组织多普勒Tei指数评估肝硬化患者左、右心室整体功能的临床研究

发布时间：2018-03-25 06:25

本文选题：肝硬化　切入点：心功能　出处：《南昌大学》2017年硕士论文

【摘要】：目的:通过测量不同病情程度的肝硬化患者左、右心室的组织多普勒(Tissue Doppler Imaging,TDI)TDI-Tei指数对心脏的整体功能进行定量评价,为评估肝硬化患者心脏状况提供可量化的临床参考数据。资料和方法:选取59例在南昌大学第一附属医院消化内科诊断为肝硬化的患者作为肝硬化实验组,依据肝功能Child-pugh分级分为Child A级、Child B级、Child C级3组,其中Child A级27例、Child B级18例、Child C级14例。随机抽取同期在我院进行心脏彩超检查的30例健康体检者作为正常对照组,要求正常对照组受检者的年龄、性别、体重指数(Body Mass Index,BMI)值与肝硬化实验组相匹配。所有受检者检查前休息5~10分钟,待呼吸、心率平稳后再予以检测。嘱受检者取左侧卧位,同步连接肢体导联心电图。经胸超声心动图在二维或M型超声模式下于心脏左心室长轴切面、心尖四腔心切面常规测量心脏相关指标,包括左心房前后径(Left atrial anterior and posterior diameter,LAAPD)、左心室舒张末期内径(Left ventricular end diastolic diameter,LVEDD)、左心室收缩末期内径(Left ventricular end systolic diameter,LVESD)、室间隔厚度(Interventricular spetal dimension,IVSD)、左室后壁厚度(Left ventricular posterior wall dimension,LVPWD)、左心室射血分数(Left ventricular ejection fraction,LVEF)、右心房上下径(Right atrial up and down diameter,RAUDD)、右心房左右径(Right atrial left and right diameter,RALRD)、右心室舒张末期内径(Right ventricular end diastolic diameter,RVEDD)。切换至心尖四腔心切面TDI模式下,将脉冲多普勒取样容积分别置于心室壁与二尖瓣后瓣和三尖瓣前瓣连接处,测量左、右心室TDI-Tei指数。对以上数据进行统计学处理并进一步分析左、右心室TDI-Tei指数与肝功能Child-pugh分级的相关性,同时利用ROC曲线分析左、右心室TDI-Tei指数评判肝硬化并发心功能损害的诊断效能。结果:1)肝硬化实验组与正常对照组一般资料比较:肝硬化实验组受检者的年龄、性别、BMI值与正常对照组比较,差异均无统计学意义(p0.05);肝硬化实验组与正常对照组受检者心率比较明显增快,差异具有统计学意义(p0.05)。2)肝硬化实验组与正常对照组常规超声指标比较:肝硬化实验组受检者的LAAPD、LVEDD、IVSD、RAUDD、RALRD、RVEDD均明显大于正常对照组(p0.05),而LVESD、LVPWD、LVEF与正常对照组比较则无明显差异(p0.05)。3)肝硬化实验组与正常对照组左、右心室TDI-Tei指数比较:肝硬化实验组受检者左、右心室TDI-Tei指数均明显高于正常对照组,差异具有统计学意义(p0.05)。4)肝硬化分级组与正常对照组左、右心室TDI-Tei指数比较:随着肝硬化Child-pugh分级逐渐升高,病情程度逐渐加重,左、右心室TDI-Tei指数均呈递增趋势。Child A级组左、右心室TDI-Tei指数均高于正常对照组,但差异均无统计学意义(p0.05);Child B级组左心室TDI-Tei指数高于正常对照组,差异有统计学意义(p0.05),与Child A级组比较,差异无统计学意义(p0.05),右心室TDI-Tei指数高于正常对照组和Child A级组,差异均有统计学意义(p0.05);Child C级组左心室TDI-Tei指数高于正常对照组、Child A级组和Child B级组,差异均具有统计学意义(p0.05),右心室TDI-Tei指数高于正常对照组和Child A级组,差异均具有统计学意义(p0.05),与Child B级组比较,差异无统计学意义(p0.05)。5)肝硬化各分级组左、右心室TDI-Tei指数与肝功能Child-pugh分级的相关分析:左、右心室TDI-Tei指数与肝功能Child-pugh分级均呈明显正相关。6)肝硬化实验组和正常对照组左、右心室TDI-Tei指数ROC曲线下面积分析得出:左心室TDI-Tei指数曲线下面积为0.837,最佳节点值为0.395,其灵敏度为80.0%,特异度为78.6%;右心室TDI-Tei指数曲线下面积为0.755,最佳节点值为0.380,其灵敏度为63.3%,特异度为78.6%。结论:1)肝硬化可对患者的心脏产生一定的影响,表现为心率增快、心脏腔室结结果:构不同程度增大。2)肝硬化患者的左、右心室TDI-Tei指数均增高,提示左、右心室整体功能均受到损害,且随肝硬化病情程度加重而加重。3)当左心室TDI-Tei指数0.395或右心室TDI-Tei指数0.380时,应警惕肝硬化患者并发了心脏整体功能的损害。4)TDI-Tei指数能客观、敏感、全面的反应心脏的整体功能,操作无创、简便,是对常规超声心动图一个很好的补充,值得在临床上推广应用。
[Abstract]:Objective: to measure the severity of liver cirrhosis patients with different left and right ventricular tissue Doppler (Tissue Doppler, Imaging, TDI) TDI-Tei index for quantitative evaluation of cardiac function, and provide clinical reference data for quantitative cardiac status assessment of patients with cirrhosis. Materials and methods: select 59 cases in the First Affiliated Hospital of Nanchang University Department of Gastroenterology diagnosis for patients with cirrhosis and cirrhosis as the experimental group, according to Child-pugh classification of liver function is divided into a Child, Child B, Child C in 3 groups, including 27 cases of Child grade Child, B grade 18 cases, Child 14 cases of grade C were randomly selected for cardiac ultrasound examination in our hospital 30 cases of healthy persons as the normal control group, normal control group subjects of age, gender, body mass index (Body Mass, Index, BMI) values matched with cirrhosis group. All subjects before the examination to rest 5~10 minutes, Breathing, heart rate and then be detected. Subjects were asked to take a leftlie, synchronous connection limb lead ECG. Transthoracic echocardiography in 2D or M type ultrasound mode in left ventricular long axis view of the heart, the relevant index of routine measurement of cardiac apical four chamber view, including left ventricular diameter (Left atrial in front of the house after anterior and posterior diameter, LAAPD), left ventricular end diastolic diameter (Left ventricular end diastolic diameter, LVEDD), left ventricular end systolic diameter (Left ventricular end systolic diameter, LVESD), interventricular septal thickness (Interventricular spetal, dimension, IVSD), left ventricular posterior wall thickness (Left ventricular posterior wall dimension, LVPWD). The left ventricular ejection fraction (Left ventricular ejection fraction, LVEF), right atrium diameter (Right atrial up and down diameter, RAUDD), right atrial diameter (Right atrial left and R Ight diameter, RALRD), right ventricular end diastolic diameter (Right ventricular end diastolic diameter, RVEDD). Switching to the apical