CAJ | 학술논문

目的应用超声速度向量成像(velocity vector imaging,VVI)技术评价不同阶段肝硬化右心室心肌力学功能状态;联合标准等长握力试验,进一步揭示早期肝硬化等长负荷前后右心室心肌力学功能变化,探索肝硬化性心肌病超声心动图早期诊断的方法和指标.方法肝硬化患者82例,根据Child-Pugh评分分为3组:A组(42例)、B组(28例)、C组(12例),其中A组中31例进行标准等长握力试验.对照组34例.采集连续三个心动周期的心尖四腔观右心室长轴切面,运用VVI图像工作站获取右心室6个节段心肌收缩期纵向峰值应变(Smax)及整体射血分数(RVEF).结果 ①肝硬化组与对照组比较,A组RVEF正常,右心室各节段Smax无明显变化(P＞0.05);B组RVEF无明显改变(P＞0.05),右心室各节段Smax增大为主(P＜0.05～0.01);C组RVEF明显减低(P＜0.01),右心室各节段心肌Smax减低为主(P ＜0.05～0.01).②肝硬化组组间比较:A、B组间血压、RVEF、右心室各节段Smax差异无统计学意义(P＞0.05);与A组比较,C组血压及RVEF显著下降;右心室各节段Smax以减低为主(P＜0.05～0.01);与B组比较,C组血压及RVEF显著降低;右心室各节段Smax明显减低(P＜0.01).③与静息状态相比,标准等长握力试验后A组RVEF明显降低,右心室各节段Smax明显减低(P＜0.05～0.01).结论等长负荷实验有助于揭示肝硬化早期患者右心室心肌功能损伤;肝硬化病情程度不同,右室心肌收缩功能存在明显差异.
목적 응용초성속도향량성상(velocity vector imaging,VVI)기술평개불동계단간경화우심실심기역학공능상태;연합표준등장악력시험,진일보게시조기간경화등장부하전후우심실심기역학공능변화,탐색간경화성심기병초성심동도조기진단적방법화지표.방법 간경화환자82례,근거Child-Pugh평분분위3조:A조(42례)、B조(28례)、C조(12례),기중A조중31례진행표준등장악력시험.대조조34례.채집련속삼개심동주기적심첨사강관우심실장축절면,운용VVI도상공작참획취우심실6개절단심기수축기종향봉치응변(Smax)급정체사혈분수(RVEF).결과 ①간경화조여대조조비교,A조RVEF정상,우심실각절단Smax무명현변화(P＞0.05);B조RVEF무명현개변(P＞0.05),우심실각절단Smax증대위주(P＜0.05～0.01);C조RVEF명현감저(P＜0.01),우심실각절단심기Smax감저위주(P ＜0.05～0.01).②간경화조조간비교:A、B조간혈압、RVEF、우심실각절단Smax차이무통계학의의(P＞0.05);여A조비교,C조혈압급RVEF현저하강;우심실각절단Smax이감저위주(P＜0.05～0.01);여B조비교,C조혈압급RVEF현저강저;우심실각절단Smax명현감저(P＜0.01).③여정식상태상비,표준등장악력시험후A조RVEF명현강저,우심실각절단Smax명현감저(P＜0.05～0.01).결론 등장부하실험유조우게시간경화조기환자우심실심기공능손상;간경화병정정도불동,우실심기수축공능존재명현차이.
Objective To study regional myocardial function of right ventricle at different stages of cirrhosis,using velocity vector imaging combined with standard isometric grip strength test to reveal the mechanical function in patients with liver cirrhosis at early stage further,and to benefit reliable quantitative evaluation and efficacy indicators for the establishment of the early diagnostic criteria of cirrhotic cardiomyopathy by echocardiography,and found myocardial mechanics basis for explicit pathogenesis of cirrhotic cardiomyopathy.Methods Accorded to Child-Pugh score,the cirrhosis experimental groups were divided into three groups:group A (42 patients),group B (28 patients) and group C (12 patients).There were 31 patients in group A to be conducted standard isometric grip strength test.While 34 healthy people were selected as the control group.The dynamic gray scale long-axis view images of the right ventricle were collected in 3 complete cardiac cycles in apical four-chamber view.Peak systolic longitudinal strain (Smax) and global ejection fraction of the right ventricle were derived from 6 myocardial segments with the Syngo VVI workstation off-line.Results 1)Compared with the control group,in group A,global ejection fraction of the right ventricle was normal,there were not significant change of Smax of each segment (P ＞0.05).In group B,there was not significant change of global ejection fraction of the right ventricle,the Smax of each segment were increased mainly (P ＜0.05-0.01).In group C,global ejection fraction of the right ventricle was significantly lower (P ＜ 0.01),the Smax of each segment reduced mainly (P ＜ 0.05-0.01).2)Compared with group A,in group B,there was no significant difference of blood pressure and global ejection fraction of the right ventricle,while including the Smax of each segment in systole and diastole.Compared with group A and group B,in group C,systolic and diastolic blood pressure and global ejection fraction of the right ventricle decreased significantly; the Smax of each segment were reduced mainly (P ＜ 0.05-0.01).3)Compared with the resting state,after the standard isometric grip strength test,the global ejection fraction of the right ventricle decreased significantly,there was a significant reduction mainly in Smax of each segment (P ＜ 0.01).Conclusions The regional myocardial function of right ventricle in patients with liver cirrhosis is abnormality even at early stage and could be revealed by standard isometric stress test.The right ventricular systolic dyfunction is related to the stages of liver cirrhosis disease.