摘要
目的分析正常人与基于不同肝功能分级(Child-Pugh分级)乙型病毒性肝炎患者左心室腔内压差(IVPD)及左心室内压力梯度(IVPG)的变化特点,探讨血流向量成像(VFM)技术评价不同肝功能分级乙型病毒性肝炎患者左心功能的价值。方法选取2022年1月至2023年4月在哈尔滨医科大学附属第一医院收治的慢性乙型病毒性肝炎患者126例(其中Child-Pugh A级患者69例为A组,Child-Pugh B级患者35例为B组,Child-Pugh C级患者22例为C组)及同期正常对照组65例。常规采集临床及常规超声心动图指标,并应用VFM技术获取左心室收缩期及舒张期各时相中等容收缩期(IC)、快速射血期(RE)、等容舒张期(IR)、快速充盈期(RF)、缓慢充盈期(SF)和心房收缩期(AC)的IVPD及IVPG,分析各组之间指标的差异以及VFM参数与常规超声心动图指标、Child-Pugh分级之间的相关性,绘制ROC曲线计算VFM参数预测Child-Pugh C级乙型病毒性肝炎的效能。结果C组患者的e'、a'、TRV显著高于正常组、A组及B组(P均<0.05);A级、B级患者的左心房容积指数(LAVI)、E/e’、二尖瓣口E峰减速时间(DT)、舒张末期室间隔厚度(LVSd)、舒张末期左心室后壁厚度(LVPWd)均高于正常组(P均<0.05)。3组患者IC-IVPG绝对值较对照组均升高(P均<0.05);A组AC-IVPD及AC-IVPG绝对值较对照组均升高(P均<0.05);C组患者IC-IVPD、RE-IVPD、IR-IVPD和IR-IVPG绝对值均较对照组升高(P均<0.05)。相关性分析结果显示,IC-IVPD及IC-IVPG均与A、E/A、e'、a'、E/e'、e'/a'、DT、LVSd、LVPWd相关;IC-IVPD与心率(HR)相关;RE-IVPD及RE-IVPG均与E、a'、E/e'、DT相关;IR-IVPD及IR-IVPG与HR、左心室射血分数(LVEF)、A、E/A、a'、E/e'、e'/a'、DT、LVSd、LVPWd相关;RF-IVPD及RF-IVPG与E、A相关;SF-IVPD及SF-IVPG与E相关;AC-IVPD及AC-IVPG与A、E/A、e'、a'、E/e'、e'/a'、DT、LVSd、LVPWd相关(P均<0.05)。IR-IVPD、RF-IVPD和AC-IVPD与Child-Pugh分级呈正相关(r=0.172、0.203、0.225,P均<0.05)。IR-IVPD和AC-IVPD预测Child-Pugh C级乙型病毒性肝炎患者的ROC曲线下面积分别为0.78和0.843(P均<0.01)。结论左心室内IVPD及IVPG可以量化其腔内血流的变化情况,早期提示乙型病毒性肝炎患者左心收缩及舒张功能的改变,并可以提示乙型病毒性肝炎患者肝功能损伤程度,有望成为评价乙型病毒性肝炎患者心脏舒张功能的新参数。
Objective To assess the changes of left intraventricular pressure difference(IVPD)and left intraventricular pressure gradient(IVPG)by vector flow mapping(VFM)in normal subjects and hepatitis B patients with different Child-Pugh grades,in order to explore the value of VFM in evaluating left ventricular function in hepatitis B patients with different liver function grades from the perspective of hemodynamics.Methods A total of 126 patients with chronic viral hepatitis B(including 69 patients with Child-Pugh grade A as group A,35 with Child-Pugh grade B as group B,and 22 with Child-Pugh grade C as group C)admitted to the First Affiliated Hospital of Harbin Medical University from January 2022 to April 2023 were selected.Sixty-five normal controls were selected in the same period.Clinical and conventional echocardiographic parameters were collected routinely,and IVPD and IVPG were obtained by VFM technology during the isovolumetric contraction(IC),rapid ejection(RE),isovolumetric relaxation(IR),rapid filling(RF),slow filling(SF),and atrial contraction(AC)phases at left ventricular systole and diastole.The differences in the above indicators among the groups and the correlation between VFM parameters and conventional echocardiographic indicators and Child-Pugh classification were analyzed.Receiver operating characteristic(ROC)curve analysis was performed to calculate the efficacy of VFM parameters in predicting Child-Pugh C hepatitis B.Results The e',a'and tricuspid regurgitation velocity(TRV)in Child-Pugh grade C patients were significantly higher than those in the normal group and groups A and B(P<0.05).The absolute values of left atrial volume index(LAVI),E/e',deceleration time(DT),interventricular septal end-diastolic thinkness(LVSd),and end-diastolic left ventricular posterior wall thickness(LVPWd)in patients with Child-Pugh grade A and B were higher than those in the normal group(P<0.05).The absolute values of IC-IVPG in patients with hepatitis B were higher than those of the control group(P<0.05).The absolute values of IC-IVPD,RE-IVPD,IR-IVPD,and IR-IVPG in Child-Pugh grade C patients were higher than those of the control group(P<0.05).IC-IVPD and IC-IVPG were correlated with A,E/a,e',a',E/e',e'/a',DT,LVSd,and LVPWd.IC-IVPD was correlated with heart rate(HR).RE-IVPD and RE-IVPG were correlated with E,a',E/e',and DT,while IR-IVPD and IR-IVPG were correlated with HR,left ventricular ejection fraction(LVEF),A,E/a,a',E/e',e'/a',DT,LVSd,and LVPWd.RF-IVPD and RF-IVPG were correlated with E and A.SF-IVPD and SF-IVPG were correlated with E.AC-IVPD and AC-IVPG were correlated with A,E/a,e',a',E/e',e'/a',DT,LVSd,and LVPWd.IR-IVPD,RF-IVPD,and AC-IVPD were positively correlated with Child-Pugh classification(r=0.172,0.203,and 0.225,respectively,P<0.05).The area under the ROC curve of IR-IVPD and AC-IVPD for predicting Child-Pugh grade C hepatitis B was 0.78 and 0.843,respectively(P<0.01).Conclusion Left ventricular IVPD and IVPG can quantify the changes of intracavity blood flow,indicate the changes of left ventricular systolic and diastolic function early,and reflect the degree of liver function damage in patients with viral hepatitis B,which is expected to become new parameters for evaluating cardiac diastolic function in patients with viral hepatitis B.
作者
卢天祺
张巍
周康
毕士玉
张羽
杨秀华
Tianqi Lu;Wei Zhang;Kang Zhou;Shiyu Bi;Yu Zhang;Xiuhua Yang(Department of Cardiac Ultrasound,First Affiliated Hospital of Harbin Medical University,Harbin 150000,China)
出处
《中华医学超声杂志（电子版）》
CSCD
北大核心
2024年第4期352-360,共9页
Chinese Journal of Medical Ultrasound(Electronic Edition)
关键词
血流向量成像
超声心动图
乙型病毒性肝炎
左心室内压差
左心室内压力梯度
左心室功能
Vector flow mapping
Echocardiography
Viral hepatitis B
Left ventricular pressure difference
Left ventricular pressure gradient
Left ventricular function
