组织多普勒技术对肝硬化肾功能损害患者左心室舒张功能障碍的评价

Evaluation of Tissue Doppler Imaging on Left Ventricular Diastolic Function of Liver Cirrhosis Patients with Impaired Renal Function

目的探讨应用组织多普勒超声显像技术定量评估肝硬化伴肾功能损害患者左心室舒张功能的临床应用价值。方法纳入研究肝硬化伴肾功能损害患者24例肝硬化无肾功能损害患者33例正常对照组30例。运用二维超声检测左心室收缩末期内径(LVDS)、左心室舒张末期内径(LVDD)、室间隔厚度(IVST)、左心室舒张末期容量(LVEDV)、左心室收缩末期容量(LVESV),并计算左心室射血分数(LVEF)。运用组织多普勒技术定量检测二尖瓣舒张早期血流速度(E)和舒张晚期血流速度(A)二尖瓣环舒张早期峰值速度(E_m)和舒张晚期峰值速度(A_m)并计算E/A和E_m/A_m比值。结果肝硬化伴肾功能损害组的腹腔积液发生率、血清总胆红素、血清肌酐值明显高于正常对照组及肝硬化无肾功能损害组,而平均动脉压明显下降(P<0.05)。肝硬化伴肾功能损害组的LVDD、LVDS、LVEDV、LVESV显著增高,E_m降低,E_m/A_m比值明显降低,同正常对照组及肝硬化无肾功能损害组比较差异有统计学意义(P<0.05)。3组的LVEF无明显差异。结论肝硬化伴肾功能损害会导致早期、严重的左心室舒张功能异常组织多普勒超声心动图可以对肝硬化患者左心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 assess the clinical value of Tissue Doppler Imaging in evaluating the left ventricular diastolic function of liver cirrhosis patients with impaired renal function. Methods Twenty four 24 liver cirrhosis patients with impaired renal function, 33 liver cirrhosis patients without renal injury and 30 normal controls were enrolled. Average left ventricular end systolic diameter （LVDS）, left ventricular end-diastolic diameter （LVDD）, interventricular septum thickness （IVST）, left ventricular end-diastolic volume （LVEDV）, left ventricular end-systolic volume （LVESV） of all patients were determined by 2D echocardiography. The early and late diastolic mitral annular velocities （Em and Am） were detected by Tissue Doppler Imaging, the ratio of Em/Am were analyzed. Results Compared with cirrhosis patients without renal injury, patients with impaired renal function had increased incidence of ascites and levels of serum total bilirubin （TBLL）, serum creatinine （P〈0.05）. Compared with normal controls and patients without renal injury, myocardial segments in patients with repaired renal function had lower peak velocity of the early diastolic mitral annular velocity （Em）, higher peak velocity of the late diastolic mitral annular velocity （Am） and decreased Em/Am ratio （P〈0.05）. Conclusion Tissue Doppler imaging techniques are more useful and flexible noninvasive modalities for the early recognition of improvement in left ventricular diastolic dysfunction of patients with liver cirrhosis.