多普勒组织速度成像和实时三维超声心动图评价中晚期肝硬化患者左心室舒张功能的研究

Evaluation of Doppler tissue velocity imaging and real time three dimensional echocardiography on left ventricular diastolic function of the patients with middle and advanced liver cirrhosis

目的探讨应用多普勒组织速度成像(TVI)及实时三维超声心动图(RT-3DE)技术定量评价中晚期肝硬化患者左心室舒张功能的临床应用价值。方法检测中晚期肝硬化患者32例,正常对照组20例,应用多普勒组织速度成像技术检测室间隔及侧壁的二尖瓣环舒张早期峰值速度(Ea),舒张晚期峰值速度(Aa),并计算Ea/Aa比值,将两个位置的平均值作为平均Ea,Aa和Ea/Aa值。应用实时三维超声心动图进行时间-容积曲线分析,测量左室舒张末容积(EDV)、收缩末容积(ESV)、左室射血分数(LVEF)和左室最大充盈速率(PFR)。结果肝硬化组平均Ea降低、平均Aa增高,Ea/Aa比值降低,与对照组比较差异有显著性意义(P<0.05)。实时三维参数EDV、ESV、和LVEF两组间比较无显著性差异(P>0.05),与对照组比较PFR明显降低,差异有显著性意义(P<0.05)。结论肝硬化高动力循环状态下,多普勒组织速度成像及实时三维超声心动图可以对肝硬化患者左室舒张功能减低进行综合的评价,是简便、实用的检测方法。

Objective To explore the clinical application value of left ventricular diastolic function of the patients with middle and advanced hver cirrhosis evaluated by Doppler tissue velocity imaging （TVI） and real time three dimensional echocardiography （RT-3DE） . Methods 32 patients with middle and advanced liver cirrhosis and 20 normal controls were enrolled to detect early and late diastolic mitral annular velocities （Ea and Aa） of interventricular septum and lateral wall by Doppler TVI to calculate Ea/Aa, taking the average value of two sites as average Ea, Aa.and Ea/Aa. Time-volume curve was analyzed by RT-3DE to detect left ventricular end-diastolic volume （EDV）, end-systolic volume （ESV）, left ventricular ejection fraction （LVEF） and peak filling rate （PFR）. Results Average Ea and Ea/Aa were reduced, average Aa was increased in hver cirrhosis group than those in control group （P 〈 0. 05 ）. There was no significant difference in EDV, ESV and LVEF between two groups （P 〉0.05）, but PFR in liver cirrhosis group was significantly lower than that in control group （P 〈 0. 05）. Conclusions Doppler TVI and RT-3DE could generally evaluate the degraded left ventricular diastolic function of the patients with liver cirrhosis under hyperkinetic circulatory state of liver cirrhosis, which is a of easy and pragmatic detection method.