组织多普勒心肌综合指数联合血浆脑钠肽检测评价肝硬化失代偿期患者心功能的临床研究

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摘要目的探讨组织多普勒心肌综合指数（Tei指数）联合血浆脑钠肽（BNP）水平定量评价肝硬化失代偿期患者心功能的价值。方法选取2014年6月~2016年6月河北北方学院附属第一医院消化内科确诊并住院的肝硬化患者100例，依据肝功能Child-Pugh分级和临床症状，将患者分为肝硬化代偿期组和肝硬化失代偿期组，每组50例。另选取同期于我院行健康体检的人群40名为正常对照组。比较三组Tei指数、血浆BNP水平及肝功能指标；分析肝硬化失代偿期患者的左、右心室Tei指数和血浆BNP水平的相关性；比较肝硬化失代偿期患者不同分级Tei指数和血浆BNP水平。结果肝硬化失代偿期组丙氨酸转氨酶、天冬氨酸转氨酶水平高于正常对照组，总胆红素（TBil）水平高于正常对照组和肝硬化代偿期组，白蛋白（ALB）水平低于正常对照组和肝硬化代偿期组；肝硬化代偿期组TBil水平高于正常对照组，ALB水平低于正常对照组（均P < 0.05）。肝硬化失代偿期组左、右心室Tei指数、BNP水平高于正常对照组和肝硬化代偿期组；肝硬化代偿期组左、右心室Tei指数、BNP水平高于正常对照组（均P < 0.05）。肝硬化失代偿期患者左、右心室Tei指数与血浆BNP水平均呈正相关（r = 0.717、0.618，均P < 0.01）。C级肝硬化失代偿期患者左、右心室Tei指数、血浆BNP水平高于B级肝硬化失代偿期患者（均P < 0.05）。结论 Tei指数和血浆BNP水平与肝硬化失代偿期患者心功能有明显的相关性，二者联合检测能对肝硬化失代偿期患者定量评价。

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	陈曦王立坤王义成

关键词 ：心肌综合指数, 血浆脑钠肽, 肝硬化, 失代偿期, 心功能, 相关性

Abstract：Objective To evaluate the cardiac function in patients with decompensated cirrhosis by tissue Doppler myocardial performance index (Tei index) combined with plasma B-type natriuretic peptide (BNP). Methods A total of 100 patients with cirrhosis diagnosed and hospitalized in the Department of Gastroenterology, the First Affiliated Hospital of Hebei North University (“our hospital” for short) from June 2014 to June 2016 were selected, and they were divided into the compensated cirrhosis group and the decompensated cirrhosis group according to Child-Pugh grading of liver function and clinical symptoms, with 50 cases in each group. In addition, 40 healthy people who underwent physical examination in our hospital during the same period were selected as the normal control group. Tei index, plasma BNP level and liver function indexes among three groups were compared. The correlation between left and right ventricular Tei indexes and plasma BNP levels in patients with decompensated cirrhosis in different grading were analyzed. Tei index and plasma BNP levels of patients with decompensated cirrhosis in different grading were compared. Results The levels of alanine aminotransferase and aspartate aminotransferase in the decompensated cirrhosis group were higher than those in the normal control group, the levels of total bilirubin (TBil) were higher than those in the normal control group and the compensated cirrhosis group, and the levels of albumin (ALB) were lower than those in the normal control group and the compensated cirrhosis group; the levels of TBil in the compensated cirrhosis group were higher than those in the normal control group and the levels of ALB in the compensated cirrhosis group were lower than those in the normal control group (all P < 0.05). Left and right ventricle Tei indexes and BNP levels in the decompensated cirrhosis group were higher than those in the normal control group and the compensated cirrhosis group; left and right ventricle Tei indexes and BNP levels of in the compensated cirrhosis group were higher than those in the normal control group (all P < 0.05). Left and right ventricular Tei indexes were positively correlated with plasma BNP level in patients with decompensated cirrhosis (r = 0.717, 0.618, all P < 0.01). Left and right ventricular Tei indexes and plasma BNP levels in patients with grade C decompensated cirrhosis were higher than those in patients with grade B decompensated cirrhosis (all P < 0.05). Conclusion Tei index and plasma BNP level were significantly correlated with cardiac function in patients with decompensated cirrhosis, and the combination can quantitatively evaluate the decompensated stage of cirrhosis.

Key words： Myocardial composite index Plasma B-type natriuretic peptide Cirrhosis Decompensation period Cardiac function Correlation

基金资助:河北省医学科学研究重点课题计划项目（20160 367）；
河北省张家口市科技攻关计划项目（1621084D）。

通讯作者: 王义成（1963.3-），男，主任医师，硕士生导师；研究方向：心血管疾病的超声诊断。

引用本文:

陈曦王立坤王义成. 组织多普勒心肌综合指数联合血浆脑钠肽检测评价肝硬化失代偿期患者心功能的临床研究[J]. 中国医药导报, 2020, 17(29): 65-68.
CHEN Xi WANG Likun WANG Yicheng. Clinical study on the evaluation of cardiac function in patients with decompensated cirrhosis by tissue Doppler myocardial composite index and plasma B-type natriuretic peptide. 中国医药导报, 2020, 17(29): 65-68.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2020/V17/I29/65

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