肝硬化合并肝肺综合征患者的影响因素及右心声学造影的诊断价值

唐理斌; 顾小丽; 何曜臻维; 祁飞; 夏加伟; 李海雯

doi:10.7619/jcmp.20220470

肝硬化合并肝肺综合征患者的影响因素及右心声学造影的诊断价值

Influencing factors of liver cirrhosis patients complicated with hepatopulmonary syndrome and diagnostic value of contrast echocardiography of right heart

摘要

摘要:
目的分析肝硬化合并肝肺综合征(HPS)患者的影响因素及右心声学造影的临床诊断价值。
方法选取2019年7月—2021年2月诊断为肝硬化并符合筛查标准的286例患者为研究对象。右心声学造影检查前3 d内，检测所有患者的血常规和肝功能、肾功能、凝血功能指标以及内皮素-1(ET-1)、肿瘤坏死因子-α(TNF-α)水平; 观察右心声学造影对HPS的诊断敏感度和不良反应。分析HPS的发生率和危险因素，分析微泡量半定量与HPS严重程度、肝功能、ET-1及TNF-α的相关性。
结果本研究286例肝硬化患者中，共有36例右心声学造影结果呈阳性，临床诊断HPS者32例。单因素和多因素Logistics回归分析发现, Child-Pugh分级C级、D-二聚体、ET-1和TNF-α是发生HPS的危险因素(P < 0.05)。32例HPS患者中, 17例为少量微泡, 10例为中量微泡, 5例为大量微泡。右心声学造影微泡量与HPS分级、血清ET-1具有正相关性(P < 0.01)。
结论 Child-Pugh C级以及高D-二聚体、ET-1和TNF-α水平是肝硬化患者发生HPS的危险因素。右心声学造影诊断HPS具有较高的敏感性，右心声学造影半定量测定可以对HPS的严重程度进行预测。

Abstract:
Objective To analyze the influencing factors of liver cirrhosis patients complicated with hepatopulmonary syndrome (HPS) and diagnostic value of contrast echocardiography of right heart.
Methods A total of 286 patients diagnosed as liver cirrhosis and meeting the screening criteria from July 2019 to February 2021 were selected as research objects. Indicators of blood routine, liver function, renal function, coagulation function, endothelin-1 (ET-1) and tumor necrosis factor-α (TNF-α) levels were detected in all patients within 3 days before right cardiography examination were detected, and the diagnostic sensitivity and adverse reactions of right phonography for HPS were observed. Incidence and risk factors of HPS were analyzed, and the correlations of semi-quantitative microbubble volume with the severity of HPS, liver function, ET-1 and TNF-α were analyzed.
Results Of 286 patients with liver cirrhosis in this study, 36 cases were positive in contrast echocardiography of right heart, and 32 cases were clinically diagnosed as HPS. Univariate analysis and multifactor Logistic regression analysis showed that grade C of Child-Pugh classification, D-dimer, ET-1 and TNF-α were the risk factors for HPS (P < 0.05). In 32 patients with HPS, 17 cases had small amount of microbubbles, 10 cases had medium amount of microbubbles, and 5 cases had large amount of microbubbles. The number of microbubbles in contrast echocardiography of right heart was positively correlated with HPS classification and serum ET-1 (P < 0.01).
Conclusion Grade C of Child-Pugh classification and high levels of D-dimer, ET-1 and TNF-α are the risk factors for HPS in liver cirrhosis patients. Contrast echocardiography of right heart has a high sensitivity in the diagnosis of HPS, and the semi-quantitative determination of contrast echocardiography of right heart can predict the severity of HPS.

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