本文選題：肝硬化　切入點(diǎn)：心功能　出處：《南昌大學(xué)》2017年碩士論文

【摘要】：目的:通過(guò)測(cè)量不同病情程度的肝硬化患者左、右心室的組織多普勒(Tissue Doppler Imaging,TDI)TDI-Tei指數(shù)對(duì)心臟的整體功能進(jìn)行定量評(píng)價(jià),為評(píng)估肝硬化患者心臟狀況提供可量化的臨床參考數(shù)據(jù)。資料和方法:選取59例在南昌大學(xué)第一附屬醫(yī)院消化內(nèi)科診斷為肝硬化的患者作為肝硬化實(shí)驗(yàn)組,依據(jù)肝功能Child-pugh分級(jí)分為Child A級(jí)、Child B級(jí)、Child C級(jí)3組,其中Child A級(jí)27例、Child B級(jí)18例、Child C級(jí)14例。隨機(jī)抽取同期在我院進(jìn)行心臟彩超檢查的30例健康體檢者作為正常對(duì)照組,要求正常對(duì)照組受檢者的年齡、性別、體重指數(shù)(Body Mass Index,BMI)值與肝硬化實(shí)驗(yàn)組相匹配。所有受檢者檢查前休息5~10分鐘,待呼吸、心率平穩(wěn)后再予以檢測(cè)。囑受檢者取左側(cè)臥位,同步連接肢體導(dǎo)聯(lián)心電圖。經(jīng)胸超聲心動(dòng)圖在二維或M型超聲模式下于心臟左心室長(zhǎng)軸切面、心尖四腔心切面常規(guī)測(cè)量心臟相關(guān)指標(biāo),包括左心房前后徑(Left atrial anterior and posterior diameter,LAAPD)、左心室舒張末期內(nèi)徑(Left ventricular end diastolic diameter,LVEDD)、左心室收縮末期內(nèi)徑(Left ventricular end systolic diameter,LVESD)、室間隔厚度(Interventricular spetal dimension,IVSD)、左室后壁厚度(Left ventricular posterior wall dimension,LVPWD)、左心室射血分?jǐn)?shù)(Left ventricular ejection fraction,LVEF)、右心房上下徑(Right atrial up and down diameter,RAUDD)、右心房左右徑(Right atrial left and right diameter,RALRD)、右心室舒張末期內(nèi)徑(Right ventricular end diastolic diameter,RVEDD)。切換至心尖四腔心切面TDI模式下,將脈沖多普勒取樣容積分別置于心室壁與二尖瓣后瓣和三尖瓣前瓣連接處,測(cè)量左、右心室TDI-Tei指數(shù)。對(duì)以上數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)處理并進(jìn)一步分析左、右心室TDI-Tei指數(shù)與肝功能Child-pugh分級(jí)的相關(guān)性,同時(shí)利用ROC曲線分析左、右心室TDI-Tei指數(shù)評(píng)判肝硬化并發(fā)心功能損害的診斷效能。結(jié)果:1)肝硬化實(shí)驗(yàn)組與正常對(duì)照組一般資料比較:肝硬化實(shí)驗(yàn)組受檢者的年齡、性別、BMI值與正常對(duì)照組比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(p0.05);肝硬化實(shí)驗(yàn)組與正常對(duì)照組受檢者心率比較明顯增快,差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。2)肝硬化實(shí)驗(yàn)組與正常對(duì)照組常規(guī)超聲指標(biāo)比較:肝硬化實(shí)驗(yàn)組受檢者的LAAPD、LVEDD、IVSD、RAUDD、RALRD、RVEDD均明顯大于正常對(duì)照組(p0.05),而LVESD、LVPWD、LVEF與正常對(duì)照組比較則無(wú)明顯差異(p0.05)。3)肝硬化實(shí)驗(yàn)組與正常對(duì)照組左、右心室TDI-Tei指數(shù)比較:肝硬化實(shí)驗(yàn)組受檢者左、右心室TDI-Tei指數(shù)均明顯高于正常對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。4)肝硬化分級(jí)組與正常對(duì)照組左、右心室TDI-Tei指數(shù)比較:隨著肝硬化Child-pugh分級(jí)逐漸升高,病情程度逐漸加重,左、右心室TDI-Tei指數(shù)均呈遞增趨勢(shì)。Child A級(jí)組左、右心室TDI-Tei指數(shù)均高于正常對(duì)照組,但差異均無(wú)統(tǒng)計(jì)學(xué)意義(p0.05);Child B級(jí)組左心室TDI-Tei指數(shù)高于正常對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(p0.05),與Child A級(jí)組比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05),右心室TDI-Tei指數(shù)高于正常對(duì)照組和Child A級(jí)組,差異均有統(tǒng)計(jì)學(xué)意義(p0.05);Child C級(jí)組左心室TDI-Tei指數(shù)高于正常對(duì)照組、Child A級(jí)組和Child B級(jí)組,差異均具有統(tǒng)計(jì)學(xué)意義(p0.05),右心室TDI-Tei指數(shù)高于正常對(duì)照組和Child A級(jí)組,差異均具有統(tǒng)計(jì)學(xué)意義(p0.05),與Child B級(jí)組比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。5)肝硬化各分級(jí)組左、右心室TDI-Tei指數(shù)與肝功能Child-pugh分級(jí)的相關(guān)分析:左、右心室TDI-Tei指數(shù)與肝功能Child-pugh分級(jí)均呈明顯正相關(guān)。6)肝硬化實(shí)驗(yàn)組和正常對(duì)照組左、右心室TDI-Tei指數(shù)ROC曲線下面積分析得出:左心室TDI-Tei指數(shù)曲線下面積為0.837,最佳節(jié)點(diǎn)值為0.395,其靈敏度為80.0%,特異度為78.6%;右心室TDI-Tei指數(shù)曲線下面積為0.755,最佳節(jié)點(diǎn)值為0.380,其靈敏度為63.3%,特異度為78.6%。結(jié)論:1)肝硬化可對(duì)患者的心臟產(chǎn)生一定的影響,表現(xiàn)為心率增快、心臟腔室結(jié)結(jié)果:構(gòu)不同程度增大。2)肝硬化患者的左、右心室TDI-Tei指數(shù)均增高,提示左、右心室整體功能均受到損害,且隨肝硬化病情程度加重而加重。3)當(dāng)左心室TDI-Tei指數(shù)0.395或右心室TDI-Tei指數(shù)0.380時(shí),應(yīng)警惕肝硬化患者并發(fā)了心臟整體功能的損害。4)TDI-Tei指數(shù)能客觀、敏感、全面的反應(yīng)心臟的整體功能,操作無(wú)創(chuàng)、簡(jiǎn)便,是對(duì)常規(guī)超聲心動(dòng)圖一個(gè)很好的補(bǔ)充,值得在臨床上推廣應(yīng)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.

【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R540.45;R575.2

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