE can objectively evaluate left ventricular dysfunction in patients with different degrees of cirrhosis.