four chamber view of TDI mode, the pulse Doppler sample volume was placed after ventricular wall and mitral valve and three anterior tricuspid junction, measuring left and right ventricular TDI-Tei index on the above. The data were statistically analyzed and further analyze the correlation between left and right ventricular TDI-Tei index and Child-pugh classification of liver function, at the same time using the ROC curve analysis of left and right ventricular function diagnostic efficacy of ventricular TDI-Tei index in patients with liver cirrhosis damage. Results: 1) experimental cirrhosis group and normal control group comparison of general information: the experimental group subjects with liver cirrhosis age, gender, BMI value compared with the normal control group showed no significant difference (P0.05); experimental liver cirrhosis group and normal control group subjects heart rate increased obviously, the difference There was statistical significance (P0.05).2) of liver cirrhosis in experimental group compared with control group conventional ultrasound index: liver cirrhosis experimental group subjects LAAPD, LVEDD, IVSD, RAUDD, RALRD, RVEDD were significantly higher than the normal control group (P0.05), LVESD, LVPWD, LVEF compared with the normal control group had no significant difference (P0.05).3) experimental cirrhosis group and normal control group comparison of left and right ventricular TDI-Tei index in liver cirrhosis: experimental group subjects with left and right ventricular TDI-Tei index were significantly higher than the normal control group, the difference was statistically significant (P0.05).4) classification of liver cirrhosis group and normal control group comparison of left and right ventricular TDI-Tei index: with the Child-pugh grading of liver cirrhosis gradually increased, the severity gradually increased, left and right ventricular TDI-Tei index were increased in.Child a group of left and right ventricular TDI-Tei index was higher than the normal control group, but the differences were not statistically significant (P0.05); Child B Left ventricular TDI-Tei index is higher than the normal control group, the difference was statistically significant (P0.05), compared with Child in group A, the difference was not statistically significant (P0.05), right ventricular TDI-Tei index was higher than the normal control group and a Child group, the differences were statistically significant (P0.05); Child C group left ventricular TDI-Tei index is higher than the normal control Child group and Child group, a B group, the differences were statistically significant (P0.05), right ventricular TDI-Tei index was higher than the normal control group and a Child group, the differences were statistically significant (P0.05), compared with Child B group, the difference was not statistically significant (P0.05).5) the classification of cirrhosis group left. Analysis of right ventricular TDI-Tei index and Child-pugh classification of liver function: left and right ventricular TDI-Tei index and Child-pugh classification of liver function were positively correlated.6) of hepatic cirrhosis group and normal control group, the left and right ventricular TDI-Tei index ROC curve The area under the analysis shows that the area of the left ventricular TDI-Tei index curve was 0.837 and the best node value is 0.395, the sensitivity was 80%, specificity was 78.6%; the area of the right ventricular TDI-Tei index curve was 0.755 and the best node value is 0.380, the sensitivity was 63.3%, specificity was 78.6%. Conclusion: 1) can cause liver cirrhosis a certain impact on the patient's heart, manifested as increased heart rate, cardiac chamber results: the increased.2) in patients with cirrhosis of the left and right ventricular TDI-Tei index were increased, suggesting that the left and right ventricular function were damaged, and with the severity of liver cirrhosis and exacerbation of.3) when left ventricular TDI-Tei index 0.395 or the right ventricular TDI-Tei index 0.380, should be alert to the overall function of patients of liver cirrhosis complicated with heart injury.4) TDI-Tei index can be objective, sensitive, comprehensive response to the overall heart function, the operation is simple, noninvasive, on conventional ultrasound Cardiography is a good supplement and is worthy of clinical application.

【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R540.45;R575.2

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