超声三维斑点追踪技术早期诊断失代偿期肝硬化患者心肌损害应用价值分析

Application of ultrasound three-dimensional speckle tracking imaging in the early diagnosis of cirrhotic cardiomyopathy in patients with decompensated cirrhosis

目的 探讨使用超声三维斑点追踪技术(3D-STI)早期诊断失代偿期肝硬化患者肝硬化性心肌病(CCM)的价值。方法 2020年2月~2022年2月我院诊治的82例失代偿期肝硬化患者和同期健康体检者30例,作为对照组。使用常规二维超声测量左室舒张末内径(LVDd)、左室收缩末内径(LVDs)和二尖瓣口舒张早期/舒张晚期峰值血流速度(E/A)比值,使用实时三维超声测量左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室射血分数(LVEF)和左室质量指数(LVMI),使用3D-STI技术测量左心室整体纵向应变(GLS)、整体周向应变(GCS)、整体径向应变(GRS)和整体面积应变(GAS)。结果 肝硬化患者E/A比值为(1.0±0.2),显著低于健康人【(1.2±0.3),P<0.05】,而LVDd和LVDs分别为(46.5±5.0) mm和(31.1±4.3) mm,与健康人【分别为(45.3±4.2) mm和(30.9±4.1) mm,P>0.05】比,无显著性差异;在本组肝硬化患者中,诊断CCM者58例;合并CCM的肝硬化患者、未合并CCM的肝硬化患者和健康人LVEF、LVEDV、LVESV和LVMI差异均无统计学意义(P>0.05);肝硬化合并CCM患者GLS、GCS、GRS和GAS绝对水平分别为(14.5±3.8)%、(17.1±3.5)%、(40.7±6.0)%和(24.3±4.0)%,显著低于肝硬化未合并CCM患者【分别为(17.9±2.6)%、(19.5±2.9)%、(44.8±8.5)%和(27.7±4.2)%,P<0.05】或健康人【分别为(18.7±2.2)%、(19.7±3.0)%、(45.4±6.1)%和(28.7±3.4)%,P<0.05】。结论 失代偿期肝硬化患者CCM发生率高,使用3D-STI技术可以敏感地反映失代偿期肝硬化患者左心收缩功能变化,有助于临床早期正确评估其心功能损害。

Objective The aim of this study was to explore the application of three-dimensional speckle tracking imaging(3D-STI)in the early diagnosis of cirrhotic cardiomyopathy(CCM)in patients with decompensated cirrhosis.Methods 82 patients with decompensated cirrhosis and 30 healthy individuals at the same time were enrolled in our hospital between February 2020 and February 2022.The scores of model for end-stage liver disease(MELD)were calculated for evaluation of liver functions.The left ventricular end-diastolic diameter(LVDd),left ventricular end-systolic diameter(LVDs)and ratio of early and late peak diastolic velocity of mitral valve(E/A)were measured by routine two-dimensional ultrasound.The left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular ejection fraction(LVEF)and left ventricular mass index(LVMI)were measured by real-time three-dimensional ultrasound.The left ventricular global longitudinal strain(GLS),global circumferential strain(GCS),global radial strain(GRS)and global area strain(GAS)were measured by 3D-STI.Results The E/A ratio in patients with liver cirrhosis was(1.0±0.2),significantly lower than[(1.2±0.3),P<0.05]in healthy individuals,while the LVDd and LVDs were(46.5±5.0)mm and(31.1±4.3)mm,both not significantly different compared to[(45.3±4.2)mm and(30.9±4.1)mm,respectively,P>0.05]in healthy persons;out of the 82 patients with liver cirrhosis,the CCM was found in 58 cases;there were no significant differences as respect to the LVEF,LVEDV,LVESV and LVMI among patients with,or without CCM and healthy persons(P>0.05);the absolute GLS,GCS,GRS and GAS in cirrhotics with CCM were(14.5±3.8)%,(17.1±3.5)%,(40.7±6.0)%and(24.3±4.0)%,significantly lower than[(17.9±2.6)%,(19.5±2.9)%,(44.8±8.5)%and(27.7±4.2)%,respectively,P<0.05]in those without CCM or[(18.7±2.2)%,(19.7±3.0)%,(45.4±6.1)%and(28.7±3.4)%,respectively,P<0.05]in healthy persons.Conclusion The incidence of CCM is not uncommon in patients with decompensated cirrhosis,and the 3D-STI could help sensitively reflect the changes of left ventricular systolic functions and diagnose CCM,which warrants further clinical investigation.