二维及三维心脏超声参数对心脏移植后心功能和形态的评估效果及预测效能研究

doi:10.7517/issn.1674-0475.200607

摘要/Abstract

摘要： 为探讨二维及三维心脏超声评价心脏移植术后心功能和形态改变的应用价值，选取心脏移植术后患者41例设为观察组，另选取同期健康体检者41例设为对照组。观察组入院术后7 d均实施二维及三维心脏超声检查，发现患者的左房内径（LAD）、左心室收缩末期内径（LVESD）大于对照组，左心室射血分数（LVEF）小于对照组（P<0.05）；随访3个月，观察组存在排异反应者的术后7 d LAD、LVESD、左室心肌质量（LVM）大于无排异反应者，LVEF、左室每搏量（LVSV）小于无排异反应者（P<0.05）；随访3个月，病死者术后7 d的LAD、LVESD、LVM大于存活者，LVEF、LVSV小于存活者（P<0.05）。LAD、LVESD、LVEF、LVM、LVSV联合预测心脏移植术后患者排异反应及患者预后的AUC均为最大。本研究提示二维及三维超声参数对心脏移植后心功能、形态具有一定评估价值，有望成为预测心脏移植术后排斥反应和预后的潜在手段，指导临床采取合理治疗措施，改善患者预后。

关键词: 二维超声, 三维超声, 心脏移植, 心功能, 排异反应

Abstract: In order to explore the application value of two-dimensional and three-dimensional echocardiography in evaluating cardiac function and morphological changes after heart transplantation,a total of 41 patients underwent heart transplantation were selected as the observation group, and 41 patients underwent healthy physical examination during the same period were selected as the control group. 7 days after surgery, two-dimensional and three-dimensional ultrasound examinations were performed. It was found that the left atrial inner diameter (LAD), left ventricular end-systolic diameter (LVESD) of the observation group were greater than those of the control group at 7 days after operation, and the left ventricular ejection fraction (LVEF) was lower than the control group (P<0.05). After 3 months of follow-up, LAD, LVESD and left ventricular mass(LVM) of those occurred rejection in the observation group were greater than those without rejection, and LVEF and left ventricular stroke volume (LVSV) were less than those without rejection (P<0.05). After 3 months of follow-up, LAD, LVESD, LVM of the deceased in the observation group were greater than those of the survivor, and LVEF and LVSV were less than those of the survivor(P<0.05). The combination of LAD, LVESD, LVEF, LVM and LVSV to predict the rejection and prognosis of patients after heart transplantation had the largest AUC. It is suggested that two-dimensional and three-dimensional ultrasound parameters have a certain evaluation value for cardiac function and morphology after heart transplantation, and they are expected to become a potential method to predict rejection and prognosis after heart transplantation, and to guide the reasonable treatment to improve the prognosis of patients.

Key words: two-dimensional ultrasound, three-dimensional ultrasound, heart transplantation, heart function, rejection

吴文芳, 李妙, 董静. 二维及三维心脏超声参数对心脏移植后心功能和形态的评估效果及预测效能研究[J]. 影像科学与光化学, 2020, 38(6): 988-993.

WU Wenfang, LI Miao, DONG Jing. Study on the Evaluation Effect and Predictive Effectiveness of Two-dimensional and Three-dimensional Ultrasound Parameters on Cardiac Function and Shape after Heart Transplantation[J]. Imaging Science and Photochemistry, 2020, 38(6): 988-993.

