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目的探讨二维斑点追踪技术评价肝硬化患者左室局部收缩功能的价值。方法诊断明确的肝硬化患者50例,分为Child A、B、C级,对照组30例,获得常规超声参数及二维动态图像,采用Qlab软件进行脱机分析,测得左室16节段纵向、径向及环向收缩期峰值应变,分析不同程度肝硬化组及对照组测量指标的变化情况。结果 (1)肝硬化患者和对照组比较,心率、血压、左房前后径、室间隔厚度、左室舒张末期容积、左室收缩末期容积差异有统计学意义(P<0.05)。(2)除前间隔、前壁、下壁及前侧壁基底段外,左室各节段纵向、径向、环向收缩期峰值应变差异有统计学意义(P<0.05)。(3)除左室侧壁心尖段径向收缩期峰值应变外,Child C级组与其他组两两比较,左室心尖各段、中间段各段及部分基底段差异有统计学意义(P<0.05)。(4)Child A、B级组与对照组两两比较,部分基底段、中间段及心尖段收缩期峰值应变差异有统计学意义(P<0.05)。结论肝硬化患者左室局部收缩功能减低,并随着肝硬化程度的加重而加重;二维斑点追踪成像技术能早期发现肝硬化患者潜在的左室局部收缩功能损害。
Objective To investigate the value of two-dimensional speckle tracking in assessing left ventricular regional systolic function in patients with liver cirrhosis. Methods Fifty patients diagnosed with cirrhosis were randomly divided into three groups: Child A, B and C, and control group. The ultrasound parameters and two-dimensional dynamic images were obtained. Off-line analysis was performed with Qlab software. Longitudinal, radial and circumferential systolic peak strain, analysis of varying degrees of changes in cirrhosis and control group measurements. Results (1) Compared with the control group, there were significant differences in heart rate, blood pressure, anteroposterior diameter, interventricular septum thickness, left ventricular end-diastolic volume, and left ventricular end-systolic volume in cirrhotic patients (P <0.05). (2) There were significant differences in peak strain in longitudinal, radial and circumferential systolic phases except anterior septum, anterior wall, inferior wall and basilar segment of anterior wall (P <0.05). (3) In addition to the peak systolic strain at the apical segment of the left ventricular wall, there was a significant difference in each segment of the left apex, middle segments and some basal segments between the Child C group and the other groups (P <0.05). (4) There was a significant difference in peak strain at systolic phase of basal segment, middle segment and apical segment between Child A, B group and control group (P <0.05). Conclusions Left ventricular regional systolic function is reduced in patients with cirrhosis and aggravates with the severity of liver cirrhosis. Two-dimensional speckle tracking imaging can detect latent partial systolic dysfunction in patients with cirrhosis.