超声观察不同肝功能分级肝硬化患者左室峰值应变离散度的价值

The value of left ventricular PSD using ultrasond in cirrhosis with different Child-Pugh grading

目的 研究超声左室峰值应变离散度(PSD)在不同肝功能分级肝硬化患者中表达水平和临床意义。方法 纳入2018年10月—2020年10月河南理工大学第一附属医院收治的肝硬化患者116例,均接受超声检查,记录PSD值。记录肝硬化患者肝功能分级,采用非条件logistic分析肝功能分级与PSD的关系。结果 116例患者中Child-Pugh分级:A级42例,PSD(40.4±8.2)ms,病程(2.6±0.7)年;B级48例,PSD(52.8±5.3)ms,病程(3.7±1.1)年;C级26例,PSD(58.7±6.6)ms,病程(4.8±0.9)年。不同肝功能分级患者PSD和病程比较,差异有统计学意义(P<0.05)。A、B、C三级血清CA125[(80.8±25.4)、(193.7±52.0)、(250.6±71.1)U/mL]和SAAG水平[(14.0±3.8)、(17.9±3.6)、(22.3±4.4)g/L]比较,差异有统计学意义(P<0.05)。非条件logistic回归分析结果显示,血清CA125(95%CI=1.071~2.478,OR=1.629,P=0.023)、SAAG(95%CI=1.328~3.242,OR=2.075,P=0.001)及PSD(95%CI=1.334~5.665,OR=2.749,P=0.006)是肝硬化进入失代偿期的危险因素。PSD(95%CI=1.102~2.399,OR=1.626,P=0.014)是肝硬化患者Child-Pugh C级的危险因素。受试者工作曲线(ROC)分析结果显示,PSD判断Child-Pugh C级的曲线下面积(AUC)为0.752(SE=0.074,95%CI=0.608~0.896,P=0.007),敏感度为0.846,特异度为0.550。结论 超声PSD水平与肝硬化患者肝功能分级密切相关,检测PSD有助于判断肝功能状态,为临床干预提供依据。

Objective To investigate the expression level and clinical value of left ventricular peak strain dispersion(PSD)in cirrhosis patients with different Child-Pugh grading.Methods One hundred and sixteen patients with liver cirrhosis admitted to our hospital from October 2018 to October 2020 were enrolled,all of them underwent ultrasound examination.The PSD value and liver function indexes were recorded,and the unconditional logistic analysis was used to analyze the relationship between Child-Pugh grading and PSD.Results Among the 116 patients,42 cases were Child-Pugh grade A,with PSD as(40.4±8.2)ms and the course of disease as(2.6±0.7)years;48 cases were grade B,with PSD as(52.8±5.3)ms and the course of disease as(3.7±1.1)years;26 cases were grade C,with PSD as(58.7±6.6)ms and the course of disease as(4.8± 0.9)years.PSD and the course of disease among patients with different Child-Pugh grading were compared with significant differences(P<0.05).The serum CA125levels of patients with Child-Pugh A,B,C were[(80.8± 25.4)U/mL,(193.7 ± 52.0)U/m,(250.6 ± 71.1)U/mL],the serum-ascites albumin gradient(SAAG)levels of patients with Child-Pugh A,B,C were[(14.0± 3.8)g/L,(17.9 ± 3.6)g/L,(22.3 ± 4.4)g/L],with significant differences(P<0.05).The unconditional logistic regression analysis showed that the serum CA125(95%CI=1.071-2.478,OR=1.629,P=0.023),SAAG(95%CI=1.328-3.242,OR=2.075,P=0.001)and PSD(95%CI=1.334-5.665,OR=2.749,P=0.006)were risk factors for decompensated cirrhosis.The PSD(95%CI=1.102-2.399,OR=1.626,P=0.014)was a risk factor for Child-Pugh C in patients with cirrhosis.The receiver operator characteristic(ROC)curve showed that the area under the curve(AUC)of PSD in predicting the Child-Pugh C was 0.752(SE=0.074,95%CI=0.608-0.896,P=0.007),the sensitivity was 0.846,and the specificity was 0.550.Conclusion The PSD is closely related to Child-Pugh grading of patients with cirrhosis.PSD is helpful to evaluate the liver function,which might provide guidance for clinical interference.