参考文献

[1] Ruiz Ortiz M, Pena M L, Mesa D, et al. Impact of asymptomatic acute cellular rejection on left ventricle myocardial function evaluated by means of two-dimensional speckle tracking echocardiography in heart transplant recipients[J]. Echocardiography, 2015, 32(2):229-237.
[2] Mingo-Santos S, Monivas-Palomero V, Garcia-Lunar I, et al. Usefulness of two-dimensional strain parameters to diagnose acute rejection after heart transplantation[J]. Journal of the American Society of Echocardiography, 2015, 28(10):1149-1156.
[3] 胡盛寿. 中国心脏移植现状[J]. 中华器官移植杂志, 2017, 38(8):449-454.
[4] 左建峰, 沈振亚, 陈月秋. IL-33与心脏移植免疫关系的研究进展[J]. 细胞与分子免疫学杂志, 2017, 33(4):567-570.
[5] Du G Q, Hsiung M C, Wu Y, et al. Three-dimensional speckle-tracking echocardiographic monitoring of acute rejection in heart transplant recipients[J]. Journal of Ultrasound in Me-dicine, 2016, 35(6):1167-1176.
[6] 中华医学会器官移植学分会. 中国心脏移植免疫抑制治疗及排斥反应诊疗规范(2019版)[J]. 中华移植杂志(电子版), 2019, 13(1):15-20.
[7] 江行配, 田海, 孙露, 等. 异种心脏移植的研究进展[J]. 器官移植, 2019, 10(5):599-602.
[8] 刘冰洋. 受者CYP3A5基因多态性对心脏移植术后他克莫司/环孢素A血药浓度及其他临床事件的影响[D]. 北京协和医学院中国医学科学院, 2017:1-37.
[9] 胡志斌, 严志焜. 更多脂肪干细胞更强抑制移植排斥反应作用[J]. 中华实验外科杂志, 2017, 34(34):2278.
[10] 曹寅, 黄晶, 邹燕珂, 等. 三维斑点追踪成像左心室应变指标正常参考范围的Meta分析[J]. 中国介入影像与治疗学, 2017, 14(7):416-421.
[11] Ghani A, Delnoy P P, Ottervanger J P, et al. Are changes in the extent of left ventricular dyssynchrony as assessed by speckle tracking associated with response to cardiac resynchronization therapy[J]. International Journal of Cardiovascular Imaging, 2016, 32(4):553-561.
[12] 权欣, 王浩. 超声心动图发展概要[J]. 中华心血管病杂志, 2020, 48(3):186-188.
[13] 陈文倩, 孙彭赛男, 吕滨, 等. 移植心脏血管病的发病率和相关危险因素分析[J]. 中国循环杂志, 2019, 34(10):961-967.
[14] Ingvarsson A, Werther E A, Waktare J, et al. Normal reference ranges for transthoracic echocardiography following heart transplantation[J]. Journal of the American Society of Echocardiography, 2018, 31(3):349-360.
[15] Medvedofsky D, Moravi V, Byku I, et al. Three-dimensional echocardiographic automated quantification of left heart chamber volumes using an adaptive analytics algorithm:feasibility and impact of image quality in nonselected patients[J]. Journal of the American Society of Echocardiography, 2018, 31(3):349-360.
[16] 孙薇. 三维斑点追踪超声心动图评估心脏移植术后双心室功能的研究[D]. 武汉:华中科技大学, 2019.
[17] 涂斌, 黄洁, 廖中凯, 等. 心脏移植后新生抗供者特异性抗体对移植心脏功能和受者存活的影响[J]. 中华器官移植杂志, 2017, 38(5):257-261.
[18] 蔡迪, 马媛媛, 郭瑞强. 斑点追踪成像技术评价移植心脏左室收缩及舒张功能[J]. 临床超声医学杂志, 2019, 21(8):607-609.
[19] Chimura M, Onishi T, Tsukishiro Y, et al. Longitudinal strain combined with delayed-enhancement magnetic resonance improves risk stratification in patients with dilated cardiomyopathy[J]. Heart, 2017, 103(9):679-686.
[20] 胡程程, 刘英杰, 田家玮, 等. 二维斑点追踪成像联合ICAM-1靶向超声造影检测心脏移植早期急性排异反应的研究[J]. 中华超声影像学杂志, 2017, 26(4):338-343.
[21] 贾一新, 孟旭, 李岩, 等. 心脏移植排斥反应中心肌细胞动作电位的变化研究[J]. 中国心脏起搏与心电生理杂志, 2018, 32(3):258-262.
[22] 张骊, 蒋文涛. 大鼠心脏移植模型中mTOR C1/C2信号通路在消除慢性排斥反应中的作用[J]. 国际生物医学工程杂志, 2017, 40(5):372-377.
[23] Moñivas P V, Mingo S S, Goirigolzarri A J, et al. Two-dimensional speckle tracking echocardiography in heart transplant patients:two-year follow-up of right and left ventricular function[J]. Echocardiography, 2016, 33(5):703-713.
[24] 于岩, 王辉山, 金岩, 等. 超声心动图监测心脏移植术后排斥反应价值研究[J]. 临床军医杂志, 2018, 46(12):1395-1397.