应变率成像对研究肝硬化患者右心室纵向功能的价值

Value of strain rate imaging in research of longitudinal function of the right ventricle in patients with liver cirrhosis

目的:探讨运用超声应变率成像(strainrate imaging,SRI)观察肝硬化患者右心纵向功能改变的研究价值.方法:将62例肝硬化患者(排除了具有器质性心脏病、糖尿病、高血压等疾病的患者)作为实验组.另外30例排除了具有器质性心脏病、糖尿病、高血压等疾病的健康成人为正常对照组.分别测量右心室游离壁3个节段收缩期峰值应变率(systolic peak strain rate,SRS)、舒张早期峰值应变率(early diastolic peak strain rate,SRE)及房缩期峰值应变率(atrial systole peak strain rate,SRA),并运用常规测量右心功能的方法组织多普勒技术(tissue doppler imaging,TDI)测量三尖瓣前叶瓣环处舒张早期心肌运动速度(peak early diastolic velocity,Ve)、舒张晚期心肌运动速度(peak late diastolic velocity,Va).结果:(1)肝硬化组右心室游离壁基底段SRS低于正常组(分别为:-1.93s-1±0.11s-1、-2.51s-1±0.88s-1,P<0.05),SRE低于正常组(分别为:2.17s-1±0.08s-1、2.37s-1±0.13s-1,P<0.0001),SRA低于正常组(分别为:1.43s-1±0.11s-1、1.59s-1±0.04s-1,P<0.05);(2)肝硬化组右心室游离壁中间段SRS低于正常组(分别为:-1.69s-1±0.56s-1、-1.97s-1±0.60s-1,P<0.05),SRE低于正常组(分别为:1.38s-1±0.38s-1、2.26s-1±0.70s-1,P<0.05),SRA低于正常组(分别为:1.36s-1±0.88s-1、1.49s-1±0.04s-1,P<0.05);(3)肝硬化组心尖段SRS低于正常组(分别为:-1.36s-1±0.31s-1、-2.37s-1±0.78s-1,P<0.0001),SRE低于正常组(分别为:1.47s-1±0.05s-1、1.79s-1±0.12s-1,P<0.05),SRA低于正常组(分别为:1.22s-1±0.05s-1、1.37s-1±0.10s-1,P<0.05);(4)三尖瓣前叶瓣环处Ve及Va均低于正常组(肝硬化组Ve、Va分别为:0.12m/s±0.03m/s、0.15m/s±0.04m/s;正常组Ve、Va分别为0.19m/s±0.02m/s、0.17m/s±0.02m/s(P<0.05,P<0.01).结论:超声应变率成像可以更准确的评价肝硬化患者右心室的纵向收缩及舒张功能,为临床医生的治疗及判断预后提供有力的证据.

AIM： To assess the value of ultrasound strain rate imaging in research of longitudinal function of the right ventricle （RV） in patients with liver cirrhosis. METHODS： Sixty-two patients with liver cirrhosis were selected as an experimental group and were divided into three subgroups based on the Child-Hugh grade： level A （n = 20）, level B （n = 22） and level C （n = 20）, and another 30 healthy volunteers were included in a control group. The systolic peak strain rate （SRS）, early diastolic peak strain rate （SRE） and atrial systole peak strain rate （SRA） of three segments of the RV free wall were measured. Tissue Doppler imaging was used to measure the Em and Am at the posterior tricuspid annuli. RESULTS： The SRS, SRA and SRE of the base segment of the RV free wall were significantly decreased in the experimental group compared to the control group （-1.93 s^-1 ± 0.11 s^-1 vs -2.51 s^-1 ± 0.88 s^-1, 1.43 s^-1 ± 0.11 s^-1 vs 1.59 s^-1 ± 0.04 s^-1, 2.17 s^-1 ± 0.08 s^-1 vs 2.37 s^-1 ± 0.13 s^-1; all P 〈 0.05）. The SRS, SRE and SRA of the middle segment of the RV free wall were also significantly decreased in the experimental group compared to the control group （-1.69 s^-1 ± 0.56 s^-1 vs -1.97 s^-1 ± 0.60 s^-1, 1.38 s^-1 ± 0.38 s^-1 vs 2.26 s^-1 ± 0.70 s^-1, 1.36 s^-1 ± 0.88s^-1 vs 1.49 s^-1 ± 0.04 s^-1; all P 〈 0.05）. The SRS, SRE and SRA of the apex cordis segment of the RV free wall were also significantly decreased in the experimental group compared to the control group （-1.36 s^-1 ± 0.31 s^-1 vs -2.37 s^-1 ± 0.78 s^-1, 1.47 s^-1 ± 0.05 s^-1 vs 1.79 s^-1 ± 0.12 s^-1, 1.22 s^-1 ± 0.05 s^-1 vs 1.37 s^-1 ± 0.10 s^-1; all P 〈 0.05）. The peak early diastolic velocity and peak late diastolic velocity at the posterior tricuspid annuli in the experimental group were markedly decreased compared with those in the control group （0.12 m/s ± 0.03 m/s vs 0.19 m/s ± 0.02 m/s, 0.15 m/s ± 0.04 m/s vs 0.17 m/s ± 0.02 m/s, both P 〈 0.05）. CONCLUSION： Ultrasonic strain rate imaging allows for more accurate evaluation of longitudinal systolic and diastolic function of the RV in patients with liver cirrhosis and can help evaluate therapeutic effects and prognosis.