肝硬化失代偿期患者6 min台阶试验前后心脏结构和功能情况分析

Analysis of cardiac structure and function in patients with decompensated liver cirrhosis before and after 6-min step test

目的探讨肝硬化失代偿期患者6min台阶试验(6MST)前后心脏结构和功能的变化。方法选取我院肝硬化失代偿期患者66例(病例组)和年龄性别与之匹配的体检健康者35例(对照组)。测量两组血液生化和血气分析指标;应用超声心动图技术获取两组6MST前及试验停止即刻心脏结构功能参数左房内径(LAD)及左室收缩末期内径(LVEDs)、左室舒张末期内径(LVEDd)、室间隔舒张末期厚度(IVSTd)及左室射血分数(LVEF),检测血流动力学参数二尖瓣舒张早期血流速度峰值(E)、心输出量(C O)、肺动脉反流压差(PRPG)、二尖瓣反流压差(M RPG)及二尖瓣舒张早期减速时间(E DT);组织多普勒获取等容舒张时间(IVRT)、等容收缩时间,并计算右室心肌指数(R V-Tei)、二尖瓣舒张早期血流峰值速度与二尖瓣环舒张早期间隔侧运动速度比值(E/e-sep);比较两组上述各参数之间的差异。结果病例组球蛋白、二氧化碳分压、剩余碱均高于对照组,差异均有统计学意义(均P<0.05)。组间比较:①6MST前静息状态下,病例组较对照组LAD增大,IVSTd增厚,EDT、IVRT延长,E/e-sep、RV-Tei增大,CO增加,PRPG和MRPG增高,与对照组比较差异均有统计学意义(均P<0.05);②6MST完毕即刻,病例组心率变化率较对照组小[(5.60±3.89)%vs.(16.34±4.21)%],LAD增大,LVEDd、LVEDs、LVSTd、RV-Tei增大,LVEF减小,IVRT、EDT延长,E/e-sep增加,PRPG、MRPG增加,与对照组比较差异均有统计学意义(均P<0.05)。组内比较:①对照组6MST后即刻较6MST前心率增快,LVEDs、E/e-sep减小,LVEF、CO增加,EDT减小,MRPG增高,差异均有统计学意义(均P<0.05);②病例组6MST后即刻较6MST前心率增快,LVEDs增大,IVRT、EDT延长,E/e-sep、PRPG、MRPG增高,差异均有统计学意义(均P<0.05)。结论肝硬化失代偿期患者心脏功能存在左室舒张功能和右心功能损害,受损心肌存在心肌正性变力、变时功能障碍;6MST可提高心脏收缩和心率变异性异常的检出。

Objective To explore the cardiac structure and function changes before and after 6-min step test(6MST)in patients with decompensated cirrhosis.Methods Sixty-six patients(case group)with decompensated cirrhosis in our hospital and 35 healthy controls(control group)with matched age and sex were selected.The blood biochemical and blood gas analysis indexes of the two groups were measured,and the echocardiographic technique was used to obtain the cardiac structural and functional parameters and hemodynamic parameters before 6MST and the test stop.Structural and functional parameters included left ventricular diameter(LAD),left ventricular end systolic diameter(LVEDs),left ventricular end diastolic diameter(LVEDd),ventricular septal end stage thickness(IVSTd)and left ventricular ejection fraction(LVEF).Hemodynamic parameters included early mitral diastolic blood flow velocity peak(E),cardiac output volume(CO),pulmonary reflux pressure difference(PRPG),mitral regurgitation pressure difference(MRPG)and mitral early diastolic deceleration time(EDT).Tissue Doppler ultrasound was used to obtain myocardial motion information,isovolumetric relaxation time(IVRT),isovolumetric contraction time,RV-Tei,etc,and the ratio of the peak velocity of early mitral valve relaxation to the early diastolic velocity of the mitral annulus(E/e-sep).The difference of parameters between the two groups were compared.Results The globulin,carbon dioxide partial pressure and residual alkali were higher in the case group than those in the control group,and the differences were statistically significant(all P<0.05).In pre-6MST,LAD increased,IVSTd thickened,EDT and IVRT prolonged,E/e-sep and RV-Tei increased,CO increased,PRPG and MRPG increased in the case group,and the difference were statistically significant compared with those in the control group(all P<0.05).Immediately after 6MST,the rate of change of HR decreased[(5.60±3.89)%vs.(16.34±4.21)%],LAD increased,LVEDd,LVEDs,LVSTd and RV-Tei increased,LVEF decreased,IVRT and EDT prolonged,E/e-sep,PRPG and MRPG increased in the case group,and the difference were statistically significant compared with those in the control group(all P<0.05).Comparison within the group:immediately after 6MST in the control group,HR increased,LVEDs and E/e-sep decreased,LVEF and CO increased,EDT decreased,MRPG increased,and the difference were significant compared with those before 6MST(all P<0.05).Immediately after 6MST in the case group,HR increased,LVEDs increased,IVRT and EDT prolonged,E/e-sep,PRPG and MRPG increased,the difference were statistically significant compared with those before 6MST(all P<0.05).Conclusion In patients with decompensated liver cirrhosis,left ventricular diastolic function and right cardiac function are easily identified,and the impaired myocardium has dysfunction of cardiac positive alternations and alternations.6MST can improve the detection of abnormal cardiac contraction and heart rate variability.