超声心动图评价肝硬化右心功能的临床价值

Clinical value of echocardiography in assessment of right heart function of patients with liver cirrhosis

目的探讨超声心动图评估肝硬化患者右心功能改变的临床价值。方法用超声心动图测量56例肝硬化患者与30例健康对照组的(1)右心腔结构指标:右房上下径、右房横径、右室基底部左右径、右室游离壁厚度(RVFWT)、右室舒张末面积;(2)右心舒张功能指标:右室外侧和内侧壁组织多普勒舒张早期波峰值(Em)/组织多普勒舒张晚期波峰值(Am)、舒张期血流E峰/A峰比值(E/A)、三尖瓣舒张早期流速E与三尖瓣环舒张早期组织运动速度Em之比(E/Em);(3)右心收缩功能指标:三尖瓣内侧壁瓣环Sm、三尖瓣内侧壁瓣环Em、三尖瓣内侧壁瓣环Am、三尖瓣外侧壁瓣环Sm、三尖瓣外侧壁瓣环Em、三尖瓣外侧壁瓣环Am、右心室面积变化率(FAC)、三尖瓣环收缩期位移(TAPSE)、右心室心肌机能指数(RIMP)。结果与对照组比较,肝硬化组右房上下径明显增大(P<0.05)、RVFWT增厚(P<0.05);右心室外侧壁Em/Am、右心室内侧壁Em/Am、E/A减小(P<0.05);E/Em比值稍增加,但两组E/Em比值比较,差异无统计学意义(P>0.05);三尖瓣内外侧壁瓣环Em、FAC、RIMP更低(P<0.05)。结论超声心动图可以评价肝硬化患者右心形态和右心功能变化,测量方法简单,重复性好。

Objective To investigate the clinical assessment of echocardiography in the assessment of right heart function changes in patients with liver cirrhosis. Methods Fifty-six patients with liver cirrhosis and 30 healthy controls were examined by echocardiography to obtain the following indexes, （1） Right heart chamber indexes included right atrial superoinferior diameter, right atrial transverse diameter,left-right diameter of right ventricular basal part, right ventricular free wall thickness （RVFWT） and right ventricular end-diastolic area. （2） Right heart diastolic function indexes included right ventricular lateral and medial tissue Doppler early diastolic peak value（Em）/tissue Doppler late diastolic peak value（Am） ,the ratio of diastolic blood flow E peak/A peak（E/A） ,the ratio of tricuspid early diastolic flow velocity E and tricuspid annular early diastolic tissue velocity Em（E/Em）. （3） Right heart systolic function indexes included tricuspid internal annular Sm, tricuspid internal annular Em,tricuspid internal annular Am, tricuspid lateral annular Sm, tricuspid lateral annular Em, tricuspid lateral annular Am, right ventricular fractional area change rate （FAC）, tricuspid annular plane systolic excursion （TAPSE）, right ventricular index of myocardial performance （RIMP）. Results Compared with control group, the liver cirrhosis group showed significantly increased right atrial superoinferior diameter and RVFWT（P 〈 0.05） as well as decreased right ventricular lateral Em/Am, right ventricular internal Era/Am and E/A（P 〈 0.05）. The value of E/Em increased slightly in the liver cirrhosis group, but it showed no statistically significant difference between two groups （P 〉 0.05）. The tricuspid internal and lateral annular Era, FAC and RIMP in the liver cirrhosis group were more lower than the controls （ P 〈 0. 05 ）. Conclusion Echocardingraphy can be applied to assessing the morphological and functional changes of right heart among patients with liver cirrhosis, which is simple and reproducible.