负荷超声心动图在评估肝硬化患者左心功能储备中的应用

The application of stress echocardiography in evaluating left heart function reserve in patients with liver cirrhosis

目的观察标准等长握力试验前后乙型肝炎肝硬化及酒精性肝硬化患者超声心动图左心功能变化,评估患者应激状态下左心功能储备情况。方法选取北京佑安医院诊断为乙型肝炎肝硬化患者60例,酒精性肝硬化患者62例,将两组患者按照Child-Pugh分级分为Child A级组和Child B+C级组,进行标准等长握力实验,测量负荷试验前后患者左心室Tei指数,分析两组患者负荷试验前后心功能差异。结果乙型肝炎肝硬化组患者实验前后Tei指数分别为0.43±0.03比0.45±0.07,酒精性肝硬化组分别为0.44±0.05比0.46±0.08,差异有统计学意义(P<0.05)。乙型肝炎肝硬化患者Child A级组和Child B+C级组及酒精性肝硬化患者Child A级组负荷前后Tei值差异无统计学意义(P>0.05),酒精性肝硬化患者Child B+C级组负荷前后Tei值差异0.44±0.04比0.47±0.07,差异有统计学意义(P<0.05)。结论乙型肝炎肝硬化与酒精性肝硬化患者在静息状态下心脏结构及功能大致相同时,负荷试验后两组患者心功能均有所下降,说明负荷超声心动图在肝硬化患者应激状态下左心功能储备中有应用价值,且失代偿期酒精性肝硬化患者心脏储备功能下降更加显著。

Objective To observe the changes of left ventricular function in patients with hepatitis B-related cirrhosis and alcoholic cirrhosis before and after the standard isometric grip test,and to evaluate the left ventricular function reserve of patients in these two groups under stress.Methods Sixty patients with hepatitis B-related cirrhosis and 62 patients with alcoholic cirrhosis were selected in this study.The two groups of patients were further divided into Child A group and Child B+C group according to Child-Pugh classification.Standard isometric grip test was carried out to measure the left ventricular Tei index of patients before and after the load test,and analyze the difference of cardiac function between the two groups of patients before and after the load test.Results 1.The Tei index of patients with hepatitis B-related cirrhosis(0.43±0.03 vs 0.45±0.07)and alcoholic cirrhosis(0.44±0.05 vs 0.46±0.08)before and after the experiment had statistical significance(P<0.05).2.There was no statistical difference in Tei index before and after the experiment in Child A group,Child B+C group of patients with hepatitis B-related cirrhosis and Child A group of patients with alcoholic cirrhosis(P>0.05).However,there was statistical difference in Tei value before and after the experiment in Child B+C group of patients with alcoholic cirrhosis(0.44±0.04 vs 0.47±0.07)(P<0.05).Conclusion While the cardiac structure and function of patients with hepatitis B-related cirrhosis and alcoholic cirrhosis are roughly the same at rest,the cardiac function of patients in both groups has decreased after stress test.There has application value of stress echocardiography in reflecting left heart function reserve under stress in patients with liver cirrhosis,and the cardiac reserve function of patients with decompensated alcoholic cirrhosis has decreased more significantly.